Assessment of Outcomes of Treatment of Fractures of Distal Femur with a Locking Plate Taking into Account Factors Influencing the Result.

PubMed

Pakuła, Grzegorz; Kwiatkowski, Krzysztof; Kuczmera, Piotr; Fudalej, Piotr

2015-10-01

The aim of this paper is to evaluate the results of treatment of distal femoral fractures (DFF) fixed with locking plates and analysis of factors that influence the final outcome. The patients were treated at the Department of Traumatology and Orthopedics, Military Medical Institute in Warsaw, and the Department of Orthopedics and Traumatology, 4th Military Research Hospital in Wroclaw. We analysed 39 patients with 42 fractures of the distal femur. Treatment results were analysed using the KOOS and KSS scales. Factors influencing the outcome were also investigated. Statistical analysis was performed using STATISTICA v. 10. Mean KOOS scores indicate a predominance of poor outcomes, while mean KSS scores indicate good outcomes. Treatment outcomes were significantly influenced by pain and limited mobility. 1. Subjective evaluation of treatment of fractures of the distal femur using the KOOS scale per form edworse than a clinical evaluation using the KSS. 2. Post-operative management should emphasise pain relief and restoration of the performance of the treated lower limb to ensure good mobility without crutches. 3. Despite the use of modern operational methods of fracture fixation, treatment of distal femur fractures is still a challenge.

Fracture identification based on remote detection acoustic reflection logging

NASA Astrophysics Data System (ADS)

Zhang, Gong; Li, Ning; Guo, Hong-Wei; Wu, Hong-Liang; Luo, Chao

2015-12-01

Fracture identification is important for the evaluation of carbonate reservoirs. However, conventional logging equipment has small depth of investigation and cannot detect rock fractures more than three meters away from the borehole. Remote acoustic logging uses phase-controlled array-transmitting and long sound probes that increase the depth of investigation. The interpretation of logging data with respect to fractures is typically guided by practical experience rather than theory and is often ambiguous. We use remote acoustic reflection logging data and high-order finite-difference approximations in the forward modeling and prestack reverse-time migration to image fractures. First, we perform forward modeling of the fracture responses as a function of the fracture-borehole wall distance, aperture, and dip angle. Second, we extract the energy intensity within the imaging area to determine whether the fracture can be identified as the formation velocity is varied. Finally, we evaluate the effect of the fracture-borehole distance, fracture aperture, and dip angle on fracture identification.

Literature review of outcome parameters used in studies of Geriatric Fracture Centers.

PubMed

Liem, I S L; Kammerlander, C; Suhm, N; Kates, S L; Blauth, M

2014-02-01

A variety of multidisciplinary treatment models have been described to improve outcome after osteoporotic hip fractures. There is a tendency toward better outcomes after implementation of the most sophisticated model with a shared leadership for orthopedic surgeons and geriatricians; the Geriatric Fracture Center. The purpose of this review is to evaluate the use of outcome parameters in published literature on the Geriatric Fracture Center evaluation studies. A literature search was performed using Medline and the Cochrane Library to identify Geriatric Fracture Center evaluation studies. The outcome parameters used in the included studies were evaluated. A total of 16 outcome parameters were used in 11 studies to evaluate patient outcome in 8 different Geriatric Fracture Centers. Two of these outcome parameters are patient-reported outcome measures and 14 outcome parameters were objective measures. In-hospital mortality, length of stay, time to surgery, place of residence and complication rate are the most frequently used outcome parameters. The patient-reported outcomes included activities of daily living and mobility scores. There is a need for generally agreed upon outcome measures to facilitate comparison of different care models.

Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients.

PubMed

Metsemakers, W-J; Handojo, K; Reynders, P; Sermon, A; Vanderschot, P; Nijs, S

2015-04-01

Despite modern advances in the treatment of tibial shaft fractures, complications including nonunion, malunion, and infection remain relatively frequent. A better understanding of these injuries and its complications could lead to prevention rather than treatment strategies. A retrospective study was performed to identify risk factors for deep infection and compromised fracture healing after intramedullary nailing (IMN) of tibial shaft fractures. Between January 2000 and January 2012, 480 consecutive patients with 486 tibial shaft fractures were enrolled in the study. Statistical analysis was performed to determine predictors of deep infection and compromised fracture healing. Compromised fracture healing was subdivided in delayed union and nonunion. The following independent variables were selected for analysis: age, sex, smoking, obesity, diabetes, American Society of Anaesthesiologists (ASA) classification, polytrauma, fracture type, open fractures, Gustilo type, primary external fixation (EF), time to nailing (TTN) and reaming. As primary statistical evaluation we performed a univariate analysis, followed by a multiple logistic regression model. Univariate regression analysis revealed similar risk factors for delayed union and nonunion, including fracture type, open fractures and Gustilo type. Factors affecting the occurrence of deep infection in this model were primary EF, a prolonged TTN, open fractures and Gustilo type. Multiple logistic regression analysis revealed polytrauma as the single risk factor for nonunion. With respect to delayed union, no risk factors could be identified. In the same statistical model, deep infection was correlated with primary EF. The purpose of this study was to evaluate risk factors of poor outcome after IMN of tibial shaft fractures. The univariate regression analysis showed that the nature of complications after tibial shaft nailing could be multifactorial. This was not confirmed in a multiple logistic regression model, which only revealed polytrauma and primary EF as risk factors for nonunion and deep infection, respectively. Future strategies should focus on prevention in high-risk populations such as polytrauma patients treated with EF. Copyright © 2014 Elsevier Ltd. All rights reserved.

Investigation of Mechanical Properties and Fracture Simulation of Solution-Treated AA 5754

NASA Astrophysics Data System (ADS)

Kumar, Pankaj; Singh, Akhilendra

2017-10-01

In this work, mechanical properties and fracture toughness of as-received and solution-treated aluminum alloy 5754 (AA 5754) are experimentally evaluated. Solution heat treatment of the alloy is performed at 530 °C for 2 h, and then, quenching is done in water. Yield strength, ultimate tensile strength, impact toughness, hardness, fatigue life, brittle fracture toughness (K_{Ic} ) and ductile fracture toughness (J_{Ic} ) are evaluated for as-received and solution-treated alloy. Extended finite element method has been used for the simulation of tensile and fracture behavior of material. Heaviside function and asymptotic crack tip enrichment functions are used for modelling of the crack in the geometry. Ramberg-Osgood material model coupled with fracture energy is used to simulate the crack propagation. Fracture surfaces obtained from various mechanical tests are characterized by scanning electron microscopy.

Economic evaluation of osteoporosis liaison service for secondary fracture prevention in postmenopausal osteoporosis patients with previous hip fracture in Japan.

PubMed

Moriwaki, K; Noto, S

2017-02-01

A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of secondary fracture prevention by osteoporosis liaison service (OLS) relative to no therapy in patients with osteoporosis and a history of hip fracture. Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture. The purpose of this study was to estimate, from the perspective of Japan's healthcare system, the cost-effectiveness of secondary fracture prevention by OLS relative to no therapy in patients with osteoporosis and a history of hip fracture. A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in patients with or without secondary fracture prevention by OLS. The incremental cost-effectiveness ratio (ICER) of secondary fracture prevention compared with no therapy was estimated. Sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results. Compared with no therapy, secondary fracture prevention in patients aged 65 with T-score of -2.5 resulted in an additional lifetime cost of $3396 per person and conferred an additional 0.118 QALY, resulting in an ICER of $28,880 per QALY gained. Deterministic sensitivity analyses showed that treatment duration and offset time strongly affect the cost-effectiveness of OLS. According to the results of scenario analyses, secondary fracture prevention by OLS was cost-saving compared with no therapy in patients with a family history of hip fracture and high alcohol intake. Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture. In addition, secondary fracture prevention is less expensive than no therapy in high-risk patients with multiple risk factors.

Vitamin D status and falls, frailty, and fractures among postmenopausal Japanese women living in Hawaii.

PubMed

Pramyothin, P; Techasurungkul, S; Lin, J; Wang, H; Shah, A; Ross, P D; Puapong, R; Wasnich, R D

2009-11-01

Vitamin D status and its relationship to physical performance, falls, and fractures in 495 postmenopausal women of Japanese ancestry in Hawaii were investigated. The mean 25-hydroxyvitamin D (25-OHD) was 31.94 ng/mL. No significant association of 25-OHD was demonstrated with most outcomes, possibly due to higher 25-OHD levels in this population. In this study, we investigated vitamin D status and its relationship to physical performance, muscle strength, falls, and fractures in postmenopausal Japanese females living in Hawaii. Of 510 community-dwelling women who participated in the eighth examination of the Hawaii Osteoporosis Study, 495 were included in these analyses. Multivariate regression models were used to evaluate the relationship of 25-OHD (D(3) and total) to eight performance-based measurements, 12 activities of daily living (ADLs), and muscle strength (grip, triceps, and quadriceps). Logistic regression analyses were performed to evaluate the relationship of 25-OHD to falls, vertebral fractures, and non-vertebral fractures. The mean total 25-OHD was 31.94 +/- 9.46 ng/mL; 44% of subjects had values <30 ng/mL, while none had values <10-12 ng/mL. There was little evidence of seasonal variation. Among performance-based measures, ADLs, and strength tests, only quadriceps strength was significantly associated with total 25-OHD (p = 0.0063) and 25-OHD(3) (p = 0.0001). No significant association of 25-OHD was found with vertebral or non-vertebral fractures, or incidence of one or more falls. Lack of serum 25-OHD relationship with falls and fractures or most physical performance measures in this study may be related to the low prevalence of very low 25-OHD levels in this population.

Integration of fracturing dynamics and pressure transient analysis for hydraulic fracture evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arihara, N.; Abbaszadeh, M.; Wright, C.A.

This paper presents pre- and post-fracture pressure transient analysis, combined with net fracture pressure interpretation, for a well in a naturally fractured geothermal reservoir. Integrated analysis was performed to achieve a consistent interpretation of the created fracture geometry, propagation, conductivity, shrinkage, reservoir flow behavior, and formation permeability characteristics. The interpreted data includes two-rate pre-frac injection tests, step-rate injection tests, a series of pressure falloff tests, and the net fracturing pressure from a massive fracture treatment. Pressure transient analyses were performed utilizing advanced well test interpretation techniques and a thermal reservoir simulator with fracture propagation option. Hydraulic fracture propagation analysis wasmore » also performed Milt a generalized 3-D dynamic fracture growth model simulator. Three major conclusions resulted from the combined analysis: (1) that an increasing number of hydraulic fractures were being simultaneously propagated during the fracture treatment. (2) that the reservoir behaved as a composite reservoir Keith the outer region permeability being greater than the permeability of the region immediately surrounding the wellbore, and (3) that the created fractures extended into the outer region during the fracture treatment but retreated to the inner region several days after stimulation had ceased. These conclusions were apparent from independent pressure transient analysis and from independent hydraulic fracture propagation analysis. Integrated interpretation, however, increased the confidence in these conclusions and greatly aided the quantification of the created hydraulic fracture geometry and characterization of the reservoir permeability.« less

Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures.

PubMed

Kumar, Sanjay; Khan, A N; Sonanis, S V

2016-12-01

Fracture of the distal radius is a common clinical problem. Complex fracture requires open reduction and stabilization with plating to restore anatomy. Dorsal plating has advantages of buttressing the fracture better but often complicated with tendon problems as per literature. The rate of complications however, was not compared between the low-profile dorsal and the volar plates. This was a retrospective study on seventy one patients with dorsally angulated or displaced distal radius fractures, who underwent fixation of fractures with either dorsal or volar locking plate from Jan - Nov 2012. Preoperative radiographs were classified based on Universal and Fernandez classification. Postoperative radiographs were assessed for anatomical restoration of Radial length, radial inclination and volar tilt. Tendon and nerve related complications were assessed and functional evaluation was performed on the basis of PRWE (Patient related wrist evaluation) score. Both groups were matched for their demographic profile and fracture types (p 0.033). Dorsal plating group had 89% excellent/good restoration and fair in 11%. Volar group had 96% excellent/good restoration and fair in 4%. Statistical analysis was performed with unpaired t test for radiographic parameters. Three patients had tendon related complications in dorsal plating group; two patients in volar group had nerve related complications. Functional outcome with PRWE was comparable between two groups. Results with low profile dorsal plating were comparable to volar plating. Therefore dorsal plating can be used as an alternative method when dorsal buttressing of comminuted fracture is required, especially with concomitant osteoporosis.

Performance on physical function tests and the risk of fractures and admissions: Findings from a national health screening of 557,648 community-dwelling older adults.

PubMed

Chun, So Hyun; Cho, Belong; Yang, Hyung-Kook; Ahn, Eunmi; Han, Min Kyu; Oh, Bumjo; Shin, Dong Wook; Son, Ki Young

Falls and fractures in older adults are often preventable, yet remain major health concerns as comprehensive physical function assessment may not be readily available. This study investigated whether simple timed up and go test (TUG) and unipedal stance test (UST) are effective in identifying people with an increased risk of fractures, femoral fractures, or admissions due to femoral fractures. Community-dwelling Korean older adults aged 66 years participated in the Korean National Screening Program for the Transitional Ages (n=557,648) between 2007 and 2010. Overall fractures, femoral fractures, and admissions due to femoral fracture during this period were outcome measures. The outcome measures were overall fractures, femoral fractures, and admissions due to femoral fracture after the health screening. The associations between inferior physical function test results and outcome measures were evaluated. A total of 523,502 subjects were followed-up for a mean period of 1.42 years, which resulted in 12,965 subjects with any fractures. Fracture data were retrieved from medical claims record. Subjects who performed poorly on one or both of the two physical function tests experienced higher number of overall fractures (aHR 1.21, 95% CI: 1.16-1.26), femoral fractures (aHR 1.80, 95% CI: 1.59-2.17), and admissions due to femoral fractures (aHR 1.85, 95% CI: 1.55-2.22) as compared to subjects with normal results on both tests. Combining TUG and UST was not superior to performing UST alone in predicting the increased risk of overall fractures (p=0.347), femoral fractures (p=0.402) or admissions due to femoral fractures (p=0.774). Poor performance on physical performance tests is associated with a higher risk of overall fractures, femoral fractures and admissions due to femoral fractures. The TUG and UST can be used to identify community-dwelling older individuals who are more vulnerable to fractures. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Rib Fractures on a Single-in-plane Image Reformation of the Rib Cage in CT Examinations.

PubMed

Dankerl, Peter; Seuss, Hannes; Ellmann, Stephan; Cavallaro, Alexander; Uder, Michael; Hammon, Matthias

2017-02-01

This study aimed to evaluate the diagnostic performance of using a reformatted single-in-plane image reformation of the rib cage for the detection of rib fractures in computed tomography (CT) examinations, employing different levels of radiological experience. We retrospectively evaluated 10 consecutive patients with and 10 patients without rib fractures, whose CT scans were reformatted to a single-in-plane image reformation of the rib cage. Eight readers (two radiologists, two residents in radiology, and four interns) independently evaluated the images for the presence of rib fractures using a reformatted single-in-plane image and a multi-planar image reformation. The time limit was 30 seconds for each read. A consensus of two radiologist readings was considered as the reference standard. Diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) was assessed and evaluated per rib and per location (anterior, lateral, posterior). To determine the time limit, we prospectively analyzed the average time it took radiologists to assess the rib cage, in a bone window setting, in 50 routine CT examinations. McNemar test was used to compare the diagnostic performances. Single image reformation was successful in all 20 patients. The sensitivity, specificity, PPV, and NPV for the detection of rib fractures using the conventional multi-planar read were 77.5%, 99.2%, 89.9%, and 98.0% for radiologists; 46.3%, 99.7%, 92.5%, and 95.3% for residents; and 29.4%, 99.4%, 82.5%, and 93.9% for interns, respectively. Sensitivity, PPV, and NPV increased across all three groups of experience, using the reformatted single-in-plane image of the rib cage (radiologists: 85.0%, 98.6%, and 98.7%; residents: 80.0%, 92.8%, and 98.2%; interns: 66.9%, 89.9%, and 97.1%), whereas specificity did not change significantly (99.9%, 99.4%, and 99.3%). The diagnostic performance of the interns and residents was significantly better when evaluating the single-in-plane image reformations (P < .01). The diagnostic performance of the radiologists was better when evaluating the single-in-plane image reformations; however, there was no significant difference (statistical power: 0.32). The diagnostic performance for the detection of rib fractures, using CT images that have been reformatted to a single-in-plane image, improves for readers from different educational levels when the evaluation time is restricted to 30 seconds or less. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Subcritical fracture propagation in rocks: An examination using the methods of fracture mechanics and non-destructive testing. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Swanson, P. L.

1984-01-01

An experimental investigation of tensile rock fracture is presented with an emphasis on characterizing time dependent crack growth using the methods of fracture mechanics. Subcritical fracture experiments were performed in moist air on glass and five different rock types at crack velocities using the double torsion technique. The experimental results suggest that subcritical fracture resistance in polycrystals is dominated by microstructural effects. Evidence for gross violations of the assumptions of linear elastic fracture mechanics and double torsion theory was found in the tests on rocks. In an effort to obtain a better understanding of the physical breakdown processes associated with rock fracture, a series of nondestructive evaluation tests were performed during subcritical fracture experiments on glass and granite. Comparison of the observed process zone shape with that expected on the basis of a critical normal principal tensile stress criterion shows that the zone is much more elongated in the crack propagation direction than predicted by the continuum based microcracking model alone.

Classification of fracture and non-fracture groups by analysis of coherent X-ray scatter

PubMed Central

Dicken, A. J.; Evans, J. P. O.; Rogers, K. D.; Stone, N.; Greenwood, C.; Godber, S. X.; Clement, J. G.; Lyburn, I. D.; Martin, R. M.; Zioupos, P.

2016-01-01

Osteoporotic fractures present a significant social and economic burden, which is set to rise commensurately with the aging population. Greater understanding of the physicochemical differences between osteoporotic and normal conditions will facilitate the development of diagnostic technologies with increased performance and treatments with increased efficacy. Using coherent X-ray scattering we have evaluated a population of 108 ex vivo human bone samples comprised of non-fracture and fracture groups. Principal component fed linear discriminant analysis was used to develop a classification model to discern each condition resulting in a sensitivity and specificity of 93% and 91%, respectively. Evaluating the coherent X-ray scatter differences from each condition supports the hypothesis that a causal physicochemical change has occurred in the fracture group. This work is a critical step along the path towards developing an in vivo diagnostic tool for fracture risk prediction. PMID:27363947

Cost And Performance Report Evaluating the Longevity and Hydraulic Performance of Permeable Reactive Barriers at Department of Defense Sites

DTIC Science & Technology

2003-12-01

construction methods, such as jetting, hydraulic fracturing , and vibratory beam, have been demonstrated at some sites, as they offer some cost... hydraulic fracturing , are available, but there is not as much widespread experience yet with these techniques for PRBs. Also, these innovative... hydraulic fracturing ) can be used at relatively higher cost. The cost comparison of a PRB versus an active remedy, such as a pump-and-treat system, often

Non-destructive evaluation of laboratory scale hydraulic fracturing using acoustic emission

NASA Astrophysics Data System (ADS)

Hampton, Jesse Clay

The primary objective of this research is to develop techniques to characterize hydraulic fractures and fracturing processes using acoustic emission monitoring based on laboratory scale hydraulic fracturing experiments. Individual microcrack AE source characterization is performed to understand the failure mechanisms associated with small failures along pre-existing discontinuities and grain boundaries. Individual microcrack analysis methods include moment tensor inversion techniques to elucidate the mode of failure, crack slip and crack normal direction vectors, and relative volumetric deformation of an individual microcrack. Differentiation between individual microcrack analysis and AE cloud based techniques is studied in efforts to refine discrete fracture network (DFN) creation and regional damage quantification of densely fractured media. Regional damage estimations from combinations of individual microcrack analyses and AE cloud density plotting are used to investigate the usefulness of weighting cloud based AE analysis techniques with microcrack source data. Two granite types were used in several sample configurations including multi-block systems. Laboratory hydraulic fracturing was performed with sample sizes ranging from 15 x 15 x 25 cm3 to 30 x 30 x 25 cm 3 in both unconfined and true-triaxially confined stress states using different types of materials. Hydraulic fracture testing in rock block systems containing a large natural fracture was investigated in terms of AE response throughout fracture interactions. Investigations of differing scale analyses showed the usefulness of individual microcrack characterization as well as DFN and cloud based techniques. Individual microcrack characterization weighting cloud based techniques correlated well with post-test damage evaluations.

Evaluating the fracture toughness and flexural strength of pressable dental ceramics: an in vitro study.

PubMed

Gurram, Ravi; Krishna, C H Vamsi; Reddy, K Mahendranadh; Reddy, G V K Mohan; Shastry, Y Mahadev

2014-12-01

The study was undertaken to evaluate the biaxial flexural strength, biaxial flexural strength after etching with 9 % HF acid and fracture toughness of three commonly used pressable all ceramic core materials. Ninety glass ceramic specimens were fabricated from three commercially available leucite based core ceramic material (1) Esthetic Empress, (2) Cergo, and (3) Performance Plus. Thirty discs of each material were divided into three groups of 10 discs each. Biaxial flexural strength (30 discs,) Biaxial flexural strength for samples treated with 9 % HF acid (30 discs) and fracture toughness (30 discs) were evaluated. Core material Performance Plus had the lowest biaxial strength of 124.89 MPa, Cergo had strength of 152.22 MPa and the highest value of 163.95 was reported for Esthetic Empress. For samples treated 9 % HF, Performance Plus had the lowest biaxial strength of 98.37 MPa, Cergo had strength of 117.42 MPa and the highest value of 143.74 was reported for Esthetic Empress. Core material Performance Plus had the lowest fracture toughness of 1.063 MPa, Cergo had strength of 1.112 MPa and the highest value of 1.225 was reported for Esthetic Empress. The results shows that Esthetic Empress had better mechanical properties compared to Cergo had Performance Plus in relation to the parameters tested.

External validation of the Garvan nomograms for predicting absolute fracture risk: the Tromsø study.

PubMed

Ahmed, Luai A; Nguyen, Nguyen D; Bjørnerem, Åshild; Joakimsen, Ragnar M; Jørgensen, Lone; Størmer, Jan; Bliuc, Dana; Center, Jacqueline R; Eisman, John A; Nguyen, Tuan V; Emaus, Nina

2014-01-01

Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance. The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture. The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction.

Nano-scale zero valent iron transport in a variable aperture dolomite fracture and a glass fracture

NASA Astrophysics Data System (ADS)

Mondal, P.; Sleep, B. E.; Cui, Z.; Zhou, Z.

2014-12-01

Experiments and numerical simulations are being performed to understand the transport behavior of carboxymethyl cellulose polymer stabilized nano-scale zero valent iron (nZVI) in a variable aperture dolomite rock fracture and a variable aperture glass replica of a fractured slate. The rock fracture was prepared by artificially inducing a fracture in a dolomite block along a stylolite, and the glass fracture was prepared by creating molds with melted glass on two opposing sides of a fractured slate rock block. Both of the fractures were 0.28 m in length and 0.21 m in width. Equivalent hydraulic apertures are about 110 microns for the rock fracture and 250 microns for the glass replica fracture. Sodium bromide and lissamine green B (LGB) serve as conservative tracers in the rock fracture and glass replica fracture, respectively. A dark box set-up with a light source and digital camera is being used to visualize the LGB and CMC-nZVI movement in the glass fracture. Experiments are being performed to determine the effects of water specific discharge and CMC concentration on nZVI transport in the fractures. Transmission electron microscopy, dynamic light scattering, and UV-visual spectrophotometry were performed to determine the stability and characteristics of the CMC-nZVI mixture. The transport of bromide, LGB, CMC, and CMC-nZVI in both fractures is being evaluated through analysis of the effluent concentrations. Time-lapse images are also being captured for the glass fracture. Bromide, LGB, and CMC recoveries have exceeded 95% in both fractures. Significant channeling has been observed in the fractures for CMC transport due to viscous effects.

Corrective Septorhinoplasty in Acute Nasal Bone Fractures.

PubMed

Kim, Jisung; Jung, Hahn Jin; Shim, Woo Sub

2018-03-01

Closed reduction is generally recommended for acute nasal bone fractures, and rhinoplasty is considered in cases with an unsatisfactory outcome. However, concomitant rhinoplasty with fracture reduction might achieve better surgical outcomes. This study investigated the surgical techniques and outcomes in patients who underwent rhinoplasty and fracture reduction concomitantly, during the acute stage of nasal bone fracture. Forty-five patients who underwent concomitant rhinoplasty and fracture reduction were enrolled. Nasal bone fractures were classified into three major types (type I, simple fracture; type II, fracture line that mimics nasal osteotomy; and type III, comminuted fracture) based on computed tomography images and preoperative facial images. Two independent otolaryngology-head and neck surgeons evaluated the surgical outcomes and telephone based survey were made to evaluate patients satisfaction. Among 45 patients, there were 39 males and 6 females. Type I was the commonest type of fracture with 18 patients (40%), while the most frequently used surgical technique for corrective surgery was dorsal augmentation with 44 patients (97.8%). The mean visual analogue scale satisfaction score of the surgeons and patients were 7.62 and 8, respectively, with no significant differences between fracture types. Concomitant rhinoplasty with fracture reduction can be performed for acute nasal bone fracture patients, and it might lead to better aesthetic outcomes.

Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review.

PubMed

Chaudhry, Zaira S; Raikin, Steven M; Harwood, Marc I; Bishop, Meghan E; Ciccotti, Michael G; Hammoud, Sommer

2017-12-01

Although most anterior tibial stress fractures heal with nonoperative treatment, some may require surgical management. To our knowledge, no systematic review has been conducted regarding surgical treatment strategies for the management of chronic anterior tibial stress fractures from which general conclusions can be drawn regarding optimal treatment in high-performance athletes. This systematic review was conducted to evaluate the surgical outcomes of anterior tibial stress fractures in high-performance athletes. Systematic review; Level of evidence, 4. In February 2017, a systematic review of the PubMed, MEDLINE, Cochrane, SPORTDiscus, and CINAHL databases was performed to identify studies that reported surgical outcomes for anterior tibial stress fractures. Articles meeting the inclusion criteria were screened, and reported outcome measures were documented. A total of 12 studies, published between 1984 and 2015, reporting outcomes for the surgical treatment of anterior tibial stress fractures were included in this review. All studies were retrospective case series. Collectively, surgical outcomes for 115 patients (74 males; 41 females) with 123 fractures were evaluated in this review. The overall mean follow-up was 23.3 months. The most common surgical treatment method reported in the literature was compression plating (n = 52) followed by drilling (n = 33). Symptom resolution was achieved in 108 of 123 surgically treated fractures (87.8%). There were 32 reports of complications, resulting in an overall complication rate of 27.8%. Subsequent tibial fractures were reported in 8 patients (7.0%). Moreover, a total of 17 patients (14.8%) underwent a subsequent procedure after their initial surgery. Following surgical treatment for anterior tibial stress fracture, 94.7% of patients were able to return to sports. The available literature indicates that surgical treatment of anterior tibial stress fractures is associated with a high rate of symptom resolution and return to play in athletes, although the high complication rate and potential need for subsequent procedures are important considerations for surgeons and patients.

Fractured reservoir characterization through injection, falloff, and flowback tests

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peng, C.P.; Singh, P.K.; Halvorsen, H.

1992-09-01

This paper presents the development of a multiphase pressure-transient-analysis technique for naturally fractured reservoirs and the analysis of a series of field tests performed to evaluate the water injection potential and the reservoir characteristics of a naturally fractured reservoir. These included step-rate, water-injectivity, pressure-falloff, and flowback tests. Through these tests, a description of the reservoir was obtained.

Computed tomography of calcaneal fractures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heger, L.; Wulff, K.; Seddiqi, M.S.A.

1985-07-01

Computed tomography (CT) of 25 fractured calcanei was performed to investigate the potential of CT in evaluating the pattern and biomechanics of these fractures. The characteristic findings of typical fractures are presented, including the number and type of principal fragments, size and dislocation of the sustentacular fragment, and involvement of the anterior and posterior facets of the subtalar joint. In 17 cases, the calcaneus consisted of four or more fragments. Furthermore, in 17 cases the sustentacular fragment included all or part of the posterior facet joint. In 18 of the 25 cases, the sustentacular fragment was displaced. It is concludedmore » that well performed CT is an invaluable adjunct in understanding the fracture mechanism and in detecting pain-provoking impingement between the fibular malleolus and the tuberosity fragment.« less

Angular stable plates in proximal meta-epiphyseal tibial fractures: study of joint restoration and clinical and functional evaluation.

PubMed

Giannotti, S; Giovannelli, D; Dell'Osso, G; Bottai, V; Bugelli, G; Celli, F; Citarelli, C; Guido, G

2016-04-01

The tibial plateau fractures involve one of the main weight bearing joints of the human body. The goals of surgical treatment are anatomical reduction, articular surface reconstruction and high primary stability. The aim of this study was to evaluate the clinical and functional outcomes after internal plate fixation of this kind of fractures. From January 2009 to December 2012, we treated 75 cases of tibial plateau fracture with angular stable plates. We used Rasmussen Score and the Knee Society Score for the clinical and functional evaluation. Twenty-five cases that underwent hardware removal had arthroscopic and CT evaluation of the joint. No complications occurred. The clinical and functional evaluation, performed by the KSS and Rasmussen Score, highlighted the high percentage of good-to-excellent results (over 90 %). In every case, the range of motion was good with flexion >90°. Arthroscopy showed the presence of chondral damage in 100 % of patients. In all the cases, we found that X-ray images seem better than the CT images. Angular stable plates allow to obtain a good primary stability, permitting an early joint recovery with an excellent range of motion. Avoiding to perform a knee arthrotomy at the time of fracture reduction could prove to be an advantage in terms of functional recovery. The meniscus on the injured bone should be preserved in order to maintain good function of the joint. X-ray images remain the gold standard in checking the progression of post-traumatic osteoarthritis.

Identification of the Cause of the Stem Neck Fracture in the Hip Joint Endoprosthesis

NASA Astrophysics Data System (ADS)

Ryniewicz, A. M.; Bojko, Ł.; Ryniewicz, A.; Pałka, P.; Ryniewicz, W.

2018-02-01

Endoprosthesis stem fractures are among the rarest complications that occur after hip joint arthroplasty. The aim of this paper is to evaluate the causes of the fractures of the Aura II stem neck, which is an element of an endoprosthesis implanted in a patient. In order to achieve it, a radiogram was evaluated, the FEM analysis was carried out for the hip joint replaced using the Aura II prosthesis and scanning tests as well as a chemical analysis were performed for the focus of fatigue. The tests performed indicate that the most probable causes leading to the fatigue fracture of the Aura II stem under examination were material defects in the process of casting and forging (forging the material with delamination and the presence of brittle oxides and carbides) that resulted in a significant reduction of strength and resistance to corrosion. In the light of an unprecedented stem neck fracture, this information should be an indication for non-destructive tests of ready-made stems aiming to discover the material and technological defects that may arise in the process of casting and drop forging.

A comprehensive study on the damage tolerance of ultrafine-grained copper

PubMed Central

Hohenwarter, A.; Pippan, R.

2012-01-01

In this study the fracture behavior of ultrafine-grained copper was assessed by means of elasto-plastic fracture mechanics. For the synthesis of the material high pressure torsion was used. The fracture toughness was quantitatively measured by JIC as a global measure by recording the crack growth resistance curve. Additionally, the initiation toughness in terms of the crack opening displacement (CODi) was evaluated as a local fracture parameter. The results presented here exhibit a low fracture initiation toughness but simultaneously a remarkably high fracture toughness in terms of JIC. The origin of the large difference between these two parameters, peculiarities of the fracture surface and the fracture mechanical performance compared to coarse grained copper will be discussed. PMID:23471016

[Functional and aesthetic results of orthopaedic treatment of midshaft fractures of the clavicle. A 22 years follow-up study].

PubMed

Sirvent-Díaz, E; Calmet-García, J; Capdevila-Baulenes, J

2014-01-01

To evaluate the functional results of the orthopaedic treatment of midshaft clavicle fractures with a minimum follow-up of 15 years. A retrospective study was conducted on 40 patients, mean age 35 years (18-64) with a non-surgically treated clavicle fracture. The mean follow-up was more than 22 years (15-32). The clinical evaluation was performed with the Disability of Arm, Shoulder and Hand score (DASH), Constant Shoulder Score test (CSS), EVA score, and a subjective assessment of the final result. Fractures were classified according to Neer's criteria. The radiological evaluation was performed with an anteroposterior and 45° cefalic anteroposterior oblique X-Ray. A mean DASH score 2.17 points (0-20.82), the mean CSS score was 98.2 (79-100), the mean EVA score was 0.42 (0-6), and 100% patients were satisfied, with good or excellent results. The control X-Ray showed 39 healed fractures (97.5%) with a mean shortening of 6.4mm (0-20). The presence of comminution and/or shortening of 15 mm or more had the worst functional and radiographic results. Despite this, non-surgical treatment showed excellent functional and radiographic results, and a high personal satisfaction. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Armed Forces Institute of Regenerative Medicine Annual Report 2010

DTIC Science & Technology

2011-01-01

manufacture a PDO bioabsorbable stent (Figure II-12) and a fracture -resistant nitinol stent (Figure II-13). 2. Mechanically test tissue following...storage in anhy­ drous fluid (Figure II-14). 3. Conduct fatigue tests on fracture -resistant stents (Figure II-15). 4. Mechanically evaluate the...veloped a fracture -resistant tissue-lined nitinol stent, and mechanically tested both stents. Both designs performed exceptionally well in mechanical

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

PubMed Central

Lockwood, Megan M.; Smith, Gabriel A.; Tanenbaum, Joseph; Lubelski, Daniel; Seicean, Andreea; Pace, Jonathan; Benzel, Edward C.; Mroz, Thomas E.; Steinmetz, Michael P.

2017-01-01

OBJECT Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care, the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures. METHODS A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio’s Level I trauma institution from 2002 to 2012 was performed. RESULTS There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio’s Level I trauma institution between 2002 and 2012. CTA screening was performed in 732 patients, and 51 patients (0.7%) were found to have a VAI. Fracture patterns with increased odds of VAI were C-1 and C-2 combined fractures, transverse foramen fractures, and subluxation of adjacent vertebral levels. Ten posterior circulation strokes were identified in this patient population (0.6%) and found in only 4 of 51 cases of VAI (7.8%). High-risk fractures defined by Denver Criteria, VAI, and antiplatelet treatment of VAI were not independent predictors of stroke. CONCLUSIONS Cost-effective screening must be reevaluated in the setting of blunt cervical spine fractures on a case-by-case basis. Further prospective studies must be performed to elucidate the utility of screening for VAI and posterior circulation stroke prevention, if identified. PMID:26613284

External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

PubMed Central

Ahmed, Luai A.; Nguyen, Nguyen D.; Bjørnerem, Åshild; Joakimsen, Ragnar M.; Jørgensen, Lone; Størmer, Jan; Bliuc, Dana; Center, Jacqueline R.; Eisman, John A.; Nguyen, Tuan V.; Emaus, Nina

2014-01-01

Background Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. Methods The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance. Results The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture. Conclusions The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction. PMID:25255221

Fracture network evaluation program (FraNEP): A software for analyzing 2D fracture trace-line maps

NASA Astrophysics Data System (ADS)

Zeeb, Conny; Gomez-Rivas, Enrique; Bons, Paul D.; Virgo, Simon; Blum, Philipp

2013-10-01

Fractures, such as joints, faults and veins, strongly influence the transport of fluids through rocks by either enhancing or inhibiting flow. Techniques used for the automatic detection of lineaments from satellite images and aerial photographs, LIDAR technologies and borehole televiewers significantly enhanced data acquisition. The analysis of such data is often performed manually or with different analysis software. Here we present a novel program for the analysis of 2D fracture networks called FraNEP (Fracture Network Evaluation Program). The program was developed using Visual Basic for Applications in Microsoft Excel™ and combines features from different existing software and characterization techniques. The main novelty of FraNEP is the possibility to analyse trace-line maps of fracture networks applying the (1) scanline sampling, (2) window sampling or (3) circular scanline and window method, without the need of switching programs. Additionally, binning problems are avoided by using cumulative distributions, rather than probability density functions. FraNEP is a time-efficient tool for the characterisation of fracture network parameters, such as density, intensity and mean length. Furthermore, fracture strikes can be visualized using rose diagrams and a fitting routine evaluates the distribution of fracture lengths. As an example of its application, we use FraNEP to analyse a case study of lineament data from a satellite image of the Oman Mountains.

U.S. ENVIRONMENTAL PROTECTION AGENCY'S SUPERFUND INNOVATIVE TECHNOLOGY EVALUATION OF PNEUMATIC FRACTURING EXTRACTION

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA), in cooperation with Accutech Remedial Systems (ARS) and the New Jersey Institute of Technology (NJIT) performed a field demonstration of Pneumatic Fracturing Extraction (PFE) for the removal of chlorinated volatile organics (VOCS) f...

The Evaluation Of Therapeutic Efficacy and Safety Profile of Simvastatin Prodrug Micelles in a Closed Fracture Mouse Model

PubMed Central

Zhang, Yijia; Jia, Zhenshan; Yuan, Hongjiang; Dusad, Anand; Ren, Ke; Wei, Xin; Fehringer, Edward V.; Purdue, P. Edward; Daluiski, Aaron; Goldring, Steven R.; Wang, Dong

2016-01-01

Purpose To evaluate the therapeutic efficiency of a micellar prodrug formulation of simvastatin (SIM/SIM-mPEG) and explore its safety in a closed femoral fracture mouse model. Methods The amphiphilic macromolecular prodrug of simvastatin (SIM-mPEG) was synthesized and formulated together with free simvastatin into micelles. It was also labeled with a near infrared dye for in vivo imaging purpose. A closed femoral fracture mouse model was established using a three-point bending device. The mice with established closed femoral fracture were treated with SIM/SIM-mPEG micelle, using free simvastatin and saline as controls. The therapeutic efficacy of the micelles was evaluated using a high-resolution micro-CT. Serum biochemistry and histology analyses were performed to explore the potential toxicity of the micelle formulation. Results Near Infrared Fluorescence (NIRF) imaging confirmed the passive targeting of SIM/SIM-mPEG micelles to the bone lesion of the mice with closed femoral fracture. The micelle was found to promote fracture healing with an excellent safety profile. In addition, the accelerated healing of the femoral fracture also helped to prevent disuse-associated same-side tibia bone loss accompanying the femur fracture. Conclusion SIM/SIM-mPEG micelle was found to be an effective and safe treatment for closed femoral fracture repair in mice. The evidence obtained in this study suggests that it may have the potential to be translated into a novel therapy for clinical management of skeletal fractures and non-union. PMID:27164897

Reactor Pressure Vessel Fracture Analysis Capabilities in Grizzly

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spencer, Benjamin; Backman, Marie; Chakraborty, Pritam

2015-03-01

Efforts have been underway to develop fracture mechanics capabilities in the Grizzly code to enable it to be used to perform deterministic fracture assessments of degraded reactor pressure vessels (RPVs). Development in prior years has resulted a capability to calculate -integrals. For this application, these are used to calculate stress intensity factors for cracks to be used in deterministic linear elastic fracture mechanics (LEFM) assessments of fracture in degraded RPVs. The -integral can only be used to evaluate stress intensity factors for axis-aligned flaws because it can only be used to obtain the stress intensity factor for pure Mode Imore » loading. Off-axis flaws will be subjected to mixed-mode loading. For this reason, work has continued to expand the set of fracture mechanics capabilities to permit it to evaluate off-axis flaws. This report documents the following work to enhance Grizzly’s engineering fracture mechanics capabilities for RPVs: • Interaction Integral and -stress: To obtain mixed-mode stress intensity factors, a capability to evaluate interaction integrals for 2D or 3D flaws has been developed. A -stress evaluation capability has been developed to evaluate the constraint at crack tips in 2D or 3D. Initial verification testing of these capabilities is documented here. • Benchmarking for axis-aligned flaws: Grizzly’s capabilities to evaluate stress intensity factors for axis-aligned flaws have been benchmarked against calculations for the same conditions in FAVOR. • Off-axis flaw demonstration: The newly-developed interaction integral capabilities are demon- strated in an application to calculate the mixed-mode stress intensity factors for off-axis flaws. • Other code enhancements: Other enhancements to the thermomechanics capabilities that relate to the solution of the engineering RPV fracture problem are documented here.« less

Novel Method to Characterize and Model the Multiaxial Constitutive and Damage Response of Energetic Materials.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kaneshige, Michael J.; Rabbi, Md Fazle; Kaneshige, Michael J.

2017-12-01

Simulant polymer bonded explosives are widely used to simulate the mechanical response of real energetic materials. In this paper, the fracture resistance of a simulant polymer bo nded explosive (PBX) is experimentally investigated. The simulant is composed of 80 wt.% soda lime glass beads (SLGB) and 20 wt.% high impact Polystyrene 825 (HIPS). Brazilian disk tests are performed to characterize the tensile and compressive properties. Fracture toughness and energy tests are performed in the semi - circular bending (SCB) configuration on 80, 81, 82, and 83 wt % SLGB compositions. Digital image correlation is performed to record the surface displacementsmore » and calculate surface strains during testing. The m icromechanical behavior of ductile and brittle fracture are evaluated using digital microscopy and scanning electron microscopy of the fracture surface. It is determined that (i) the manufacturing process produces a credible simulant of PBX properties, and (ii) the SCB test measures fracture resistance with a reasonable coefficient of variation.« less

Prevalence of Jones Fracture Repair and Impact on Short-Term NFL Participation.

PubMed

Tu, Leigh-Anne; Knapik, Derrick M; Sheehan, Joseph; Salata, Michael J; Voos, James E

2018-01-01

Elite American football athletes are at high risk for Jones fractures. Fixation is recommended to minimize nonunion and allow early return to play. The purpose of this investigation was to evaluate the prevalence of Jones fracture repair in athletes invited to the National Football League (NFL) Combine and the impact of fracture repair on short-term NFL participation compared to athletes with no history of repair. A total of 1311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with history of Jones fracture repair were identified. Athlete demographic information was collected while physical examination findings were recorded. Radiographs were evaluated to determine fixation type and the presence of nonunion. Future participation in the NFL was evaluated based on draft status, games played, and games started in the athlete's first season following the Combine. Fixation was performed for 41 Jones fractures in 40 athletes (3.1%). The highest prevalence was in defensive linemen (n = 10 athletes), with the greatest rate in tight ends (5.1%, n = 4 of 79 athletes). Intramedullary screw fixation was used for all fractures. Incomplete bony union was present in 3 (8%) fractures. Athletes with a history of repair were not at significant risk for going undrafted ( P = .61), playing ( P = .23), or starting ( P = .76) fewer NFL games compared to athletes with no history of repair during athletes' first NFL season. Athletes with a history of Jones fracture repair were not at significant risk of going undrafted or for diminished participation during their first season in the NFL. Level IV, case series.

Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial.

PubMed

Merle, B; Chapurlat, R; Vignot, E; Thomas, T; Haesebaert, J; Schott, A-M

2017-05-01

We conducted a multicenter, randomized controlled trial to evaluate the impact of a population-based patient-centered post-fracture care program with a dedicated case manager, PREVention of OSTeoporosis (PREVOST), on appropriate post-fracture osteoporosis management. We showed that, compared to usual care, BMD investigation post-fracture was significantly improved (+20%) by our intervention program. Our study aims to evaluate the impact of a population-based patient-centered post-fracture care program, PREVOST, on appropriate post-fracture care. Multicenter, randomized controlled trial enrolling 436 women aged 50 to 85 years and attending a French hospital, for a low-energy fracture of the wrist or humerus. Randomization was stratified by age, hospital department, and site of fracture. The intervention was performed by a trained case manager who interacted only with the patients, with repeated oral and written information about fragility fractures and osteoporosis management, and prompting them to visit their primary care physicians. Control group received usual care. The primary outcome was the initiation of an appropriate post-fracture care defined by Bone Mineral Density (BMD) and/or anti-osteoporotic treatment prescription at 6 months. At 6 months, 53% of women in intervention group initiated a post-fracture care versus 33% for usual care (adjOR 2.35, 95%CI [1.58-3.50], p < 0.001). Post-fracture care was more frequent after wrist than humerus fracture (adjOR 1.93, 95%CI [1.14-3.30], p = 0.015) and decreased with age (adjOR for 10 years increase 0.76, 95%CI [0.61-0.96], p = 0.02). The intervention resulted in BMD prescription in 50% of patients (adjOR 2.10, 95%CI [1.41-3.11], p < 0.001) and in BMD performance in 41% of patients (adjOR 2.12, 95%CI [1.40-3.20], p < 0.001) versus 33 and 25% for usual care, respectively. Having performed a BMD increased treatment prescription; however, only 46% of women with a low BMD requiring a treatment according to the French guidelines received a prescription. A patient-centered care program with a dedicated case manager can significantly improve post-fracture BMD investigation.

Scanning electron microscopy fractography analysis of fractured hollow implants.

PubMed

Sbordone, Ludovico; Traini, Tonino; Caputi, Sergio; Scarano, Antonio; Bortolaia, Claudia; Piattelli, Adriano

2010-01-01

Fracture of the implant is one of the possible complications affecting dental implants; it is a rare event but of great clinical relevance. The aim of the present study was to perform a scanning electron microscopy (SEM) fractography evaluation of 7 International Team for oral Implantology (ITI) hollow implants removed because of fracture. The most common clinical risk factors, such as malocclusion, bruxism, and cantilevers on the prosthesis, were absent. Seven fractured ITI hollow implants were retrieved from 5 patients and were analyzed with the use of SEM. SEM analysis showed typical signs of a cleavage-type fracture. Fractures could be due to an association of multiple factors such as fatigue, inner defects, material electrochemical problems, and tensocorrosion.

Fracture mechanics criteria for turbine engine hot section components

NASA Technical Reports Server (NTRS)

Meyers, G. J.

1982-01-01

The application of several fracture mechanics data correlation parameters to predicting the crack propagation life of turbine engine hot section components was evaluated. An engine survey was conducted to determine the locations where conventional fracture mechanics approaches may not be adequate to characterize cracking behavior. Both linear and nonlinear fracture mechanics analyses of a cracked annular combustor liner configuration were performed. Isothermal and variable temperature crack propagation tests were performed on Hastelloy X combustor liner material. The crack growth data was reduced using the stress intensity factor, the strain intensity factor, the J integral, crack opening displacement, and Tomkins' model. The parameter which showed the most effectiveness in correlation high temperature and variable temperature Hastelloy X crack growth data was crack opening displacement.

Investigation of flaw geometry and loading effects on plane strain fracture in metallic structures

NASA Technical Reports Server (NTRS)

Hall, L. R.; Finger, R. W.

1971-01-01

The effects on fracture and flaw growth of weld-induced residual stresses, combined bending and tension stresses, and stress fields adjacent to circular holes in 2219-T87 aluminum and 5AI-2.5Sn(ELI) titanium alloys were evaluated. Static fracture tests were conducted in liquid nitrogen; fatigue tests were performed in room air, liquid nitrogen, and liquid hydrogen. Evaluation of results was based on linear elastic fracture mechanics concepts and was directed to improving existing methods of estimating minimum fracture strength and fatigue lives for pressurized structure in spacecraft and booster systems. Effects of specimen design in plane-strain fracture toughness testing were investigated. Four different specimen types were tested in room air, liquid nitrogen and liquid hydrogen environments using the aluminum and titanium alloys. Interferometry and holograph were used to measure crack-opening displacements in surface-flawed plexiglass test specimens. Comparisons were made between stress intensities calculated using displacement measurements, and approximate analytical solutions.

Goal-directed ultrasound in the detection of long-bone fractures

NASA Technical Reports Server (NTRS)

Marshburn, Thomas H.; Legome, Eric; Sargsyan, Ashot; Li, Shannon Melton James; Noble, Vicki A.; Dulchavsky, Scott A.; Sims, Carrie; Robinson, David

2004-01-01

BACKGROUND: New portable ultrasound (US) systems are capable of detecting fractures in the remote setting. However, the accuracy of ultrasound by physicians with minimal ultrasound training is unknown. METHODS: After one hour of standardized training, physicians with minimal US experience clinically evaluated patients presenting with pain and trauma to the upper arm or leg. The investigators then performed a long-bone US evaluation, recording their impression of fracture presence or absence. Results of the examination were compared with routine plain or computer aided radiography (CT). RESULTS: 58 patients were examined. The sensitivity and specificity of US were 92.9% and 83.3%, and of the physical examination were 78.6% and 90.0%, respectively. US provided improved sensitivity with less specificity compared with physical examination in the detection of fractures in long bones. CONCLUSION: Ultrasound scans by minimally trained clinicians may be used to rule out a long-bone fracture in patients with a medium to low probability of fracture.

The methodological quality of health economic evaluations for the management of hip fractures: A systematic review of the literature.

PubMed

Sabharwal, Sanjeeve; Carter, Alexander; Darzi, Lord Ara; Reilly, Peter; Gupte, Chinmay M

2015-06-01

Approximately 76,000 people a year sustain a hip fracture in the UK and the estimated cost to the NHS is £1.4 billion a year. Health economic evaluations (HEEs) are one of the methods employed by decision makers to deliver healthcare policy supported by clinical and economic evidence. The objective of this study was to (1) identify and characterize HEEs for the management of patients with hip fractures, and (2) examine their methodological quality. A literature search was performed in MEDLINE, EMBASE and the NHS Economic Evaluation Database. Studies that met the specified definition for a HEE and evaluated hip fracture management were included. Methodological quality was assessed using the Consensus on Health Economic Criteria (CHEC). Twenty-seven publications met the inclusion criteria of this study and were included in our descriptive and methodological analysis. Domains of methodology that performed poorly included use of an appropriate time horizon (66.7% of studies), incremental analysis of costs and outcomes (63%), future discounting (44.4%), sensitivity analysis (40.7%), declaration of conflicts of interest (37%) and discussion of ethical considerations (29.6%). HEEs for patients with hip fractures are increasing in publication in recent years. Most of these studies fail to adopt a societal perspective and key aspects of their methodology are poor. The development of future HEEs in this field must adhere to established principles of methodology, so that better quality research can be used to inform health policy on the management of patients with a hip fracture. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Reproducibility of three dimensional digital preoperative planning for the osteosynthesis of distal radius fractures.

PubMed

Yoshii, Yuichi; Kusakabe, Takuya; Akita, Kenichi; Tung, Wen Lin; Ishii, Tomoo

2017-12-01

A three-dimensional (3D) digital preoperative planning system for the osteosynthesis of distal radius fractures was developed for clinical practice. To assess the usefulness of the 3D planning for osteosynthesis, we evaluated the reproducibility of the reduction shapes and selected implants in the patients with distal radius fractures. Twenty wrists of 20 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The 3D preoperative planning was performed prior to each surgery. Four surgeons conducted the surgeries. The surgeons performed the reduction and the placement of the plate while comparing images between the preoperative plan and fluoroscopy. Preoperative planning and postoperative reductions were compared by measuring volar tilt and radial inclination of the 3D images. Intra-class correlation coefficients (ICCs) of the volar tilt and radial inclination were evaluated. For the implant choices, the ICCs for the screw lengths between the preoperative plan and the actual choices were evaluated. The ICCs were 0.644 (p < 0.01) and 0.625 (p < 0.01) for the volar tilt and radial inclination in the 3D measurements, respectively. The planned size of plate was used in all of the patients. The ICC for the screw length between preoperative planning and actual choice was 0.860 (p < 0.01). Good reproducibility for the reduction shape and excellent reproducibility for the implant choices were achieved using 3D preoperative planning for distal radius fracture. Three-dimensional digital planning was useful to visualize the reduction process and choose a proper implant for distal radius fractures. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2646-2651, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Fracture temperature and flaw growth in nitronic 40 at cryogenic temperatures

NASA Technical Reports Server (NTRS)

Domack, M. S.

1984-01-01

The fracture resistance and fatigue response of Armco Nitronic 40 austenitic stainless steel were evaluated under cryogenic conditions. Tensile, fracture toughness and fatigue crack growth properties were measured at -275 F. The tensile yield strength was approximately 120 ksi and the fracture toughness was estimated to be 350 ksi-in /2 on the basis of fracture toughness measurements. Testing was conducted to evaluate the behavior of a simulated section of the wing of the Pathfinder 1 model subject to a load and temperature history typical of that for testing in the National Transonic Facility. The wing section model incorporated a proposed brazing technique for pressure-transducer attachment. The simulated wing section performed satisfactorily at stress levels of nearly 60 percent of the material yield strength. The brazing technique proved to be an effective method of transducer attachment under conditions of high stress levels and large temperature excursions.

An Effective Modal Approach to the Dynamic Evaluation of Fracture Toughness of Quasi-Brittle Materials

NASA Astrophysics Data System (ADS)

Ferreira, L. E. T.; Vareda, L. V.; Hanai, J. B.; Sousa, J. L. A. O.; Silva, A. I.

2017-05-01

A modal dynamic analysis is used as the tool to evaluate the fracture toughness of concrete from the results of notched-through beam tests. The dimensionless functions describing the relation between the frequencies and specimen geometry used for identifying the variation in the natural frequency as a function of crack depth is first determined for a 150 × 150 × 500-mm notched-through specimen. The frequency decrease resulting from the propagating crack is modeled through a modal/fracture mechanics approach, leading to determination of an effective crack length. This length, obtained numerically, is used to evaluate the fracture toughness of concrete, the critical crack mouth opening displacements, and the brittleness index proposed. The methodology is applied to tests performed on high-strength concrete specimens. The frequency response for each specimen is evaluated before and after each crack propagation step. The methodology is then validated by comparison with results from the application of other methodologies described in the literature and suggested by RILEM.

[Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching].

PubMed

Hernández-Elena, J; de la Red-Gallego, M Á; Garcés-Zarzalejo, C; Pascual-Carra, M A; Pérez-Aguilar, M D; Rodríguez-López, T; Alfonso-Fernández, A; Pérez-Núñez, M I

2015-01-01

An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Evaluation of a Bioabsorbable Self-Expandable Vein Stent-Base Made of Poly(L-lactide) In Vitro and In Vivo.

PubMed

Løvdal, Alexandra Liv Vest; Calve, Sarah; Yang, Shuo; Van Alstine, William; Binkert, Christoph A; Klausen, Kasper

2017-01-01

This study was designed to evaluate performance and tissue response to a self-expandable bioabsorbable vein stent-base cut from a tube with enhanced stiffness and strength in vitro and in vivo. A diamond-shaped stent-base was cut from a sequential biaxially strained poly(L-lactide) (PLLA) tube for optimized performance. The performance of the stent-base was evaluated in a finite element analysis model, and validation was attempted in vitro through a cyclic flat-plate compression and radial force measurement. The performance of the stent-base was tested in vivo using 3 sheep with 2 implants each for 2 and 3½ weeks, respectively. In vitro the stent-base showed an elliptical deformation but no fractures. In vivo the stent-base showed adequate radial force and no migration. All implanted stent-bases showed multiple fractures not only at the predicted stress zones but at all connecting points. Fragments of the caudal stent-base stayed in the vein wall indicating sufficient tissue coverage to avoid embolization of the fractured stent pieces, whereas fragments from the cranial device remaining were few. Neointima formation was confirmed histologically at 2 and 3½ weeks. A bioabsorbable self-expandable stent-base made from PLLA for large veins seems feasible, but over time, the PLLA used in this study appears too stiff and lacks the sufficient flexibility to move with the vena cava, causing multiple fractures.

Evaluation of a Bioabsorbable Self-Expandable Vein Stent-Base Made of Poly(l-lactide) In Vitro and In Vivo

DOE Office of Scientific and Technical Information (OSTI.GOV)

Løvdal, Alexandra Liv Vest, E-mail: alvlo@nanotech.dtu.dk; Calve, Sarah; Yang, Shuo

PurposeThis study was designed to evaluate performance and tissue response to a self-expandable bioabsorbable vein stent-base cut from a tube with enhanced stiffness and strength in vitro and in vivo.MethodsA diamond-shaped stent-base was cut from a sequential biaxially strained poly(l-lactide) (PLLA) tube for optimized performance. The performance of the stent-base was evaluated in a finite element analysis model, and validation was attempted in vitro through a cyclic flat-plate compression and radial force measurement. The performance of the stent-base was tested in vivo using 3 sheep with 2 implants each for 2 and 3½ weeks, respectively.ResultsIn vitro the stent-base showed anmore » elliptical deformation but no fractures. In vivo the stent-base showed adequate radial force and no migration. All implanted stent-bases showed multiple fractures not only at the predicted stress zones but at all connecting points. Fragments of the caudal stent-base stayed in the vein wall indicating sufficient tissue coverage to avoid embolization of the fractured stent pieces, whereas fragments from the cranial device remaining were few. Neointima formation was confirmed histologically at 2 and 3½ weeks.ConclusionA bioabsorbable self-expandable stent-base made from PLLA for large veins seems feasible, but over time, the PLLA used in this study appears too stiff and lacks the sufficient flexibility to move with the vena cava, causing multiple fractures.« less

[Pediatric facial fractures. Characteristics of Portuguese population].

PubMed

Ferreira, Pedro; Silva, Natividade; Silva, Alvaro; Cardoso, Augusta; Rodrigues, Jorge; Reis, Jorge; Amarante, José

2004-01-01

Fractures of the facial skeleton are relatively uncommon in children and adolescents, and there are only few reports that review a significative number of patients. We performed a retrospective study to analyse the different characteristics of such fractures in the pediatric population in the north of Portugal. We reviewed the clinical and the surgical records of a series of 247 patients younger than 19 years, that were submitted to operation due to facial fractures by the Plastic, Reconstructive and Aesthetic Service of São João Hospital, Oporto (Portugal) between 1993 and 2002. The following parameters were evaluated: age, sex, cause of the accident, time and month of hospital admission, location and type of fractures, presence and location of associated injuries, treatment methods, length of in-hospital stay, and complications. Surgical treatment of 325 fractures was performed. The ratio of boys to girls was 3.3:1. The majority of injuries occurred in patients with 16 to 18 years old. Motor-vehicle accident (MVA) was the most common cause of injuries (57.1%). Mandibular fractures were the most common (62.5%). Associated injuries occurred in 63.2% of patients. Pediatric facial fractures are usually associated with severe trauma. Although MVA was the most frequent cause of fractures, this has decreased. The incidence of these type of fractures is high in Portugal.

Effects of aggregate gradation, aggregate type, and SBS polymer-modified binder on Florida HMAC fracture energy properties : final report, March 2009.

DOT National Transportation Integrated Search

2009-03-01

"The primary objective of this research study was to evaluate the fracture mechanics properties of HMA concrete for Superpave mixtures. An experimental program was performed on asphalt mixtures with various types of materials. The laboratory testing ...

Do Concomitant Cranium and Axis Injuries Predict Worse Outcome? A Trauma Database Quantitative Analysis

PubMed Central

Chittiboina, Prashant; Banerjee, Anirban Deep; Nanda, Anil

2011-01-01

We performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used. Univariate and multiple logistic regression analysis were performed. There were 259 cases with axis fractures. Closed head injury was noted in 57% and skull base trauma in 14%. Death occurred in 17 cases (6%). Seventy-two percent had good outcome. Presence of abnormal computed tomography head findings, skull base fractures, and visceral injury was significantly associated with poor outcome. Skull base injury in association with fractures of the axis is a significant independent predictor of worse outcomes, irrespective of the severity of the head injury. We propose that presence of concomitant cranial and upper vertebral injuries require careful evaluation in view of the associated poor prognosis. PMID:22470268

Clinic research on the treatment for humeral shaft fracture with minimal invasive plate osteosynthesis: a retrospective study of 128 cases.

PubMed

Chen, H; Hu, X; Yang, G; Xiang, M

2017-04-01

Minimal invasive plate osteosynthesis (MIPO) is one of the most important techniques in the treatment for humeral shaft fractures. This study was performed to evaluate the efficacy of MIPO technique for the treatment for humeral shaft fractures. We retrospectively evaluated 128 cases with humeral shaft fractures that were treated with MIPO technique from March 2005 to August 2008. All the patients were followed up by routine radiological imaging and clinical examinations. Constant-Murley score and HSS elbow joint score were used to evaluate the treatment outcome. The average duration of the surgery was 60 min (range 40-95 min) without blood transfusion. All fractures healed without infection. All cases recovered carrying angle except four cases with 10°-15° cubitus varus. After the average follow-up of 23 (13-38) months, satisfactory function was achieved according to Constant-Murley score and HSS elbow joint score. Constant-Murley score was 80 on average (range 68-91). According to HSS elbow joint score, there were 123 cases of excellent clinical outcome and five cases of effective outcome. It seems to be a safe and effective method for managing humeral shaft fractures with MIPO technique.

Lacking evidence for performance of implants used for proximal femoral fractures - A systematic review.

PubMed

Nyholm, Anne Marie; Palm, Henrik; Malchau, Henrik; Troelsen, Anders; Gromov, Kirill

2016-03-01

Evaluation of the long-term performance of implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists. The purpose of this study was to evaluate the evidence of performance of implants currently used for treating proximal femoral fractures (PFF) in Denmark. PubMed was searched for clinical studies on primary PFF with follow-up ≥12 months, reporting implant-related failure and evaluating one of following: DHS, CHS, HipLoc, Gamma3, IMHS, InterTan, PFN, PFNA or PTN. English language and publication date after 1st of January 1990. All studies were evidence level II or III. 30 publications for SHS were found: 13 of CHS, 15 of DHS and 2 of HipLoc. In total CHS was evaluated in 1110 patients (900 prospectively), DHS in 2486 (567 prospectively) and HipLoc in 251 (all prospectively). Fifty-four publications for nails were found: 13 of Gamma3, 7 of IMHS, 5 of InterTan, 10 of PFN, 24 of PFNA and 0 of PTN. In total Gamma3 was evaluated in 1088 patients (829 prospectively), IMHS in 1543 (210 prospectively), InterTan in 595 (585 prospectively), PFN in 716 (557 prospectively), PFNA in 1762 (1018 prospectively) and PTN in 0. The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide. Sporadic evaluation is not sufficient to identify long term problems. A systematic post market surveillance of implants used for fracture treatment, preferable by a national register, is necessary in the future. Copyright © 2016 Elsevier Ltd. All rights reserved.

Spinopelvic dissociation: multidetector computed tomographic evaluation of fracture patterns and associated injuries at a single level 1 trauma center.

PubMed

Gupta, Pushpender; Barnwell, Jonathan C; Lenchik, Leon; Wuertzer, Scott D; Miller, Anna N

2016-06-01

The objective of the present study is to evaluate multidetector computed tomographic (MDCT) fracture patterns and associated injuries in patients with spinopelvic dissociation (SPD). Our institutional trauma registry database was reviewed from Jan. 1, 2006, to Sept. 30, 2012, specifically evaluating patients with sacral fractures. MDCT scans of patients with sacral fractures were reviewed to determine the presence of SPD. SPD cases were characterized into the following fracture patterns: U-shaped, Y-shaped, T-shaped, H-shaped, and burst. The following MDCT features were recorded: level of the horizontal fracture, location of vertical fracture, kyphosis between major fracture fragments, displacement of fracture fragment, narrowing of central spinal canal, narrowing of neural foramina, and extension into sacroiliac joints. Quantitative evaluation of the sacral fractures was performed in accordance with the consensus statement by the Spine Trauma Study Group. Medical records were reviewed to determine associated pelvic and non-pelvic fractures, bladder and bowel injuries, nerve injuries, and type of surgical intervention. Twenty-one patients had SPD, of whom 13 were men and eight were women. Mean age was 41.8 years (range 18.8 to 87.7). Five fractures (24 %) were U-shaped, six (29 %) H-shaped, four (19 %) Y-shaped, and six (29 %) burst. Nine patients (43 %) had central canal narrowing, and 19 (90 %) had neural foramina narrowing. Eleven patients (52 %) had kyphotic angulation between major fracture fragments, and seven patients (33 %) had either anterior (24 %) or posterior (10 %) displacement of the proximal fracture fragment. Fourteen patients (67 %) had associated pelvic fractures, and 20 (95 %) had associated non-pelvic fractures. Two patients (10 %) had associated urethral injuries, and one (5 %) had an associated colon injury. Seven patients (33 %) had associated nerve injuries. Six patients (29 %) had surgical fixation while 15 (71 %) were managed non-operatively. On trauma MDCT examinations, patients with SPD have characteristic fracture patterns. It is important to differentiate SPD from other pelvic ring injuries due to high rate of associated injuries. Although all SPD injuries are unstable and need fixation, the decision for operative management in an individual patient depends on the systemic injury pattern, specific fracture pattern, and the ability to attain stable screw fixation.

Classification of Radiological Changes in Burst Fractures

PubMed Central

Şentürk, Salim; Öğrenci, Ahmet; Gürçay, Ahmet Gürhan; Abdioğlu, Ahmet Atilla; Yaman, Onur; Özer, Ali Fahir

2018-01-01

AIM: Burst fractures can occur with different radiological images after high energy. We aimed to simplify radiological staging of burst fractures. METHODS: Eighty patients whom exposed spinal trauma and had burst fracture were evaluated concerning age, sex, fracture segment, neurological deficit, secondary organ injury and radiological changes that occurred. RESULTS: We performed a new classification in burst fractures at radiological images. CONCLUSIONS: According to this classification system, secondary organ injury and neurological deficit can be an indicator of energy exposure. If energy is high, the clinical status will be worse. Thus, we can get an idea about the likelihood of neurological deficit and secondary organ injuries. This classification has simplified the radiological staging of burst fractures and is a classification that gives a very accurate idea about the neurological condition. PMID:29531604

Performance of an artificial neural network for vertical root fracture detection: an ex vivo study.

PubMed

Kositbowornchai, Suwadee; Plermkamon, Supattra; Tangkosol, Tawan

2013-04-01

To develop an artificial neural network for vertical root fracture detection. A probabilistic neural network design was used to clarify whether a tooth root was sound or had a vertical root fracture. Two hundred images (50 sound and 150 vertical root fractures) derived from digital radiography--used to train and test the artificial neural network--were divided into three groups according to the number of training and test data sets: 80/120,105/95 and 130/70, respectively. Either training or tested data were evaluated using grey-scale data per line passing through the root. These data were normalized to reduce the grey-scale variance and fed as input data of the neural network. The variance of function in recognition data was calculated between 0 and 1 to select the best performance of neural network. The performance of the neural network was evaluated using a diagnostic test. After testing data under several variances of function, we found the highest sensitivity (98%), specificity (90.5%) and accuracy (95.7%) occurred in Group three, for which the variance of function in recognition data was between 0.025 and 0.005. The neural network designed in this study has sufficient sensitivity, specificity and accuracy to be a model for vertical root fracture detection. © 2012 John Wiley & Sons A/S.

Direct Resin Composite Restoration of Maxillary Central Incisors with Fractured Tooth Fragment Reattachment: Case Report.

PubMed

Szmidt, Monika; Górski, Maciej; Barczak, Katarzyna; Buczkowska-Radlińska, Jadwiga

This article presents a clinical protocol to reconstruct two accidentally damaged maxillary central incisors using composite resin material and a fractured tooth component. A patient was referred to the clinic with fracture of the two maxillary central incisors. Clinical examination revealed that both teeth were fractured in the middle third of the crown and that the fractures involved enamel and dentin with no pulp exposure. The patient had also suffered a lower lip laceration. When the lip was evaluated, a fractured fragment of the maxillary right central incisor was found inside the wound. The missing part of the tooth was replaced via adhesive attachment. Due to the damage of the fractured part of the maxillary left central incisor, direct composite restoration of this tooth was performed. With the advent of adhesive dentistry, the process of fragment reattachment has become simplified and more reliable. This procedure provides improved function, is faster to perform, and provides long-lasting effects, indicating that reattachment of a coronal fragment is a realistic alternative to placement of conventional resin composite restorations.

Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases.

PubMed

Simon, P; Goldzak, M; Eschler, A; Mittlmeier, T

2015-10-01

The best treatment for intra-articular fractures of the calcaneus is still debated. The aims of this study were to determine whether intrafocal reduction of thalamic fractures is effective, to evaluate whether a locking nail is able to maintain reduction of the articular surface and to analyse the functional results of this original method. This prospective study assessed 69 fractures treated with a locking fracture nail in 63 cases and with primary subtalar fusion in six (Calcanail (®), FH). Articular congruity and global reduction of the calcaneus was assessed in all patients by computed tomography (CT) scan three months postoperatively. Functional results were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and all complications recorded. For the 63 fracture nails, the average AOFAS score was 85.9 at a mean final follow-up of 12 months. Only three secondary fusions were performed. For the six comminuted fractures requiring primary fusion, the average AOFAS score was 75.9 at the last follow-up. The posterior intrafocal approach for both reduction and locked nailing of intra-articular calcaneal fractures has been proven as an effective and reliable procedure.

The application of probabilistic fracture analysis to residual life evaluation of embrittled reactor vessels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dickson, T.L.; Simonen, F.A.

1992-05-01

Probabilistic fracture mechanics analysis is a major element of comprehensive probabilistic methodology on which current NRC regulatory requirements for pressurized water reactor vessel integrity evaluation are based. Computer codes such as OCA-P and VISA-II perform probabilistic fracture analyses to estimate the increase in vessel failure probability that occurs as the vessel material accumulates radiation damage over the operating life of the vessel. The results of such analyses, when compared with limits of acceptable failure probabilities, provide an estimation of the residual life of a vessel. Such codes can be applied to evaluate the potential benefits of plant-specific mitigating actions designedmore » to reduce the probability of failure of a reactor vessel. 10 refs.« less

The application of probabilistic fracture analysis to residual life evaluation of embrittled reactor vessels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dickson, T.L.; Simonen, F.A.

1992-01-01

Probabilistic fracture mechanics analysis is a major element of comprehensive probabilistic methodology on which current NRC regulatory requirements for pressurized water reactor vessel integrity evaluation are based. Computer codes such as OCA-P and VISA-II perform probabilistic fracture analyses to estimate the increase in vessel failure probability that occurs as the vessel material accumulates radiation damage over the operating life of the vessel. The results of such analyses, when compared with limits of acceptable failure probabilities, provide an estimation of the residual life of a vessel. Such codes can be applied to evaluate the potential benefits of plant-specific mitigating actions designedmore » to reduce the probability of failure of a reactor vessel. 10 refs.« less

Damage progression in Composite Structures

NASA Technical Reports Server (NTRS)

Minnetyan, Levon

1996-01-01

A computational simulation tool is used to evaluate the various stages of damage progression in composite materials during Iosipescu sheat testing. Unidirectional composite specimens with either the major or minor material axis in the load direction are considered. Damage progression characteristics are described for each specimen using two types of boundary conditions. A procedure is outlined regarding the use of computational simulation in composites testing. Iosipescu shear testing using the V-notched beam specimen is a convenient method to measure both shear strength and shear stiffness simultaneously. The evaluation of composite test response can be made more productive and informative via computational simulation of progressive damage and fracture. Computational simulation performs a complete evaluation of laminated composite fracture via assessment of ply and subply level damage/fracture processes.

Risk Factors for Open Malleolar Fractures: An Analysis of the National Trauma Data Bank (2007 to 2011).

PubMed

Shibuya, Naohiro; Liu, George T; Davis, Matthew L; Grossman, Jordan P; Jupiter, Daniel C

2016-01-01

A limited number of studies have described the epidemiology of open fractures, and the epidemiology of open ankle fractures is not an exception. Therefore, the risk factors associated with open ankle fractures have not been extensively evaluated. The frequencies and proportions of open ankle fractures among all the recorded malleolar fractures in the US National Trauma Data Bank data set from January 2007 to December 2011 were analyzed. Clinically relevant variables captured in the data set were also used to evaluate the risk factors associated with open ankle fractures, adjusting for other covariates. The entire cohort was further subdivided into "lower" and "higher" energy trauma groups and the same analysis performed for each group separately. We found that a body mass index of >40 kg/m(2) and farm location were risk factors for open ankle fractures and impaired sensorium was protective against open ankle fractures. In the "lower energy" group, male gender, alcohol use, peripheral vascular disease, other injuries, and injury occurring at a farm location were risk factors for open fractures. In the "higher energy" group, female gender, work-related injury, and injury at a farm or industry location demonstrated statistically significantly associations with open fractures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture.

PubMed

Gumieiro, David N; Rafacho, Bruna P M; Gonçalves, Andrea F; Tanni, Suzana E; Azevedo, Paula S; Sakane, Daniel T; Carneiro, Carlos A S; Gaspardo, David; Zornoff, Leonardo A M; Pereira, Gilberto J C; Paiva, Sergio A R; Minicucci, Marcos F

2013-05-01

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies

PubMed Central

Zhang, Xinge; Zhang, Rui; Wang, Yueqiao; Yan, Hanyi; Wu, Yingru; Tan, Anran; Fu, Jialin; Shen, Ziqiong; Qin, Guiyu; Li, Rui; Chen, Guoxun

2017-01-01

This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I2 test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability. PMID:28891953

Anatomical predisposition of the ankle joint for lateral sprain or lateral malleolar fracture evaluated by radiographic measurements.

PubMed

Lee, Kyoung Min; Chung, Chin Youb; Sung, Ki Hyuk; Lee, SeungYeol; Kim, Tae Gyun; Choi, Young; Jung, Ki Jin; Kim, Yeon Ho; Koo, Seung Bum; Park, Moon Seok

2015-01-01

Injury mechanism and the amount of force are important factors determining whether a fracture or sprain occurs at the time of an ankle inversion injury. However, the anatomical differences between the ankle fracture and sprain have not been investigated sufficiently. This study was performed to investigate whether an anatomical predisposition of the ankle joint results in a lateral malleolar fracture or lateral ankle sprain. Two groups of consecutive patients, one with lateral malleolar fracture (274 patients, mean age 49.0 years) and the other with lateral ankle sprain (400 patients, mean age 38.4 years), were evaluated. Ankle radiographs were examined for 7 measures: distal tibial articular surface (DTAS) angle, bimalleolar tilt (BT), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), medial malleolar slip angle (MMSA), anterior inclination of tibia (AI), and fibular position (FP). After an interobserver reliability test, the radiographic measurements were compared between the 2 groups. Linear regression analysis was performed to correct for age and sex effects between the groups. The fracture group and the sprain group showed significant differences in BT (P = .001), MMSA (P < .001), AI (P = .023), and FP (P < .001). In multiple regression analysis, after adjusting for age and sex effects, fracture and sprain groups showed a significant difference in BT (P = .001), MMRL (P < .001), MMSA (P < .001), and FP (P < .001). The lateral malleolar fracture group tended to show more bony constraint than that of the lateral ankle sprain group. Further 3-dimensional assessment of the bony structure and subsequent biomechanical studies are needed to elucidate the mechanism of injury according to the various types of ankle fractures and ankle sprain. Level III, retrospective comparative study. © The Author(s) 2014.

TOUGH-RBSN simulator for hydraulic fracture propagation within fractured media: Model validations against laboratory experiments

NASA Astrophysics Data System (ADS)

Kim, Kunhwi; Rutqvist, Jonny; Nakagawa, Seiji; Birkholzer, Jens

2017-11-01

This paper presents coupled hydro-mechanical modeling of hydraulic fracturing processes in complex fractured media using a discrete fracture network (DFN) approach. The individual physical processes in the fracture propagation are represented by separate program modules: the TOUGH2 code for multiphase flow and mass transport based on the finite volume approach; and the rigid-body-spring network (RBSN) model for mechanical and fracture-damage behavior, which are coupled with each other. Fractures are modeled as discrete features, of which the hydrological properties are evaluated from the fracture deformation and aperture change. The verification of the TOUGH-RBSN code is performed against a 2D analytical model for single hydraulic fracture propagation. Subsequently, modeling capabilities for hydraulic fracturing are demonstrated through simulations of laboratory experiments conducted on rock-analogue (soda-lime glass) samples containing a designed network of pre-existing fractures. Sensitivity analyses are also conducted by changing the modeling parameters, such as viscosity of injected fluid, strength of pre-existing fractures, and confining stress conditions. The hydraulic fracturing characteristics attributed to the modeling parameters are investigated through comparisons of the simulation results.

Mixed integer simulation optimization for optimal hydraulic fracturing and production of shale gas fields

NASA Astrophysics Data System (ADS)

Li, J. C.; Gong, B.; Wang, H. G.

2016-08-01

Optimal development of shale gas fields involves designing a most productive fracturing network for hydraulic stimulation processes and operating wells appropriately throughout the production time. A hydraulic fracturing network design-determining well placement, number of fracturing stages, and fracture lengths-is defined by specifying a set of integer ordered blocks to drill wells and create fractures in a discrete shale gas reservoir model. The well control variables such as bottom hole pressures or production rates for well operations are real valued. Shale gas development problems, therefore, can be mathematically formulated with mixed-integer optimization models. A shale gas reservoir simulator is used to evaluate the production performance for a hydraulic fracturing and well control plan. To find the optimal fracturing design and well operation is challenging because the problem is a mixed integer optimization problem and entails computationally expensive reservoir simulation. A dynamic simplex interpolation-based alternate subspace (DSIAS) search method is applied for mixed integer optimization problems associated with shale gas development projects. The optimization performance is demonstrated with the example case of the development of the Barnett Shale field. The optimization results of DSIAS are compared with those of a pattern search algorithm.

Bilateral femoral neck stress fractures in a fire academy student.

PubMed

Wright, Russell C; Salzman, Garrett A; Yacoubian, Stephan V; Yacoubian, Shahan V

2010-10-11

Unilateral femoral neck stress fractures are well documented in active patients; however, the risk of a subsequent contralateral stress fracture remains unknown in patients who continue to be active. This article describes a 24-year-old male fire academy student who sustained a left femoral neck stress fracture, followed approximately 11 months later by a right femoral neck stress fracture, both of which went on to completely displace. A review of the index radiographs of each hip from outside institutions revealed femoral neck stress fractures that went undiagnosed until they displaced. The patient was referred to our institution and underwent closed reduction and internal fixation using cannulated screws in both cases. A full endocrine evaluation was performed in the following weeks and proved unremarkable. Although it is difficult to extrapolate the results from 1 patient beyond the case studied, there is cause for concern in patients who remain active following femoral neck stress fractures. Our case highlights the significance of obtaining a complete and thorough medical history on physical examination and appropriately counseling patients regarding activity level. Until further research explores this possible relationship, physicians evaluating patients with a history of a stress fracture are encouraged to be vigilant of subsequent contralateral fractures and educate patients of this potentially avoidable injury. Copyright 2010, SLACK Incorporated.

Non-metallic implant for patellar fracture fixation: A systematic review.

PubMed

Camarda, Lawrence; Morello, Salvatore; Balistreri, Francesco; D'Arienzo, Antonio; D'Arienzo, Michele

2016-08-01

Despite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all abstracts and the selection of these abstracts was then performed based on inclusion and/or exclusion criteria. A total of 9 studies involving 123 patients were included. Patients had a mean age of 33.7 years and were followed up for a mean of 18.9 months. The most common method for fracture fixations included the use of suture material. Good clinical outcomes were reported among all studies. Thirteen patients (10.5%) presented complications, while 4 patients (3.2%) required additional surgery for implant removal. There is a paucity of literature focused on the use of non-metallic implant for patellar fracture fixation. However, this systematic review showed that non-metallic implants are able to deliver good clinical outcomes reducing the rate of surgical complications and re-operation. These results may assist surgeons in choosing to use alternative material such as sutures to incorporate into their routine practice or to consider it, in order to reduce the rate of re-operation. Copyright © 2016 Elsevier Ltd. All rights reserved.

A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction.

PubMed

Zeng, Canjun; Xing, Weirong; Wu, Zhanglin; Huang, Huajun; Huang, Wenhua

2016-10-01

Treatment of acetabular fractures remains one of the most challenging tasks that orthopaedic surgeons face. An accurate assessment of the injuries and preoperative planning are essential for an excellent reduction. The purpose of this study was to evaluate the feasibility, accuracy and effectiveness of performing 3D printing technology and computer-assisted virtual surgical procedures for preoperative planning in acetabular fractures. We hypothesised that more accurate preoperative planning using 3D printing models will reduce the operation time and significantly improve the outcome of acetabular fracture repair. Ten patients with acetabular fractures were recruited prospectively and examined by CT scanning. A 3-D model of each acetabular fracture was reconstructed with MIMICS14.0 software from the DICOM file of the CT data. Bone fragments were moved and rotated to simulate fracture reduction and restore the pelvic integrity with virtual fixation. The computer-assisted 3D image of the reduced acetabula was printed for surgery simulation and plate pre-bending. The postoperative CT scan was performed to compare the consistency of the preoperative planning with the surgical implants by 3D-superimposition in MIMICS14.0, and evaluated by Matta's method. Computer-based pre-operations were precisely mimicked and consistent with the actual operations in all cases. The pre-bent fixation plates had an anatomical shape specifically fit to the individual pelvis without further bending or adjustment at the time of surgery and fracture reductions were significantly improved. Seven out of 10 patients had a displacement of fracture reduction of less than 1mm; 3 cases had a displacement of fracture reduction between 1 and 2mm. The 3D printing technology combined with virtual surgery for acetabular fractures is feasible, accurate, and effective leading to improved patient-specific preoperative planning and outcome of real surgery. The results provide useful technical tips in planning pelvic surgeries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluating the Longevity and Hydraulic Performance of Permeable Reactive Barriers at Department of Defense Sites

DTIC Science & Technology

2003-01-01

Army Ammunitions Plant) PRBs have become feasible with trenching. Other construction 5 methods, such as jetting, hydraulic fracturing , and vibratory...where the affected aquifer is deeper, innovative methods, such as jetting and hydraulic fracturing , are available, but there is not as much widespread...such as jetting and hydraulic fracturing ) can be used at relatively higher cost. The cost comparison of a PRB versus an active remedy, such as a

Evaluation of metal-polymeric fixed partial prosthesis using optical coherence tomography

NASA Astrophysics Data System (ADS)

Sinescu, C.; Negrutiu, M. L.; Duma, V. F.; Marcauteanu, C.; Topala, F. I.; Rominu, M.; Bradu, A.; Podoleanu, A. Gh.

2013-11-01

Metal-Polymeric fixed partial prosthesis is the usual prosthetic treatment for many dental patients. However, during the mastication the polymeric component of the prosthesis is fractured and will be lost. This fracture is caused by the material defects or by the fracture lines trapped inside the esthetic components of the prosthesis. This will finally lead to the failure of the prosthetic treatment. Nowadays, there is no method of identification and forecast for the materials defects of the polymeric materials. The aim of this paper is to demonstrate the capability of Optical Coherence Tomography (OCT) as a non-invasive clinical method that can be used for the evaluation of metal-polymeric fixed partial prostheses. Twenty metal-polymeric fixed partial prostheses were used for this study. The esthetic component of the prostheses has been Adoro (Ivoclar). Optical investigations of the metal prostheses have revealed no material defects or fracture lines. All the prostheses were temporary cemented in the oral cavities of the patients for six month. The non-invasive method used for the investigations was OCT working in Time Domain mode at 1300 nm. The evaluations of the prostheses were performed before and after their cementation in the patient mouths. All the imagistic results were performed in 2D and than in 3D, after the reconstruction. The results obtained after the OCT evaluation allowed for the identification of 4 metal-polymeric fixed partial prostheses with material defects immediately after finishing the technological procedures. After 6 month in the oral environment other 3 fixed partial prostheses revealed fracture lines. In conclusion, OCT proved to be a valuable tool for the noninvasive evaluation of the metal-polymeric fixed partial prostheses.

Similarity in Bilateral Isolated Internal Orbital Fractures.

PubMed

Chen, Hung-Chang; Cox, Jacob T; Sanyal, Abanti; Mahoney, Nicholas R

2018-04-13

In evaluating patients sustaining bilateral isolated internal orbital fractures, the authors have observed both similar fracture locations and also similar expansion of orbital volumes. In this study, we aim to investigate if there is a propensity for the 2 orbits to fracture in symmetrically similar patterns when sustaining similar trauma. A retrospective chart review was performed studying all cases at our institution of bilateral isolated internal orbital fractures involving the medial wall and/or the floor at the time of presentation. The similarity of the bilateral fracture locations was evaluated using the Fisher's exact test. The bilateral expanded orbital volumes were analyzed using the Wilcoxon signed-rank test to assess for orbital volume similarity. Twenty-four patients with bilateral internal orbital fractures were analyzed for fracture location similarity. Seventeen patients (70.8%) had 100% concordance in the orbital subregion fractured, and the association between the right and the left orbital fracture subregion locations was statistically significant (P < 0.0001). Fifteen patients were analyzed for orbital volume similarity. The average orbital cavity volume was 31.2 ± 3.8 cm on the right and 32.0 ± 3.7 cm on the left. There was a statistically significant difference between right and left orbital cavity volumes (P = 0.0026). The data from this study suggest that an individual who suffers isolated bilateral internal orbital fractures has a statistically significant similarity in the location of their orbital fractures. However, there does not appear to be statistically significant similarity in the expansion of the orbital volumes in these patients.

Surgical repair of propagating condylar fractures of the third metacarpal/metatarsal bones with cortical screws placed in lag fashion in 26 racehorses (2007-2015).

PubMed

Moulin, N; François, I; Coté, N; Alford, C; Cleary, O; Desjardins, M R

2018-01-19

Despite the recommendation of plate fixation for propagating condylar fractures of the third metacarpal (McIII) or third metatarsal bone (MtIII), lag screw fixation can be a viable surgical option. To evaluate short-term outcome and long-term racing performance of horses that underwent lag screw fixation of long condylar fractures of the McIII/MtIII. Retrospective case series. Medical records, post-surgical racing performance and outcome of 26 horses with propagating fractures of the medial and/or lateral condyle of McIII/MtIII were reviewed. Medical information included were age, breed, sex, physical examination at admission, circumstances of fracture, radiographic evaluation, anaesthesia and recovery records, surgical and post-operative management, as well as complications. Outcome included racing data and information from telephone interviews. Twenty-six horses (9 Standardbreds and 17 Thoroughbreds) were admitted with a long condylar fracture of the McIII/MtIII. Fore- and hindlimbs were equally represented with the left hindlimb being more frequently involved. Most of the fractures had a spiralling component (76%) and four (15%) were comminuted. Fifteen (58%) horses raced post-surgery including nine Standardbreds (100%) and six Thoroughbreds (35%). Twelve of them were placed in at least one race and 11 won at least once. One horse sustained a severe complication in recovery. No significant difference was observed in the racing performances before and after surgery. Follow-up method and duration were not standardised and there is a low number of cases with six surgeons. Long condylar fractures can be repaired using lag fashion technique combined with a half-limb or full-limb tight cast for recovery as a good surgical alternative. Similar results to plate fixation can be expected, with a return to racing of more than 50%, and the prognosis being even better for pacers. © 2018 EVJ Ltd.

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

PubMed Central

Hoag, Nathan A.; Hennessey, Kiara; So, Alan

2011-01-01

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture. PMID:21470546

Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature.

PubMed

Toro, Giuseppe; Moretti, Antimo; Toro, Gabriella; Tirelli, Assunta; Calabrò, Giampiero; Toro, Antonio; Iolascon, Giovanni

2017-01-01

A clinical case of a 15-year-old cerebral palsy child with a Sandhu type 2 neglected femoral neck fracture is presented. The patient was treated using cannulated screws and cancellous bone graft augmented with mesenchymal stem cells. At 6 months after the surgery complete fracture healing was observed. To early diagnose this fractures, it is mandatory to perform a comprehensive clinical and radiological evaluation including also a second level imaging. The use of cannulated screws with cancellous bone graft and MSCs is a viable treatment option in these patients.

Failure of a gas well to respond to a foam hydraulic fracturing treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rauscher, B.D.

1996-12-31

Well No. 1 (not the real name of the well) is not producing gas at maximum capacity following a foam hydraulic fracturing treatment performed upon completion of the well in 1987. The failure of the stimulation treatment, which has affected other wells throughout the field, was due to a combination of three factors: (1) downward fracture growth and proppant settling during injection (2) embedment due to a high pressure drawdown in the wellbore during flowback procedures, and (3) poor cleanup of the fracture fluid due to high capillary pressures. The following are recommendations to help improve future fracturing treatments throughoutmore » the field: (1) Fracture at lower treating pressures; (2) Improve perforating techniques; (3) Change flowback procedures; and (4) Evaluate using N{sub 2} as a fracture fluid.« less

NOTCH signaling in skeletal progenitors is critical for fracture repair

PubMed Central

Wang, Cuicui; Inzana, Jason A.; Mirando, Anthony J.; Liu, Zhaoyang; Shen, Jie; O’Keefe, Regis J.; Awad, Hani A.; Hilton, Matthew J.

2016-01-01

Fracture nonunions develop in 10%–20% of patients with fractures, resulting in prolonged disability. Current data suggest that bone union during fracture repair is achieved via proliferation and differentiation of skeletal progenitors within periosteal and soft tissues surrounding bone, while bone marrow stromal/stem cells (BMSCs) and other skeletal progenitors may also contribute. The NOTCH signaling pathway is a critical maintenance factor for BMSCs during skeletal development, although the precise role for NOTCH and the requisite nature of BMSCs following fracture is unknown. Here, we evaluated whether NOTCH and/or BMSCs are required for fracture repair by performing nonstabilized and stabilized fractures on NOTCH-deficient mice with targeted deletion of RBPjk in skeletal progenitors, maturing osteoblasts, and committed chondrocytes. We determined that removal of NOTCH signaling in BMSCs and subsequent depletion of this population result in fracture nonunion, as the fracture repair process was normal in animals harboring either osteoblast- or chondrocyte-specific deletion of RBPjk. Together, this work provides a genetic model of a fracture nonunion and demonstrates the requirement for NOTCH and BMSCs in fracture repair, irrespective of fracture stability and vascularity. PMID:26950423

Rib fractures after percutaneous radiofrequency and microwave ablation of lung tumors: incidence and relevance.

PubMed

Alexander, Erica S; Hankins, Carol A; Machan, Jason T; Healey, Terrance T; Dupuy, Damian E

2013-03-01

To retrospectively identify the incidence and probable risk factors for rib fractures after percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of neoplasms in the lung and to identify complications related to these fractures. Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Study population was 163 patients treated with MWA and/or RFA for 195 lung neoplasms between February 2004 and April 2010. Follow-up computed tomographic images of at least 3 months were retrospectively reviewed by board-certified radiologists to determine the presence of rib fractures. Generalized estimating equations were performed to assess the effect that patient demographics, tumor characteristics, treatment parameters, and ablation zone characteristics had on development of rib fractures. Kaplan-Meier curve was used to estimate patients' probability of rib fracture after ablation as a function of time. Clinical parameters (ie, pain in ribs or chest, organ damage caused by fractured rib) were evaluated for patients with confirmed fracture. Rib fractures in proximity to the ablation zone were found in 13.5% (22 of 163) of patients. Estimated probability of fracture was 9% at 1 year and 22% at 3 years. Women were more likely than were men to develop fracture after ablation (P = .041). Patients with tumors closer to the chest wall were more likely to develop fracture (P = .0009), as were patients with ablation zones that involved visceral pleura (P = .039). No patients with rib fractures that were apparently induced by RFA and MWA had organ injury or damage related to fracture, and 9.1% (2 of 22) of patients reported mild pain. Rib fractures were present in 13.5% of patients after percutaneous RFA and MWA of lung neoplasms. Patients who had ablations performed close to the chest wall should be monitored for rib fractures.

Analysis of 809 Facial Bone Fractures in a Pediatric and Adolescent Population

PubMed Central

Kim, Sang Hun; Lee, Soo Hyang

2012-01-01

Background Facial fractures are infrequent in children and adolescents and have different clinical features from those in adults. The low incidence in children and adolescents reflects the flexibility and underdevelopment of their facial skeletons, as well as their more protected environments. Only a few reports have reviewed such patients in Korea. The authors performed a retrospective study to analyze the characteristics of facial fractures in the Korean pediatric population. Methods We conducted a retrospective review on a series of 741 patients, aged <18 years, with facial fractures who had been treated at our hospital between 2006 and 2010. The following parameters were evaluated: age, sex, cause, location and type of fractures, associated injuries, treatment and complications. Results A total of 741 consecutive patients met the inclusion criteria. The ratio of boys to girls was 5.7:1. Facial fractures most commonly occurred in patients between 13 and 15 years of age (36.3%). The most common causes of injury was violence. The nasal fracture was the most common type of fracture (69%) and the blowout fracture was the second most common (20%). Associated injuries occurred in 156 patients (21%). Conclusions The incidence of pediatric facial fractures caused by violence is high in Korea. Our results show that as age increases, etiological factors and fracture patterns gradually shift towards those found in adults. This study provides an overview of facial fractures in these age groups that helps illustrate the trends and characteristics of the fractures and may be helpful in further evaluation and management. PMID:23233885

Cost and Performance Report - Evaluating the Longevity and Hydraulic Performance of Permeable Reactive Barriers at Department of Defense Sites

DTIC Science & Technology

2002-12-01

methods, such as jetting, hydraulic fracturing , and vibratory beam, have been demonstrated at some sites, as they offer some cost advantages at deep sites...while still keeping the implementation cost relatively low. Beyond these depths, innovative methods (such as jetting and hydraulic fracturing ) can...type excavator and a trench-type barrier. For sites where the affected aquifer is deeper, innovative methods, such as jetting and hydraulic

Internal fixators: a safe option for managing distal femur fractures?

PubMed Central

Batista, Bruno Bellaguarda; Salim, Rodrigo; Paccola, Cleber Antonio Jansen; Kfuri, Mauricio

2014-01-01

OBJECTIVE: Evaluate safety and reliability of internal fixator for the treatment of intra-articular and periarticular distal femur fractures. METHODS: Retrospective data evaluation of 28 patients with 29 fractures fixed with internal fixator was performed. There was a predominance of male patients (53.5%), with 52% of open wound fractures, 76% of AO33C type fractures, and a mean follow up of 21.3 months. Time of fracture healing, mechanical axis deviation, rate of infection and postoperative complications were registered. RESULTS: Healing rate was 93% in this sample, with an average time of 5.5 months. Twenty-seven percent of patients ended up with mechanical axis deviation, mostly resulting from poor primary intra-operative reduction. There were two cases of implant loosening; two implant breakage, and three patients presented stiff knee. No case of infection was observed. Healing rate in this study was comparable with current literature; there was a high degree of angular deviation, especially in the coronal plane. CONCLUSION: Internal fixators are a breakthrough in the treatment of knee fractures, but its use does not preclude application of principles of anatomical articular reduction and mechanical axis restoration. Level of Evidence II, Retrospective Study. PMID:25061424

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

PubMed Central

Grawe, Brian

2018-01-01

Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process. PMID:29399372

Comparison of trabecular bone score and hip structural analysis with FRAX® in postmenopausal women with type 2 diabetes mellitus.

PubMed

Bonaccorsi, Gloria; Fila, Enrica; Messina, Carmelo; Maietti, Elisa; Ulivieri, Fabio Massimo; Caudarella, Renata; Greco, Pantaleo; Guglielmi, Giuseppe

2017-10-01

To evaluate (a) the performance in predicting the presence of bone fractures of trabecular bone score (TBS) and hip structural analysis (HSA) in type 2 diabetic postmenopausal women compared to a control group and (b) the fracture prediction ability of TBS versus Fracture Risk Calculator (FRAX ® ) as well as whether TBS can improve the fracture prediction ability of FRAX ® in diabetic women. Eighty diabetic postmenopausal women were matched with 88 controls without major diseases for age and body mass index. The individual 10-year fracture risk was assessed by FRAX ® tool for Europe-Italy; bone mineral density (BMD) at lumbar spine, femoral neck and total hip was evaluated through dual-energy X-ray absorptiometry; TBS measurements were taken using the same region of interest as the BMD measurements; HSA was performed at proximal femur with the HSA software. Regarding variables of interest, the only significant difference between diabetic and control groups was observed for the value of TBS (median value: 1.215; IQR 1.138-1.285 in controls vs. 1.173; IQR 1.082-1.217 in diabetic; p = 0.002). The prevalence of fractures in diabetic women was almost tripled than in controls (13.8 vs. 3.4 %; p = 0.02). The receiver operator characteristic curve analysis showed that TBS alone (AUC = 0.71) had no significantly lower discriminative power for fracture prediction in diabetic women than FRAX major adjusted for TBS (AUC = 0.74; p = 0.65). In diabetic postmenopausal women TBS is an excellent tool in identifying fragility fractures.

The prevention of postmenopausal osteoporotic fractures: results of the Health Technology Assessment of a new antiosteoporotic drug.

PubMed

de Waure, Chiara; Specchia, Maria Lucia; Cadeddu, Chiara; Capizzi, Silvio; Capri, Stefano; Di Pietro, Maria Luisa; Veneziano, Maria Assunta; Gualano, Maria Rosaria; Kheiraoui, Flavia; La Torre, Giuseppe; Nicolotti, Nicola; Sferrazza, Antonella; Ricciardi, Walter

2014-01-01

The Health Technology Assessment (HTA) approach was applied to denosumab in the prevention of osteoporotic fractures in postmenopausal women. Epidemiological, clinical, technical, economic, organizational, and ethical aspects were considered. Medical electronic databases were accessed to evaluate osteoporosis epidemiology and therapeutical approaches. A budget impact and a cost-effectiveness analyses were performed to assess economic implications. Clinical benefits and patient needs were considered with respect to organizational and ethical evaluation. In Italy around four millions women are affected by osteoporosis and have a higher risk for fractures with 70,000 women being hospitalized every year. Bisphosphonates and strontium ranelate are recommended as first line treatment for the prevention of osteoporotic fractures. Denosumab is effective in reducing vertebral, nonvertebral, and hip/femoral fractures with an advantage of being administered subcutaneously every six months. The budget impact analysis estimated a reduction in costs for the National Health Service with the introduction of denosumab. Furthermore, the economic analysis demonstrated that denosumab is cost-effective in comparison to oral bisphosphonates and strontium ranelate. Denosumab can be administered in outpatients by involving General Practitioners in the management. Ethical evaluation is positive because of its efficacy and compliance. Denosumab could add value in the prevention of osteoporotic fractures.

Tensile Fracture Behavior and Failure Mechanism of Additively-Manufactured AISI 4140 Low Alloy Steel by Laser Engineered Net Shaping

PubMed Central

Kim, Hoyeol; Liu, Zhichao; Cong, Weilong; Zhang, Hong-Chao

2017-01-01

AISI 4140 powder was directly deposited on AISI 4140 wrought substrate using laser engineered net shaping (LENS) to investigate the compatibility of a LENS-deposited part with the substrate. Tensile testing at room temperature was performed to evaluate the interface bond performance and fracture behavior of the test specimens. All the samples failed within the as-deposited zone, indicating that the interfacial bond is stronger than the interlayer bond inside the deposit. The fracture surfaces were analyzed using scanning electron microscopy (SEM) and energy disperse X-ray spectrometry (EDS). Results show that the tensile fracture failure of the as-deposited part is primarily affected by lack-of-fusion defects, carbide precipitation, and oxide particles inclusions, which causes premature failure of the deposit by deteriorating the mechanical properties and structural integrity. PMID:29120374

Tensile Fracture Behavior and Failure Mechanism of Additively-Manufactured AISI 4140 Low Alloy Steel by Laser Engineered Net Shaping.

PubMed

Kim, Hoyeol; Liu, Zhichao; Cong, Weilong; Zhang, Hong-Chao

2017-11-09

AISI 4140 powder was directly deposited on AISI 4140 wrought substrate using laser engineered net shaping (LENS) to investigate the compatibility of a LENS-deposited part with the substrate. Tensile testing at room temperature was performed to evaluate the interface bond performance and fracture behavior of the test specimens. All the samples failed within the as-deposited zone, indicating that the interfacial bond is stronger than the interlayer bond inside the deposit. The fracture surfaces were analyzed using scanning electron microscopy (SEM) and energy disperse X-ray spectrometry (EDS). Results show that the tensile fracture failure of the as-deposited part is primarily affected by lack-of-fusion defects, carbide precipitation, and oxide particles inclusions, which causes premature failure of the deposit by deteriorating the mechanical properties and structural integrity.

A fitness-for-purpose evaluation of fracture critical electro-slag welds.

DOT National Transportation Integrated Search

2009-03-01

A fitness-for-purpose evaluation was performed on the electro-slag flange welds of the West Fremont bridge approach : superstructures, per the request of FHWA. This evaluation required gathering knowledge of the material properties, fabrication : def...

Risk of Osteoporotic Fracture After Steroid Injections in Patients With Medicare.

PubMed

Carreon, Leah Y; Ong, Kevin L; Lau, Edmund; Kurtz, Steven M; Glassman, Steven D

To further evaluate the relationship between steroid injections and osteoporotic fracture risk, we analyzed Medicare administrative claims data on both large-joint steroid injections (LJSIs) into knee and hip and transforaminal steroid injections (TSIs), as well as osteoporotic hip and wrist fractures. Our hypothesis was that a systemic effect of steroid injections would increase fracture risk in all skeletal locations regardless of injection site, whereas a local effect would produce a disproportionate increased risk of spine fracture with spine injection. Patients treated with an LJSI, a TSI, or an epidural steroid injection (ESI) were identified from 5% Medicare claims data. Patients under age 65 years and patients with prior osteoporotic fracture were excluded. Analyses were performed to determine fracture risk (adjusted hazard ratio) for each type of injection. Analysis of the Medicare data revealed that ESIs were associated with decreased osteoporotic spine fracture risk, but the effect was small and might not be clinically relevant. ESIs did not influence osteoporotic hip or wrist fracture risk, but LJSIs reduced the risk.

Adolescent clavicle nonunions: potential risk factors and surgical management.

PubMed

Pennock, Andrew T; Edmonds, Eric W; Bae, Donald S; Kocher, Mininder S; Li, Ying; Farley, Frances A; Ellis, Henry B; Wilson, Philip L; Nepple, Jeffrey; Gordon, J Eric; Willimon, Samuel C; Busch, Michael T; Spence, David D; Kelly, Derek M; Pandya, Nirav K; Sabatini, Coleen S; Shea, Kevin G; Heyworth, Benton E

2018-01-01

Clavicle nonunions in adolescent patients are exceedingly rare. The purpose of this study was to evaluate a series of clavicle nonunions from a pediatric multicenter study group to assess potential risk factors and treatment outcomes. A retrospective review of all clavicle nonunions in patients younger than 19 years was performed at 9 pediatric hospitals between 2006 and 2016. Demographic and surgical data were documented. Radiographs were evaluated for initial fracture classification, displacement, shortening, angulation, and nonunion type. Clinical outcomes were evaluated, including rate of healing, time to union, return to sports, and complications. Risk factors for nonunion were assessed by comparing the study cohort with a separate cohort of age-matched patients with a diaphyseal clavicle fracture. There were 25 nonunions (mean age, 14.5 years; range, 10.0-18.9 years) identified, all of which underwent surgical fixation. Most fractures were completely displaced (68%) initially, but 21% were partially displaced and 11% were nondisplaced. Bone grafting was performed in 24 of 25 cases, typically using the hypertrophic callus. Radiographic healing was achieved in 96% of cases. One patient (4%) required 2 additional procedures to achieve union. The primary risk factor for development of a nonunion was a previous history of an ipsilateral clavicle fracture. Clavicle nonunions can occur in the adolescent population but are an uncommon clinical entity. The majority occur in male patients with displaced fractures, many of whom have sustained previous fractures of the same clavicle. High rates of union were achieved with plate fixation and the use of bone graft. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Fracture Response Enhancement Of Aluminum Using In-Situ Selective Reinforcement

NASA Technical Reports Server (NTRS)

Abada, Christopher H.; Farley, Gary L.; Hyer, Michael W.

2006-01-01

A computer-based parametric study of the effect of reinforcement architectures on fracture response of aluminum compact-tension (CT) specimens is performed. Eleven different reinforcement architectures consisting of rectangular and triangular cross-section reinforcements were evaluated. Reinforced specimens produced between 13 and 28 percent higher fracture load than achieved with the unreinforced case. Reinforcements with blunt leading edges (rectangular reinforcements) exhibited superior performance relative to the triangular reinforcements with sharp leading edges. Relative to the rectangular reinforcements, the most important architectural feature was reinforcement thickness. At failure, the reinforcements carried between 58 and 85 percent of the load applied to the specimen, suggesting that there is considerable load transfer between the base material and the reinforcement.

[Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

PubMed

Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

2018-05-25

To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma, fixed fixation, quick recovery, early postoperative functional exercise. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

Isolated displaced non-union of a triquetral body fracture: a case report.

PubMed

Rasoli, Sonia; Ricks, Matthew; Packer, Greg

2012-02-10

Fractures of the body of the triquetral bone are the second most common carpal fractures, and these fractures can be missed on plain X-ray. Although non-union of triquetral body fractures is very rare, such cases are associated with considerable morbidity and reduction in functional activity. We report the case of a 29-year-old Caucasian British man who sustained an isolated displaced triquetral body fracture that resulted in non-union, who was treated surgically. We describe an original operative management for this debilitating injury. An open reduction and internal fixation using double headed compression screws was performed, without bone grafting, and with early immobilization of the wrist. We propose this novel approach and advocate early clinical suspicion of triquetral body fractures in patients with a history of fall on an outstretched hand and ulnar sided wrist pain. We recommend evaluation using computed tomography or magnetic resonance imaging scanning.

Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work?

PubMed

Lee, Soong Joon; Kwak, Hong Suk; Yoo, Jeong Joon; Kim, Hee Joong

2016-01-01

We evaluated the short-term to midterm results of reoperation with bearing change to metal-on-polyethylene (MoP) after ceramic bearing fracture in ceramic-on-ceramic total hip arthroplasty. Nine third-generation ceramic bearing fractures (6 heads and 3 liners) were treated with bearing change to MoP. Mean age at reoperation was 52.7 years. Mean follow-up was 4.3 years. During follow-up, 2 of 3 liner-fractured hips and 1 of 6 head-fractured hips showed radiologic signs of metallosis and elevated serum chromium levels. Re-reoperation with bearing rechange to a ceramic head was performed for the hips with metallosis. One liner-fractured hip had periprosthetic joint infection. Dislocation occurred in 3 hips. From our experience, bearing change to MoP is not a recommended treatment option for ceramic bearing fracture in total hip arthroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

Fracture predictive ability of physical performance tests and history of falls in elderly women: a 10-year prospective study.

PubMed

Wihlborg, A; Englund, M; Åkesson, K; Gerdhem, P

2015-08-01

In a large cohort of elderly women followed for 10 years, we found that balance, gait speed, and self-reported history of fall independently predicted fracture. These clinical risk factors are easily evaluated and therefore advantageous in a clinical setting. They would improve fracture risk assessment and thereby also fracture prevention. The aim of this study was to identify additional risk factors for osteoporosis-related fracture by investigating the fracture predictive ability of physical performance tests and self-reported history of falls. In the population-based Osteoporosis Prospective Risk Assessment study (OPRA), 1044 women were recruited at the age of 75 and followed for 10 years. At inclusion, knee extension force, standing balance, gait speed, and bone mineral density (BMD) were examined. Falls the year before investigation was assessed by questionnaire. Cox proportional hazards regression analysis was used to determine fracture hazard ratios (HR) with BMD, history of fracture, BMI, smoking habits, bisphosphonate, vitamin D, glucocorticoid, and alcohol use as covariates. Continuous variables were standardized and HR shown for each standard deviation change. Of all women, 427 (41%) sustained at least one fracture during the 10-year follow-up. Failing the balance test had an HR of 1.98 (1.18-3.32) for hip fracture. Each standard deviation decrease in gait speed was associated with an HR of 1.37 (1.14-1.64) for hip fracture. Previous fall had an HR of 1.30 (1.03-1.65) for any fracture; 1.39 (1.08-1.79) for any osteoporosis-related fracture; and 1.60 (1.03-2.48) for distal forearm fracture. Knee extension force did not show fracture predictability. The balance test, gait speed test, and self-reported history of fall all hold independent fracture predictability. Consideration of these clinical risk factors for fracture would improve the fracture risk assessment and subsequently also fracture prevention.

Hairline fractures following volar plating of the distal radius: a recently recognized hardware-related complication.

PubMed

Otremski, Hila; Dolkart, Oleg; Atlan, Franck; Hutt, Dan; Segev, Elad; Pritsch, Tamir; Rosenblatt, Yishai

2018-06-01

Intraoperative hairline longitudinal fractures were recently reported in association with distal radius volar plating. Our aim was to further analyze this newly described complication. A retrospective radiographic and chart review was performed on 225 patients who underwent distal radius plating between June 2013 and June 2015. The Acu-Loc/Acu-Loc2© plating system (Acumed, Hillsboro, OR, USA) was used in 208 cases, and the VariAx© plating system (Stryker, Kalamazoo, MI, USA) was used in 17 cases. Three independent reviewers performed a blind evaluation of all relevant radiographs for the occurrence of longitudinal fractures around the plate, and validity was considered only when there was agreement among all three of them. Hairline longitudinal fractures were identified in 57 cases (25%), 55 with the Acu-Loc/Acu-Loc2© system and 2 with the VariAx© system. All fractures occurred with volar plating. Fracture occurrence was associated with age over 59 years, female gender, extra-articular fractures, and the use of Hexalobe screws (Acu-Loc/Acu-Loc2© system). We believe that the source of fracture occurrence lies within the screw design and that better screw design and possibly tapping in patients at risk may reduce the occurrence of intraoperative hairline longitudinal fractures. Further clinical and biomechanical research is needed to better understand this newly reported complication.

Digitized radiographs in skeletal trauma: a performance comparison between a digital workstation and the original film images.

PubMed

Wilson, A J; Hodge, J C

1995-08-01

To evaluate the diagnostic performance of a teleradiology system in skeletal trauma. Radiographs from 180 skeletal trauma patients were digitized (matrix, 2,000 x 2,500) and transmitted to a remote digital viewing console (1,200-line monitor). Four radiologists interpreted both the original film images and digital images. Each reader was asked to identify, locate, and characterize fractures and dislocations. Receiver operating characteristic curves were generated, and the results of the original and digitized film readings were compared. All readers performed better with the original film when interpreting fractures. Although the patterns varied between readers, all had statistically significant differences (P < .01) for the two image types. There was no statistically significant difference in performance with the two images when dislocations were diagnosed. The system tested is not a satisfactory alternative to the original radiograph for routine reading of fracture films.

A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures.

PubMed

Pieracci, Fredric M; Lin, Yihan; Rodil, Maria; Synder, Madelyne; Herbert, Benoit; Tran, Dong Kha; Stoval, Robert T; Johnson, Jeffrey L; Biffl, Walter L; Barnett, Carlton C; Cothren-Burlew, Clay; Fox, Charles; Jurkovich, Gregory J; Moore, Ernest E

2016-02-01

Previous studies of surgical stabilization of rib fractures (SSRF) have been limited by small sample sizes, retrospective methodology, and inclusion of only patients with flail chest. We performed a prospective, controlled evaluation of SSRF as compared with optimal medical management for severe rib fracture patterns among critically ill trauma patients. We hypothesized that SSRF improves acute outcomes. We conducted a 2-year clinical evaluation of patients with any of the following rib fracture patterns: flail chest, three or more fractures with bicortical displacement, 30% or greater hemithorax volume loss, and either severe pain or respiratory failure despite optimal medical management. In the year 2013, all patients were managed nonoperatively. In the year 2014, all patients were managed operatively. Outcomes included respiratory failure, tracheostomy, pneumonia, ventilator days, tracheostomy, length of stay, daily maximum incentive spirometer volume, narcotic requirements, and mortality. Univariate and multivariable analyses were performed. Seventy patients were included, 35 in each group. For the operative group, time from injury to surgery was 2.4 day, operative time was 1.5 hours, and the ratio of ribs fixed to ribs fractured was 0.6. The operative group had a significantly higher RibScore (4 vs. 3, respectively, p < 0.01) and a significantly lower incidence of intracranial hemorrhage (5.7% vs. 28.6%, respectively, p = 0.01). After controlling for these differences, the operative group had a significantly lower likelihood of both respiratory failure (odds ratio, 0.24; 95% confidence interval, 0.06-0.93; p = 0.03) and tracheostomy (odds ratio, 0.18; 95% confidence interval, 0.04-0.78; p = 0.03). Duration of ventilation was significantly lower in the operative group (p < 0.01). The median daily spirometry value was 250 mL higher in the operative group (p = 0.04). Narcotic requirements were comparable between groups. There were no mortalities. In this evaluation, SSRF as compared with the best medical management improved acute outcomes among a group of critically ill trauma patients with a variety of severe fracture patterns. Therapeutic study, level II.

Computed tomography for occult fractures of the proximal femur, pelvis, and sacrum in clinical practice: single institution, dual-site experience.

PubMed

Mandell, Jacob C; Weaver, Michael J; Khurana, Bharti

2018-06-01

The purpose of this study was to evaluate the diagnostic performance of CT for assessment of occult fractures of the proximal femur, pelvis, and sacrum. A retrospective review was performed on patients who received a CT of the hip or pelvis for suspected occult fracture after negative or equivocal radiographs performed within 24 h. The official radiology report was utilized for the determination of CT findings and calculation of sensitivity and specificity. Surgical reports, MRI reports, and clinical follow-up were used as the standard of reference. Sensitivity and specificity were calculated with 95% confidence intervals. Seventy-four patients received CT of the hip or pelvis for clinical concern for occult fracture after negative or equivocal radiographs. By the reference standard, a total of 40 fractures were present in 25/74 (33.8%) patients, including 35 conservatively treated fractures of the greater trochanter, pelvis, and sacrum, and 5 operatively treated proximal femoral fractures. A total of 14/74 (18.9%) of patients had an MRI within 1 day of CT. MRI identified an operatively treated femoral neck fracture not seen on CT and an operatively treated intertrochanteric fracture, which CT described as a greater trochanteric fracture. There were two false negative conservatively treated pelvic fractures not seen on CT but diagnosed on MRI. On a per-patient basis, CT had an overall sensitivity of 88% (22/25; 95% confidence intervals 69-97%), specificity of 98% (48/49; 95% confidence intervals 89-100%), and negative predictive value of 94%. For the five operative proximal femoral fractures, the sensitivity of CT was 60% (3/5; 95% confidence intervals 15-95%), specificity was 99% (68/69; 95% confidence intervals 92-100%), and negative predictive value was 97%. In the clinical setting of suspected occult fracture, the sensitivity of clinical CT reports for detection of any type of fracture of the proximal femur, pelvis, or sacrum was 88%. For the small number of operatively treated proximal femoral fractures seen in the study, sensitivity of CT was 60% (3/5) and negative predictive value was 97%, although the relatively few patients needing fixation precludes statistical analysis.

The development of in situ fracture toughness evaluation techniques in hydrogen environment

DOE PAGES

Wang, John Jy-An; Ren, Fei; Tan, Tin; ...

2014-12-19

Reliability of hydrogen pipelines and storage tanks is significantly influenced by the mechanical performance of the structural materials exposed in the hydrogen environment. Fracture behavior and fracture toughness are of specific interest since they are relevant to many catastrophic failures. However, many conventional fracture testing techniques are difficult to be realized under the presence of hydrogen. Thus it is desired to develop novel in situ techniques to study the fracture behavior of structural materials in hydrogen environments. In this study, special testing apparatus were designed to facilitate in situ fracture testing in H 2. A torsional fixture was developed tomore » utilize an emerging fracture testing technique, Spiral Notch Torsion Test (SNTT). The design concepts will be discussed. Preliminary in situ testing results indicated that the exposure to H 2 significantly reduces the fracture toughness of 4340 high strength steels by up to 50 percent. Furthermore, SNTT tests conducted in air demonstrated a significant fracture toughness reduction in samples subject to simulated welding heat treatment using Gleeble, which illustrated the effect of welding on the fracture toughness of this material.« less

Effects of exercise on fracture reduction in older adults: a systematic review and meta-analysis.

PubMed

Kemmler, W; Häberle, L; von Stengel, S

2013-07-01

In this meta-analysis, we evaluated the effect of exercise on fracture reduction in the elderly. Our results determined a significantly positive effect on overall fractures, whereas the possibility of a publication bias indicates the need for well-designed (multi-center) trials that generate enough power to focus on osteoporotic fractures. The preventive effect of exercise on fracture incidence has not been clearly determined yet. Thus, the purpose of this study is to evaluate the effectiveness of exercise in preventing overall and vertebral fractures in older adults by meta-analyses technique. This study followed the PRISMA recommendations for systematic reviews and meta-analyses. A systematic review of English articles between 1980 and March 2012 was performed. Terms used were: "exercise", "fractures", "bone", "falls", "osteoporosis", "BMD", "BMC", "bone turnover", while the search was limited to "clinical trial" and "humans". Controlled exercise trials that reported fracture number as endpoint or observation in subjects 45 years and older were included. Ten controlled exercise trials that reported overall fractures and three exercise trials that reported vertebral fractures met our inclusion criteria. Overall fracture number in the exercise group was 36 (n = 754) compared with 73 fractures in the CG (n = 670) (relative risk [RR] = 0.49; 95 % confidence interval [CI], 0.31-0.76). No significant heterogeneity of trial results (p = 0.28; I (2) = 17) was determined; however, there was some evidence to suggest a publication bias. The overall RR for vertebral fracture number (0.56; 95 % CI, 0.30-1.04) (EG: 19 fractures/103 subjects vs. CG: 31 fractures/102 subjects) was borderline non-significant while the heterogeneity of trial results also cannot be ruled out. Although there is evidence that exercise reduces overall and, to a lesser degree, vertebral fractures in the elderly, the possibility of publication bias weakens our result and demonstrates the imperative for large exercise studies with dedicated exercise protocols that focus on fractures as a primary endpoint.

Performance of engine-driven rotary endodontic instruments with a superimposed bending deflection: V. Gates Glidden and Peeso drills.

PubMed

Brantley, W A; Luebke, N H; Luebke, F L; Mitchell, J C

1994-05-01

A laboratory study was performed on Gates Glidden and Peeso drills to determine the incidence of shaft fracture when a bending deflection was superimposed on the rotating drills. Samples of sizes #1 to #6 stainless steel Gates Glidden drills, sizes #1 to #6 stainless steel and carbon steel-type P Peeso drills, and sizes #009 to #023 carbon steel-type B-1 Peeso drills from each of two manufacturers were evaluated with a unique apparatus that applied a 2-mm bending deflection while rotating the instruments. The apparatus did not restrict movement of the bur head during rotation. The test drills were rotated at 2500, 4000, and 7000 revolutions per minute, and the number of revolutions at failure was recorded. Scanning electron microscopic observations established that the stainless steel Gates Glidden and Peeso drills failed by ductile fracture, whereas the carbon steel Peeso drills failed by brittle fracture. Instrument fracture was always near the handpiece shank with this test, and the length of the fractured drills was measured from the working tip. It is recommended that this additional test be adopted to determine fatigue properties of engine-driven rotary endodontic instruments in establishing international performance standards.

Evaluation of superplastic forming and co-diffusion bonding of Ti-6Al-4V titanium alloy expanded sandwich structures

NASA Technical Reports Server (NTRS)

Arvin, G. H.; Israeli, L.; Stolpestad, J. H.; Stacher, G. W.

1981-01-01

The application of the superplastic forming/diffusion bonding (SPF/DB) process to supersonic cruise research is investigated. The capability of an SPF/DB titanium structure to meet the structural requirements of the inner wing area of the NASA arrow-wing advanced supersonic transport design is evaluated. Selection of structural concepts and their optimization for minimum weight, SPF/DB process optimization, fabrication of representative specimens, and specimen testing and evaluation are described. The structural area used includes both upper and lower wing panels, where the upper wing panel is used for static compression strength evaluation and the lower panel, in tension, is used for fracture mechanics evaluations. The individual test specimens, cut from six large panels, consist of 39 static specimens, 10 fracture mechanics specimens, and one each full size panel for compression stability and fracture mechanics testing. Tests are performed at temperatures of -54 C (-65 F), room temperature, and 260 C (500 F).

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robinson, Judith; Johnson, Timothy C.; Slater, Lee D.

There is an increasing need to characterize discrete fractures away from boreholes to better define fracture distributions and monitor solute transport. We performed a 3D evaluation of static and time-lapse cross-borehole electrical resistivity tomography (ERT) data sets from a limestone quarry in which flow and transport are controlled by a bedding-plane feature. Ten boreholes were discretized using an unstructured tetrahedral mesh, and 2D panel measurements were inverted for a 3D distribution of conductivity. We evaluated the benefits of 3D versus 2.5D inversion of ERT data in fractured rock while including the use of borehole regularization disconnects (BRDs) and borehole conductivitymore » constraints. High-conductivity halos (inversion artifacts) surrounding boreholes were removed in static images when BRDs and borehole conductivity constraints were implemented. Furthermore, applying these constraints focused transient changes in conductivity resulting from solute transport on the bedding plane, providing a more physically reasonable model for conductivity changes associated with solute transport at this fractured rock site. Assuming bedding-plane continuity between fractures identified in borehole televiewer data, we discretized a planar region between six boreholes and applied a fracture regularization disconnect (FRD). Although the FRD appropriately focused conductivity changes on the bedding plane, the conductivity distribution within the discretized fracture was nonunique and dependent on the starting homogeneous model conductivity. Synthetic studies performed to better explain field observations showed that inaccurate electrode locations in boreholes resulted in low-conductivity halos surrounding borehole locations. These synthetic studies also showed that the recovery of the true conductivity within an FRD depended on the conductivity contrast between the host rock and fractures. Our findings revealed that the potential exists to improve imaging of fractured rock through 3D inversion and accurate modeling of boreholes. However, deregularization of localized features can result in significant electrical conductivity artifacts, especially when representing features with a high degree of spatial uncertainty.« less

Fracture mechanics analyses of ceramic/veneer interface under mixed-mode loading.

PubMed

Wang, Gaoqi; Zhang, Song; Bian, Cuirong; Kong, Hui

2014-11-01

Few studies have focused on the interface fracture performance of zirconia/veneer bilayered structure, which plays an important role in dental all-ceramic restorations. The purpose of this study was to evaluate the fracture mechanics performance of zirconia/veneer interface in a wide range of mode-mixities (at phase angles ranging from 0° to 90°), and to examine the effect of mechanical properties of the materials and the interface on the fracture initiation and crack path of an interfacial crack. A modified sandwich test configuration with an oblique interfacial crack was proposed and calibrated to choose the appropriate geometry dimensions by means of finite element analysis. The specimens with different interface inclination angles were tested to failure under three-point bending configuration. Interface fracture parameters were obtained with finite element analyses. Based on the interfacial fracture mechanics, three fracture criteria for crack kinking were used to predict crack initiation and propagation. In addition, the effects of residual stresses due to coefficient of thermal expansion mismatch between zirconia and veneer on the crack behavior were evaluated. The crack initiation and propagation were well predicted by the three fracture criteria. For specimens at phase angle of 0, the cracks propagated in the interface; whereas for all the other specimens the cracks kinked into the veneer. Compressive residual stresses in the veneer can improve the toughness of the interface structure. The results suggest that, in zirconia/veneer bilayered structure the veneer is weaker than the interface, which can be used to explain the clinical phenomenon that veneer chipping rate is larger than interface delamination rate. Consequently, a veneer material with larger fracture toughness is needed to decrease the failure rate of all-ceramic restorations. And the coefficient of thermal expansion mismatch of the substrates can be larger to produce larger compressive stresses in the veneer. Copyright © 2014 Elsevier Ltd. All rights reserved.

Predictors of a Change and Correlation in Activities of Daily Living after Hip Fracture in Elderly Patients in a Community Hospital in Poland: A Six-Month Prospective Cohort Study

PubMed Central

Ganczak, Maria; Chrobrowski, Krzysztof

2018-01-01

Objectives: The consequences of hip fractures (HFs) in elderly persons include a deterioration in functional capacity to perform activities that enable independent living. Since prior research into this issue in Central Europe is rather scant, this study sought to assess the change in activities and instrumental activities of daily living (ADL/IADL) after HF surgery among Polish patients, to study predictors of regaining pre-fracture functional status three and six months later, and to evaluate the correlation between ADL and IADL limitations over time. Methods: A prospective study was conducted between 2011 and 2013 in a tertiary hospital in Western Poland. ADL/IADL were evaluated using the Katz index and Lawton scale, respectively. Results: About half (50.8%) of 120 patients (mean age 80.1 ± SD 7.59) had cognitive impairment (CI). Patients with CI were older (p = 0.002) and had lower scores for pre-fracture ADL/IADL (p = 0.001 and p < 0.001, respectively). Six months after HF, 33.3% of patients failed to return to their pre-fracture ADL and 62.5% failed to return to pre-fracture IADL; 20% of those who could walk before HF were unable to walk after six months. The pre-fracture Spearman correlation coefficient between ADL and IADL summary scores was 0.46; it increased to 0.70 at three months after HF surgery and 0.77 at six months (p < 0.0001). Regaining ADL after six months was more likely in patients with pre-fracture intact intellectual function and independence in pre-fracture ADL; regaining IADL, in younger patients and those with higher pre-fracture IADL scores. Conclusions: Impairment in functional performance is common after HF surgery. ADL and IADL were strongly correlated in these patients, with this increasing over time. Functional outcomes after HF were more dependent on patient characteristics than treatment-related factors. Therefore, more emphasis should be directed towards the pre-fracture period and, in particular, maintaining cognitive function and preserving functional capacity in older persons at high risk of HF. PMID:29316721

3-D Mixed Mode Delamination Fracture Criteria - An Experimentalist's Perspective

NASA Technical Reports Server (NTRS)

Reeder, James R.

2006-01-01

Many delamination failure criteria based on fracture toughness have been suggested over the past few decades, but most only covered the region containing mode I and mode II components of loading because that is where toughness data existed. With new analysis tools, more 3D analyses are being conducted that capture a mode III component of loading. This has increased the need for a fracture criterion that incorporates mode III loading. The introduction of a pure mode III fracture toughness test has also produced data on which to base a full 3D fracture criterion. In this paper, a new framework for visualizing 3D fracture criteria is introduced. The common 2D power law fracture criterion was evaluated to produce unexpected predictions with the introduction of mode III and did not perform well in the critical high mode I region. Another 2D criterion that has been shown to model a wide range of materials well was used as the basis for a new 3D criterion. The new criterion is based on assumptions that the relationship between mode I and mode III toughness is similar to the relation between mode I and mode II and that a linear interpolation can be used between mode II and mode III. Until mixed-mode data exists with a mode III component of loading, 3D fracture criteria cannot be properly evaluated, but these assumptions seem reasonable.

Selective perceptions of hydraulic fracturing.

PubMed

Sarge, Melanie A; VanDyke, Matthew S; King, Andy J; White, Shawna R

2015-01-01

Hydraulic fracturing (HF) is a focal topic in discussions about domestic energy production, yet the American public is largely unfamiliar and undecided about the practice. This study sheds light on how individuals may come to understand hydraulic fracturing as this unconventional production technology becomes more prominent in the United States. For the study, a thorough search of HF photographs was performed, and a systematic evaluation of 40 images using an online experimental design involving N = 250 participants was conducted. Key indicators of hydraulic fracturing support and beliefs were identified. Participants showed diversity in their support for the practice, with 47 percent expressing low support, 22 percent high support, and 31 percent undecided. Support for HF was positively associated with beliefs that hydraulic fracturing is primarily an economic issue and negatively associated with beliefs that it is an environmental issue. Level of support was also investigated as a perceptual filter that facilitates biased issue perceptions and affective evaluations of economic benefit and environmental cost frames presented in visual content of hydraulic fracturing. Results suggested an interactive relationship between visual framing and level of support, pointing to a substantial barrier to common understanding about the issue that strategic communicators should consider.

Quantitative MR imaging in fracture dating--Initial results.

PubMed

Baron, Katharina; Neumayer, Bernhard; Widek, Thomas; Schick, Fritz; Scheicher, Sylvia; Hassler, Eva; Scheurer, Eva

2016-04-01

For exact age determinations of bone fractures in a forensic context (e.g. in cases of child abuse) improved knowledge of the time course of the healing process and use of non-invasive modern imaging technology is of high importance. To date, fracture dating is based on radiographic methods by determining the callus status and thereby relying on an expert's experience. As a novel approach, this study aims to investigate the applicability of magnetic resonance imaging (MRI) for bone fracture dating by systematically investigating time-resolved changes in quantitative MR characteristics after a fracture event. Prior to investigating fracture healing in children, adults were examined for this study in order to test the methodology for this application. Altogether, 31 MR examinations in 17 subjects (♀: 11 ♂: 6; median age 34 ± 15 y, scanned 1-5 times over a period of up to 200 days after the fracture event) were performed on a clinical 3T MR scanner (TimTrio, Siemens AG, Germany). All subjects were treated conservatively for a fracture in either a long bone or in the collar bone. Both, qualitative and quantitative MR measurements were performed in all subjects. MR sequences for a quantitative measurement of relaxation times T1 and T2 in the fracture gap and musculature were applied. Maps of quantitative MR parameters T1, T2, and magnetisation transfer ratio (MTR) were calculated and evaluated by investigating changes over time in the fractured area by defined ROIs. Additionally, muscle areas were examined as reference regions to validate this approach. Quantitative evaluation of 23 MR data sets (12 test subjects, ♀: 7 ♂: 5) showed an initial peak in T1 values in the fractured area (T1=1895 ± 607 ms), which decreased over time to a value of 1094 ± 182 ms (200 days after the fracture event). T2 values also peaked for early-stage fractures (T2=115 ± 80 ms) and decreased to 73 ± 33 ms within 21 days after the fracture event. After that time point, no significant changes could be detected for T2. MTR remained constant at 35.5 ± 8.0% over time. The study shows that the quantitative assessment of T1 and T2 behaviour over time in the fractured region enable the generation of a novel model allowing for an objective age determination of a fracture. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of the Edge Crack Torsion (ECT) Test for Mode 3 Interlaminar Fracture Toughness of Laminated Composites

NASA Technical Reports Server (NTRS)

Li, Jian; Lee, Edward W.; OBrien, T. Kevin; Lee, Shaw Ming

1996-01-01

An analytical and experimental investigation was carried out on G40-800/R6376 graphite epoxy laminates to evaluate the Edge Crack Torsion (ECT) test as a candidate for a standard Mode 3 interlaminar fracture toughness test for laminated composites. The ECT test consists of a (90/(+/- 45)(sub 3)/(+/- 45)(sub 3)/90))(sub s) laminate with a delamination introduced by a non-adhesive film at the mid-plane along one edge and loaded in a special fixture to create torsion along the length of the laminate. Dye penetrate enhanced X-radiograph of failed specimens revealed that the delamination initiated at the middle of the specimen length and propagated in a self similar manner along the laminate mid-plane. A three-dimensional finite element analysis was performed that indicated that a pure Mode 3 delamination exists at the middle of specimen length away from both ends. At the ends near the loading point a small Mode 2 component exists. However, the magnitude of this Mode 2 strain energy release rate at the loading point is small compared to the magnitude of Mode 3 component in the mid-section of the specimen. Hence, the ECT test yielded the desired Mode 3 delamination. The Mode 3 fracture toughness was obtained from a compliance calibration method and was in good agreement with the finite element results. Mode 2 End-Notched Flexure (ENF) tests and Mode 1 Double Cantilever Beam (DCB) tests were also performed for the same composite material. The Mode 1 fracture toughness was much smaller than both the Mode 2 and Mode 3 fracture toughness. The Mode 2 fracture toughness was found to be 75% of the Mode 3 fracture toughness.

Evaluation of hip fracture risk factors in older adults in the Lebanese population.

PubMed

Bawab, Wafa; Saad, Mohamad; Hajjar, Nour; Rachidi, Samar; Al Hajje, Amal; Awada, Sanaa; Salameh, Pascale

2014-01-01

Hip fractures are serious fall injuries that often result in long-term functional impairment and increased mortality. As the population ages, the number of hip fractures is likely to increase worldwide. The main objective of this pilot study was to evaluate the risk factors of hip fracture among the older adults in the Lebanese population. This pilot epidemiological, prospective, and case-control study was performed in 6 hospitals in Great Beirut and South Lebanon. Subjects who met the inclusion criteria filled out a questionnaire consisting on the socio- demographic characteristics, health status, drugs intake and cigarette smoking. Overall, 195 subjects were recruited, with 65 cases of hip fracture and 130 controls all aged over 50 yr. Females represented around two third of the studied population. The logistic regression, using adjusted odds ratio (ORa), showed a significant relationship between hip fracture and chronic diseases (ORa=3.02; 95% CI: 1.63, 6.66), antihypertensive drugs intake (ORa=2.72; 95% CI: 1.56, 6.42), fall (ORa=2.79; 95% CI: 1.82, 7.06) previous fracture (ORa=3.80; 95% CI: 1.57, 9.23) and family history of fracture (ORa=4.82; 95% CI: (2.29, 10.86). Besides, smoking increased the risk of hip fracture (ORa=2.55; 95% CI: (1.96, 5.80). Having a bow was associated with the highest risk for hip fracture (ORa=5.18; 95% CI: 2.30, 12.24). Elderly people in Lebanon are exposed to many risk factors contributing to hip fracture. Our finding has implication in geriatric health improvement by preventing hip fracture in the Lebanese population.

Treatment of Pediatric Condylar Fractures: A 20-Year Experience.

PubMed

Ghasemzadeh, Ali; Mundinger, Gerhard S; Swanson, Edward W; Utria, Alan F; Dorafshar, Amir H

2015-12-01

The purpose of this study was to define patterns of injury and treatment for condylar and subcondylar fractures and evaluate short-term outcomes in the pediatric population. A retrospective chart review was performed on pediatric patients with mandibular condylar fractures who presented between 1990 and 2010. Computed tomographic imaging was reviewed for all patients to assess fracture characteristics. Mandibular fractures were codified using the Strasbourg Osteosynthesis Research Group and Lindahl classification methods. Sixty-four patients with 92 condylar fractures were identified. Of these patients, 29 had isolated condylar fracture and 35 had a condylar fracture associated with an additional mandibular arch fracture. The most common fracture patterns were diacapitular fracture in the Strasbourg Osteosynthesis Research Group system (n = 46) and vertical condylar head fracture in the Lindahl system (n = 14). Condylar fracture with additional mandibular arch fractures were treated with maxillomandibular fixation more often than patients with condylar fracture [n = 40 (74.1 percent) versus n = 14 (25.9 percent); p = 0.004]. No condylar fracture was treated in an open fashion. Forty-three patients returned for follow-up. The median follow-up period was 81 days (interquartile range, 35 to 294 days). Ten patients had complications (23.3 percent). The most common complication was malocclusion (n = 5). Nine of 10 patients with complications had condylar fracture with an additional mandibular arch fracture. Closed treatment of condylar fractures yields satisfactory results in pediatric patients. Pediatric patients with condylar fractures combined with additional arch fractures experience a higher rate of unfavorable outcomes.

A short-term clinical evaluation of IPS Empress 2 crowns.

PubMed

Toksavul, Suna; Toman, Muhittin

2007-01-01

The aim of this study was to evaluate the clinical performance of all-ceramic crowns made with the IPS Empress 2 system after an observation period of 12 to 60 months. Seventy-nine IPS Empress 2 crowns were placed in 21 patients. The all-ceramic crowns were evaluated clinically, radiographically, and using clinical photographs. The evaluations took place at baseline (2 days after cementation) and at 6-month intervals for 12 to 60 months. Survival rate of the crowns was determined using Kaplan-Meier statistical analysis. Based on the US Public Health Service criteria, 95.24% of the crowns were rated satisfactory after a mean follow-up period of 58 months. Fracture was registered in only 1 crown. One endodontically treated tooth failed as a result of fracture at the cervical margin area. In this in vivo study, IPS Empress 2 crowns exhibited a satisfactory clinical performance during an observation period ranging from 12 to 60 months.

Effect of Reinforcement Architecture on Fracture of Selectively Reinforced Metallic Compact Tension Specimens

NASA Technical Reports Server (NTRS)

Abada, Christopher H.; Farley, Gary L.; Hyer, Michael W.

2006-01-01

A computer-based parametric study of the effect of reinforcement architectures on fracture response of aluminum compact-tension (CT) specimens is performed. Eleven different reinforcement architectures consisting of rectangular and triangular cross-section reinforcements were evaluated. Reinforced specimens produced between 13 and 28 percent higher fracture load than achieved with the non-reinforced case. Reinforcements with blunt leading edges (rectangular reinforcements) exhibited superior performance relative to the triangular reinforcements with sharp leading edges. Relative to the rectangular reinforcements, the most important architectural feature was reinforcement thickness. At failure, the reinforcements carried between 58 and 85 percent of the load applied to the specimen, suggesting that there is considerable load transfer between the base material and the reinforcement.

An efficient case finding strategy to diagnose osteoporosis in a developing society with low treatment frequency.

PubMed

Sørensen, Vibeke Neergaard; Wojtek, Piotr; Pedersen, Dorthe S; Andersen, Stig

2015-08-01

Osteoporosis is a debilitating condition with rising frequency of fragility fractures with advancing age. Life expectancy increases in developing societies with the emergence of osteoporosis. There is a need for a simple protocol to diagnose fractures that merit treatment for osteoporosis. Evaluation of all consecutive lateral chest radiographs performed at the National Hospital in the capital city in Greenland over a 3-month period for vertebral body heights at the anterior, middle and posterior regions. Use of anti-osteoporotic drug was evaluated from records of dispensed drugs from Greenland National Pharmacy. 1869 vertebrae were evaluated on radiographs from 203 subjects. On average 9.2 vertebrae (range 5-13) qualified for evaluation in each individual. Median (range) age was 55 (30-82) years. Any vertebral deformity above 25 (20) % was seen in 28.6 (50.2) %. More than one fracture was seen in 10.3 (27.1) %. Fractures occurred in 18.5 (36.9) % of patients from the General Medicine Clinic and in 33.3 (56.5) % of inpatients (p = 0.029). The occurrence of vertebral fractures increased with age (p < 0.001) and hosting more than one vertebral fracture was markedly more frequent after the age of 60 years [OR, 95 % CI 9.6, 3.1-30 (5.7, 2.9-11); p < 0.001] after correction for gender in logistic regressions. The National Pharmacy handed out anti-osteoporotic drugs equal to the treatment of 36 individuals. Vertebral fractures that merit treatment can be readily diagnosed from lateral chest radiographs taken in routine clinical work-up. They are common in Greenland as demonstrated by this simple protocol to improve diagnosis and treatment of osteoporosis in a developing society.

Inclusion of Topological Measurements into Analytic Estimates of Effective Permeability in Fractured Media

NASA Astrophysics Data System (ADS)

Sævik, P. N.; Nixon, C. W.

2017-11-01

We demonstrate how topology-based measures of connectivity can be used to improve analytical estimates of effective permeability in 2-D fracture networks, which is one of the key parameters necessary for fluid flow simulations at the reservoir scale. Existing methods in this field usually compute fracture connectivity using the average fracture length. This approach is valid for ideally shaped, randomly distributed fractures, but is not immediately applicable to natural fracture networks. In particular, natural networks tend to be more connected than randomly positioned fractures of comparable lengths, since natural fractures often terminate in each other. The proposed topological connectivity measure is based on the number of intersections and fracture terminations per sampling area, which for statistically stationary networks can be obtained directly from limited outcrop exposures. To evaluate the method, numerical permeability upscaling was performed on a large number of synthetic and natural fracture networks, with varying topology and geometry. The proposed method was seen to provide much more reliable permeability estimates than the length-based approach, across a wide range of fracture patterns. We summarize our results in a single, explicit formula for the effective permeability.

Role of Ankle Arthroscopy in Management of Acute Ankle Fracture.

PubMed

Chan, Kwok Bill; Lui, Tun Hing

2016-11-01

To report the operative findings of ankle arthroscopy during open reduction and internal fixation of acute ankle fractures. This was a retrospective review of 254 consecutive patients with acute ankle fractures who were treated with open reduction and internal fixation of the fractures, and ankle arthroscopy was performed at the same time. The accuracy of fracture reduction, the presence of syndesmosis disruption and its reduction, and the presence of ligamentous injuries and osteochondral lesions were documented. Second-look ankle arthroscopy was performed during syndesmosis screw removal 6 weeks after the key operation. There were 6 patients with Weber A, 177 patients with Weber B, 51 patients with Weber C, and 20 patients with isolated medial malleolar fractures. Syndesmosis disruption was present in 0% of patients with Weber A fracture, 52% of patients with Weber B fracture, 92% of patients with Weber C fracture, and 20% of the patients with isolated medial malleolar fracture. Three patients with Weber B and one patient with Weber C fracture have occult syndesmosis instability after screw removal. Osteochondral lesion was present in no patient with Weber A fracture, 26% of the Weber B cases, 24% of the Weber C cases, and 20% of isolated medial malleolar fracture cases. The association between the presence of deep deltoid ligament tear and syndesmosis disruption (warranting syndesmosis screw fixation) in Weber B cases was statistically significant but not in Weber C cases. There was no statistically significant association between the presence of posterior malleolar fracture and syndesmosis instability that warrant screw fixation. Ankle arthroscopy is a useful adjuvant tool to understand the severity and complexity of acute ankle fracture. Direct arthroscopic visualization ensures detection and evaluation of intra-articular fractures, syndesmosis disruption, and associated osteochondral lesions and ligamentous injuries. Level IV, case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Acoustic emission characterization of microcracking in laboratory-scale hydraulic fracturing tests

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hampton, Jesse; Gutierrez, Marte; Matzar, Luis

Understanding microcracking near coalesced fracture generation is critically important for hydrocarbon and geothermal reservoir characterization as well as damage evaluation in civil engineering structures. Dense and sometimes random microcracking near coalesced fracture formation alters the mechanical properties of the nearby virgin material. Individual microcrack characterization is also significant in quantifying the material changes near the fracture faces (i.e. damage). Acoustic emission (AE) monitoring and analysis provide unique information regarding the microcracking process temporally, and information concerning the source characterization of individual microcracks can be extracted. In this context, laboratory hydraulic fracture tests were carried out while monitoring the AEs frommore » several piezoelectric transducers. In-depth post-processing of the AE event data was performed for the purpose of understanding the individual source mechanisms. Several source characterization techniques including moment tensor inversion, event parametric analysis, and volumetric deformation analysis were adopted. Post-test fracture characterization through coring, slicing and micro-computed tomographic imaging was performed to determine the coalesced fracture location and structure. Distinct differences in fracture characteristics were found spatially in relation to the openhole injection interval. Individual microcrack AE analysis showed substantial energy reduction emanating spatially from the injection interval. Lastly, it was quantitatively observed that the recorded AE signals provided sufficient information to generalize the damage radiating spatially away from the injection wellbore.« less

Acoustic emission characterization of microcracking in laboratory-scale hydraulic fracturing tests

DOE PAGES

Hampton, Jesse; Gutierrez, Marte; Matzar, Luis; ...

2018-06-11

Understanding microcracking near coalesced fracture generation is critically important for hydrocarbon and geothermal reservoir characterization as well as damage evaluation in civil engineering structures. Dense and sometimes random microcracking near coalesced fracture formation alters the mechanical properties of the nearby virgin material. Individual microcrack characterization is also significant in quantifying the material changes near the fracture faces (i.e. damage). Acoustic emission (AE) monitoring and analysis provide unique information regarding the microcracking process temporally, and information concerning the source characterization of individual microcracks can be extracted. In this context, laboratory hydraulic fracture tests were carried out while monitoring the AEs frommore » several piezoelectric transducers. In-depth post-processing of the AE event data was performed for the purpose of understanding the individual source mechanisms. Several source characterization techniques including moment tensor inversion, event parametric analysis, and volumetric deformation analysis were adopted. Post-test fracture characterization through coring, slicing and micro-computed tomographic imaging was performed to determine the coalesced fracture location and structure. Distinct differences in fracture characteristics were found spatially in relation to the openhole injection interval. Individual microcrack AE analysis showed substantial energy reduction emanating spatially from the injection interval. Lastly, it was quantitatively observed that the recorded AE signals provided sufficient information to generalize the damage radiating spatially away from the injection wellbore.« less

Fracture stimulation treatment design optimization: What can the NPV vs X{sub f} plot tell us?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huffman, C.H.; Harkrider, J.D.; Thompson, R.S.

1996-12-31

Fracture stimulation production response coupled with the hydrocarbon sales price determines the value of a fracture stimulation treatment. Many factors can significantly effect the production response of a fracture stimulated well. Some examples include stimulation fluid selection, proppant selection, pumping rates, rock properties, reservoir fluid properties, in-situ stresses, stress variations, on-site execution, post-treatment stimulation fluid recovery, and operating practices. The production response in economic terms portrays the net effect of these variables. This paper presents a case study that demonstrates how post-treatment evaluations expressed in economic terms can be used to assess the performance of stimulations and to guide futuremore » design choices.« less

Usefulness of color Doppler sonography in a growing skull fracture: case report.

PubMed

Yoshioka, H; Sakoda, K; Kohno, H; Hada, H; Kurisu, K

1997-01-01

A case of an 11-month-old infant with a growing skull fracture is described. The patient was admitted with disturbance of consciousness and left hemiparesis after a severe head injury. A pulsating protrusion appeared over the fracture line 1 month later. Color Doppler sonography revealed cerebral herniation and cystic lesion via the bony defect, together with an intracranial arterial flow pattern detected in the extracranial space. Color Doppler sonography was very useful in the diagnosis of growing skull fracture and in the evaluation of the intracranial state, including hemodynamics in this case. Successful surgical treatment was performed on the basis of sonographic data and the patient was discharged 3 months later without motor deficits.

Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures.

PubMed

Liu, W; Xiao, J; Ji, F; Xie, Y; Hao, Y

2015-04-01

The optimal treatment of midshaft clavicle fractures remains controversial. Nonunion is usually considered to be an uncommon complication following a nonoperatively treated clavicle fracture. Not every midshaft clavicular fractures shares the same risk of developing nonunion after nonoperative treatment. The present study was performed to identify the intrinsic and extrinsic independent factors that are independently predictive of nonunion in patients with midshaft clavicular fractures after nonoperative treatment. We performed a retrospective study of a series of 804 patients (391 men and 413 women with a median age of 51.3 years) with a radiographically confirmed midshaft clavicle fracture, which was treated nonoperatively. There were 96 patients who underwent nonunion. Putative intrinsic (patient-related) and extrinsic (injured-related) risk factors associated with nonunion were determined with the use of bivariate and multivariate statistical analyses. By bivariate analysis, the risk of nonunion was significantly increased by several intrinsic risk factors including age, sex, and smoking and extrinsic risk factors including displacement of the fracture and the presence of comminution (P<0.05 for all). On multivariate analysis, smoking (OR=4.16, 95% CI: 1.01-14.16), fracture displacement (OR=7.81, 95% CI: 2.27-25.38) and comminution of fracture (OR=3.86, 95% CI: 1.16-13.46) were identified as independent predictive factors. The risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures are multifactorial. Smoking, fracture displacement and comminution of fracture are independent predictors for an individual likelihood of nonunion. Further studies are still required to evaluate these factors in the future. Level III, case-control study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Early Experience with Biodegradable Fixation of Pediatric Mandibular Fractures.

PubMed

Mazeed, Ahmed Salah; Shoeib, Mohammed Abdel-Raheem; Saied, Samia Mohammed Ahmed; Elsherbiny, Ahmed

2015-09-01

This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-l/dl-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3-12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact.

Development of stimulation diagnostic technology. Annual report, May 1990--December 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warpinski, N.R.; Lorenz, J.C.

The objective of this project is to apply Sandia`s expertise and technology towards the development of stimulation diagnostic technology in the areas of in situ stress, natural fracturing, stimulation processes and instrumentation systems. Initial work has concentrated on experiment planning for a site where hydraulic fracturing could be evaluated and design models and fracture diagnostics could be validated and improved. Important issues have been defined and new diagnostics, such as inclinometers, identified. In the area of in situ stress, circumferential velocity analysis is proving to be a useful diagnostic for stress orientation. Natural fracture studies of the Frontier formation aremore » progressing; two fracture sets have been found and their relation to tectonic events have been hypothesized. Analyses of stimulation data have been performed for several sites, primarily for in situ stress information. Some new ideas in stimulation diagnostics have been proposed; these ideas may significantly improve fracture diagnostic capabilities.« less

Development of stimulation diagnostic technology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warpinski, N.R.; Lorenz, J.C.

The objective of this project is to apply Sandia's expertise and technology towards the development of stimulation diagnostic technology in the areas of in situ stress, natural fracturing, stimulation processes and instrumentation systems. Initial work has concentrated on experiment planning for a site where hydraulic fracturing could be evaluated and design models and fracture diagnostics could be validated and improved. Important issues have been defined and new diagnostics, such as inclinometers, identified. In the area of in situ stress, circumferential velocity analysis is proving to be a useful diagnostic for stress orientation. Natural fracture studies of the Frontier formation aremore » progressing; two fracture sets have been found and their relation to tectonic events have been hypothesized. Analyses of stimulation data have been performed for several sites, primarily for in situ stress information. Some new ideas in stimulation diagnostics have been proposed; these ideas may significantly improve fracture diagnostic capabilities.« less

Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment

PubMed Central

Lee, Jong-Sung; Jeon, Eun-Gyu; Seol, Guk-Jin; Choi, So-Young; Kim, Jin-Wook; Kwon, Tae-Geon; Paeng, Jun-Young

2014-01-01

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases. PMID:27489844

A new approach to the treatment of nasal bone fracture: radiologic classification of nasal bone fractures and its clinical application.

PubMed

Han, Daniel Seung Youl; Han, Yea Sik; Park, Jin Hyung

2011-11-01

A radiologic examination is required in the treatment of nasal bone fracture to determine the fracture condition. Thus, there is an increasing need for radiologic classification of nasal bone fractures that can be applied to clinical practice. Computed tomography was performed in 125 patients with nasal bone fractures to determine which axial view best showed the entire nasal view. The obtained axial view was then used as a reference for classification. The length from the top to the base of the nasal bone was divided into upper, middle, and lower levels, after which the fracture location was determined. If the fracture spanned the boundaries of these levels, it was classified as the total level. Subsequently, the fracture was subclassified based on the fracture direction and pattern and the concurrent fracture. Radiologic examination of patients with nasal bone fracture showed that nasal bone fracture was frequently found at the total, middle, upper, and lower levels, in that order. Nasal bone fractures at the upper level showed lower frequencies of complication and reoperation than the fractures at the other levels, whereas nasal bone fractures at the total level showed the highest frequencies of complication and reoperation. Radiologic classification can be useful for preoperative and postoperative evaluations of nasal bone fractures and can be helpful in understanding such fractures because it can efficiently predict the prognosis of a fracture. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction☆

PubMed Central

Machado, Daniel Gonçalves; da Cruz Cerqueira, Sergio Auto; de Lima, Alexandre Fernandes; de Mathias, Marcelo Bezerra; Aramburu, José Paulo Gabbi; Rodarte, Rodrigo Ribeiro Pinho

2016-01-01

Objective The objective of this study was to evaluate the current classifications for fractures of the distal extremity of the radius, since the classifications made using traditional radiographs in anteroposterior and lateral views have been questioned regarding their reproducibility. In the literature, it has been suggested that other options are needed, such as use of preoperative radiographs on fractures of the distal radius subjected to traction, with stratification by the evaluators. The aim was to demonstrate which classification systems present better statistical reliability. Results In the Universal classification, the results from the third-year resident group (R3) and from the group of more experienced evaluators (Staff) presented excellent correlation, with a statistically significant p-value (p < 0.05). Neither of the groups presented a statistically significant result through the Frykman classification. In the AO classification, there were high correlations in the R3 and Staff groups (respectively 0.950 and 0.800), with p-values lower than 0.05 (respectively <0.001 and 0.003). Conclusion It can be concluded that radiographs performed under traction showed good concordance in the Staff group and in the R3 group, and that this is a good tactic for radiographic evaluations of fractures of the distal extremity of the radius. PMID:26962498

ADDITIONAL STRESS AND FRACTURE MECHANICS ANALYSES OF PRESSURIZED WATER REACTOR PRESSURE VESSEL NOZZLES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walter, Matthew; Yin, Shengjun; Stevens, Gary

2012-01-01

In past years, the authors have undertaken various studies of nozzles in both boiling water reactors (BWRs) and pressurized water reactors (PWRs) located in the reactor pressure vessel (RPV) adjacent to the core beltline region. Those studies described stress and fracture mechanics analyses performed to assess various RPV nozzle geometries, which were selected based on their proximity to the core beltline region, i.e., those nozzle configurations that are located close enough to the core region such that they may receive sufficient fluence prior to end-of-life (EOL) to require evaluation of embrittlement as part of the RPV analyses associated with pressure-temperaturemore » (P-T) limits. In this paper, additional stress and fracture analyses are summarized that were performed for additional PWR nozzles with the following objectives: To expand the population of PWR nozzle configurations evaluated, which was limited in the previous work to just two nozzles (one inlet and one outlet nozzle). To model and understand differences in stress results obtained for an internal pressure load case using a two-dimensional (2-D) axi-symmetric finite element model (FEM) vs. a three-dimensional (3-D) FEM for these PWR nozzles. In particular, the ovalization (stress concentration) effect of two intersecting cylinders, which is typical of RPV nozzle configurations, was investigated. To investigate the applicability of previously recommended linear elastic fracture mechanics (LEFM) hand solutions for calculating the Mode I stress intensity factor for a postulated nozzle corner crack for pressure loading for these PWR nozzles. These analyses were performed to further expand earlier work completed to support potential revision and refinement of Title 10 to the U.S. Code of Federal Regulations (CFR), Part 50, Appendix G, Fracture Toughness Requirements, and are intended to supplement similar evaluation of nozzles presented at the 2008, 2009, and 2011 Pressure Vessels and Piping (PVP) Conferences. This work is also relevant to the ongoing efforts of the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel (B&PV) Code, Section XI, Working Group on Operating Plant Criteria (WGOPC) efforts to incorporate nozzle fracture mechanics solutions into a revision to ASME B&PV Code, Section XI, Nonmandatory Appendix G.« less

Evaluation of fracture toughness and mechanical properties of ternary thiol-ene-methacrylate systems as resin matrix for dental restorative composites.

PubMed

Beigi, Saeed; Yeganeh, Hamid; Atai, Mohammad

2013-07-01

Study and evaluation of fracture toughness, flexural and dynamic mechanical properties, and crosslink density of ternary thiol-ene-methacrylate systems and comparison with corresponding conventional methacrylate system were considered in the present study. Urethane tetra allyl ether monomer (UTAE) was synthesized as ene monomer. Different formulations were prepared based on combination of UTAE, BisGMA/TEGDMA and a tetrathiol monomer (PETMP). The photocuring reaction was conducted under visible light using BD/CQ combination as photoinitiator system. Mechanical properties were evaluated via measuring flexural strength, flexural modulus and fracture toughness. Scanning electron microscopy (SEM) was utilized to study the morphology of the fractured specimen's cross section. Viscoelastic properties of the samples were also determined by dynamic mechanical thermal analysis (DMTA). The same study was performed on a conventional methacrylate system. The data were analyzed and compared by ANOVA and Tukey HSD tests (significance level=0.05). The results showed improvement in fracture toughness of the specimens containing thiol-ene moieties. DMTA revealed a lower glass transition temperature and more homogenous structure for thiol-ene containing specimens in comparison to the system containing merely methacrylate monomer. The flexural modulus and flexural strength of the specimens with higher thiol-ene content were lower than the neat methacrylate system. The SEM micrographs of the fractured surface of specimens with higher methacrylate content were smooth and mirror-like (shiny) which represent brittle fracture. The thiol-ene-methacrylate system can be used as resin matrix of dental composites with enhanced fracture toughness in comparison to the methacrylate analogous. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Methods for assessing fracture risk prediction models: experience with FRAX in a large integrated health care delivery system.

PubMed

Pressman, Alice R; Lo, Joan C; Chandra, Malini; Ettinger, Bruce

2011-01-01

Area under the receiver operating characteristics (AUROC) curve is often used to evaluate risk models. However, reclassification tests provide an alternative assessment of model performance. We performed both evaluations on results from FRAX (World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK), a fracture risk tool, using Kaiser Permanente Northern California women older than 50yr with bone mineral density (BMD) measured during 1997-2003. We compared FRAX performance with and without BMD in the model. Among 94,489 women with mean follow-up of 6.6yr, 1579 (1.7%) sustained a hip fracture. Overall, AUROCs were 0.83 and 0.84 for FRAX without and with BMD, suggesting that BMD did not contribute to model performance. AUROC decreased with increasing age, and BMD contributed significantly to higher AUROC among those aged 70yr and older. Using an 81% sensitivity threshold (optimum level from receiver operating characteristic curve, corresponding to 1.2% cutoff), 35% of those categorized above were reassigned below when BMD was added. In contrast, only 10% of those categorized below were reassigned to the higher risk category when BMD was added. The net reclassification improvement was 5.5% (p<0.01). Two versions of this risk tool have similar AUROCs, but alternative assessments indicate that addition of BMD improves performance. Multiple methods should be used to evaluate risk tool performance with less reliance on AUROC alone. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Prediction and Monitoring Systems of Creep-Fracture Behavior of 9Cr-1Mo Steels for Teactor Pressure Vessels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Potirniche, Gabriel; Barlow, Fred D.; Charit, Indrajit

2013-11-26

A recent workshop on next-generation nuclear plant (NGNP) topics underscored the need for research studies on the creep fracture behavior of two materials under consideration for reactor pressure vessel (RPV) applications: 9Cr-1Mo and SA-5XX steels. This research project will provide a fundamental understanding of creep fracture behavior of modified 9Cr-1Mo steel welds for through modeling and experimentation and will recommend a design for an RPV structural health monitoring system. Following are the specific objectives of this research project: Characterize metallurgical degradation in welded modified 9Cr-1Mo steel resulting from aging processes and creep service conditions; Perform creep tests and characterize themore » mechanisms of creep fracture process; Quantify how the microstructure degradation controls the creep strength of welded steel specimens; Perform finite element (FE) simulations using polycrystal plasticity to understand how grain texture affects the creep fracture properties of welds; Develop a microstructure-based creep fracture model to estimate RPVs service life; Manufacture small, prototypic, cylindrical pressure vessels, subject them to degradation by aging, and measure their leak rates; Simulate damage evolution in creep specimens by FE analyses; Develop a model that correlates gas leak rates from welded pressure vessels with the amount of microstructural damage; Perform large-scale FE simulations with a realistic microstructure to evaluate RPV performance at elevated temperatures and creep strength; Develop a fracture model for the structural integrity of RPVs subjected to creep loads; and Develop a plan for a non-destructive structural health monitoring technique and damage detection device for RPVs.« less

Damage Tolerance Assessment Branch

NASA Technical Reports Server (NTRS)

Walker, James L.

2013-01-01

The Damage Tolerance Assessment Branch evaluates the ability of a structure to perform reliably throughout its service life in the presence of a defect, crack, or other form of damage. Such assessment is fundamental to the use of structural materials and requires an integral blend of materials engineering, fracture testing and analysis, and nondestructive evaluation. The vision of the Branch is to increase the safety of manned space flight by improving the fracture control and the associated nondestructive evaluation processes through development and application of standards, guidelines, advanced test and analytical methods. The Branch also strives to assist and solve non-aerospace related NDE and damage tolerance problems, providing consultation, prototyping and inspection services.

Isolated displaced non-union of a triquetral body fracture: a case report

PubMed Central

2012-01-01

Introduction Fractures of the body of the triquetral bone are the second most common carpal fractures, and these fractures can be missed on plain X-ray. Although non-union of triquetral body fractures is very rare, such cases are associated with considerable morbidity and reduction in functional activity. Case presentation We report the case of a 29-year-old Caucasian British man who sustained an isolated displaced triquetral body fracture that resulted in non-union, who was treated surgically. We describe an original operative management for this debilitating injury. An open reduction and internal fixation using double headed compression screws was performed, without bone grafting, and with early immobilization of the wrist. Conclusions We propose this novel approach and advocate early clinical suspicion of triquetral body fractures in patients with a history of fall on an outstretched hand and ulnar sided wrist pain. We recommend evaluation using computed tomography or magnetic resonance imaging scanning. PMID:22325450

Optical method of caustics applied in viscoelastic fracture analysis

NASA Astrophysics Data System (ADS)

Gao, Guiyun; Li, Zheng; Xu, Jie

2011-05-01

The optical method of caustics is developed here to study the fracture of viscoelastic materials. By adopting a distribution of viscoelastic stress fields near the crack tip, the method of caustics is used to determine the viscoelastic fracture parameters from the caustic patterns near the crack tip. Two viscoelastic materials are studied. These are PMMA and ternary composites of HDPE/POE-g-MA/CaCO 3. The transmitted and reflective methods of caustics are performed separately to investigate viscoelastic fracture behaviors. The stress intensity factors (SIFs) versus time is determined by a series of shadow spot patterns combined with viscoelastic parameters evaluated by creep tests. In order to understand the viscoelastic fracture mechanisms of HDPE/POE-g-MA/CaCO 3 composites, their fracture surfaces are observed by a Scanning Electron Microscope (SEM). The results indicate that the method of caustics can be used to characterize the fracture behaviors of viscoelastic materials and further to optimize the design of polymer composites.

Upper-limb motor and sensory function in patients with hip fracture: Comparison with community-dwelling older adults.

PubMed

Hayashi, Hiroyuki; Nakashima, Daiki; Matsuoka, Hiroka; Iwai, Midori; Nakamura, Shugo; Kubo, Ayumi; Tomiyama, Naoki

2017-11-06

Upper-limb function is important in patients with hip fracture so they can perform activities of daily living and participate in leisure activities. Upper-limb function of these patients, however, has not been thoroughly investigated. The aim of this study was to evaluate the upper-limb motor and sensory functions in patients with hip fracture by comparing these functions with those of community-dwelling older adults (control group). We compared the results of motor and sensory function tests of upper-limb function - range of motion, strength, sensibility, finger dexterity, comprehensive hand function - between patients with hip fracture (n= 32) and the control group (n= 32). Patients with hip fracture had significantly reduced grip strength, pinch strength, finger dexterity, and comprehensive hand function compared with the control group. Most upper-limb functions are impaired in the patients with hip fracture. Thus, upper-limb function of patients with hip fracture should be considered during treatment.

Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension?

PubMed

Beytemür, Ozan; Albay, Cem; Adanır, Oktay; Yüksel, Serdar; Güleç, Mehmet Akif

2016-12-01

This study aims to evaluate the functional and radiographic results and treatment complications of AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) type 43C1 and C2 fractures treated with intramedullary nailing. We retrospectively evaluated 35 AO/OTA type 43C1 and C2 patients (26 males, 9 females; mean age 39.8±16.9 years; range 19 to 82 years) treated with intramedullary nailing. Two interfragmentary screws out of nail were applied in 10 patients (29%), while one interfragmentary screw out of nail was applied in 17 patients (49%). Intramedullary nailing was applied in eight patients (23%) without external screws. Fracture union, union time, alignment problems, and complications were evaluated. Clinical evaluation of patients was conducted using the Olerud and Molander score and by measuring the ankle joint range of motion. Union was achieved in all 35 patients. Mean union time was 16.5±2.8 weeks (range 12 to 24 weeks) and mean Olerud and Molander score was 88±8.24. Varus deformity was detected in one patient, valgus deformity was detected in two patients, and rotation deformity was detected in one patient. Superficial infection was detected in three patients (9%). Deep infection was not detected in any patient. Intramedullary nailing is not contraindicated for simple intra-articular distal tibial fractures. In these fractures, intramedullary nailing performed in accordance with its technique, with an additional percutaneous screw if necessary, is a successful treatment option with high fracture union rates, high functional results, and low complication rates.

Central tarsal bone fractures in horses not used for racing: Computed tomographic configuration and long-term outcome of lag screw fixation.

PubMed

Gunst, S; Del Chicca, F; Fürst, A E; Kuemmerle, J M

2016-09-01

There are no reports on the configuration of equine central tarsal bone fractures based on cross-sectional imaging and clinical and radiographic long-term outcome after internal fixation. To report clinical, radiographic and computed tomographic findings of equine central tarsal bone fractures and to evaluate the long-term outcome of internal fixation. Retrospective case series. All horses diagnosed with a central tarsal bone fracture at our institution in 2009-2013 were included. Computed tomography and internal fixation using lag screw technique was performed in all patients. Medical records and diagnostic images were reviewed retrospectively. A clinical and radiographic follow-up examination was performed at least 1 year post operatively. A central tarsal bone fracture was diagnosed in 6 horses. Five were Warmbloods used for showjumping and one was a Quarter Horse used for reining. All horses had sagittal slab fractures that began dorsally, ran in a plantar or plantaromedial direction and exited the plantar cortex at the plantar or plantaromedial indentation of the central tarsal bone. Marked sclerosis of the central tarsal bone was diagnosed in all patients. At long-term follow-up, 5/6 horses were sound and used as intended although mild osteophyte formation at the distal intertarsal joint was commonly observed. Central tarsal bone fractures in nonracehorses had a distinct configuration but radiographically subtle additional fracture lines can occur. A chronic stress related aetiology seems likely. Internal fixation of these fractures based on an accurate diagnosis of the individual fracture configuration resulted in a very good prognosis. © 2015 EVJ Ltd.

Hip arthroscopy using the lateral approach.

PubMed

Glick, J M

1988-01-01

The benefits of hip arthroscopy are apparent. It produces little postoperative morbidity and can be performed on an outpatient basis. The prompt recovery from the operation is also beneficial, particularly for elderly patients. Distraction of the hip by traction on a fracture table is necessary. Suggested indications for this procedure include synovectomy and synovial biopsy; removal of loose bodies; removal of debris after a closed reduction of a fracture-dislocation; evaluation and treatment of osteochondritis dissecans; evaluation for arthroplasty; and unresolved hip pain. Whether the lateral approach is useful in the following situations is yet to be explored: (1) Evaluation of pediatric conditions such as Legg-Perthes disease and congenital dislocated hip; (2) treatment of localized infection; (3) removal of entrapped methylmethacrylate in total hip replacement; and (4) reducing and fixating an acetabular fracture (M. Brennan, oral communication, April 6, 1987). Arthroscopy of the hip joint by the lateral approach is a valuable addition to the evaluation and treatment of hip disorders.

The value of arthroscopy in the treatment of complex ankle fractures - a protocol of a randomised controlled trial.

PubMed

Braunstein, Mareen; Baumbach, Sebastian F; Regauer, Markus; Böcker, Wolfgang; Polzer, Hans

2016-05-12

An anatomical reconstruction of the ankle congruity is the important prerequisite in the operative treatment of acute ankle fractures. Despite anatomic restoration patients regularly suffer from residual symptoms after these fractures. There is growing evidence, that a poor outcome is related to the concomitant traumatic intra-articular pathology. By supplementary ankle arthroscopy anatomic reduction can be confirmed and associated intra-articular injuries can be treated. Nevertheless, the vast majority of complex ankle fractures are managed by open reduction and internal fixation (ORIF) only. Up to now, the effectiveness of arthroscopically assisted fracture treatment (AORIF) has not been conclusively determined. Therefore, a prospective randomised study is needed to sufficiently evaluate the effect of AORIF compared to ORIF in complex ankle fractures. We perform a randomised controlled trial at Munich University Clinic enrolling patients (18-65 years) with an acute ankle fracture (AO 44 A2, A3, B2, B3, C1 - C3 according to AO classification system). Patients meeting the inclusion criteria are randomised to either intervention group (AORIF, n = 37) or comparison group (ORIF, n = 37). Exclusion criteria are fractures classified as AO type 44 A1 or B1, pilon or plafond-variant injury or open fractures. Primary outcome is the AOFAS Score (American Orthopaedic Foot and Ankle Society). Secondary outcome parameter are JSSF Score (Japanese Society of Surgery of the Foot), Olerud and Molander Score, Karlsson Score, Tegner Activity Scale, SF-12, radiographic analysis, arthroscopic findings of intra-articular lesions, functional assessments, time to return to work/sports and complications. This study protocol is accordant to the SPIRIT 2013 recommendation. Statistical analysis will be performed using SPSS 22.0 (IBM). The subjective and functional outcome of complex ankle fractures is regularly unsatisfying. As these injuries are very common it is essential to improve the postoperative results. Potentially, arthroscopically assisted fracture treatment can significantly improve the outcome by addressing the intra-articular pathologies. Given the absolute lack of studies comparing AORIF to ORIF in complex ankle fractures, this randomised controlled trail is urgently needed to evaluate the effectiveness of additional arthroscopy. ClinicalTrials.gov reference: NCT02449096 (Trial registration date: April 7th, 2015).

Value of lateral blood pool imaging in patients with suspected stress fractures of the tibia.

PubMed

Mohan, Hosahalli K; Clarke, Susan E M; Centenara, Martin; Lucarelli, Amanda; Baron, Daniel; Fogelman, Ignac

2011-03-01

To critically evaluate the use of lateral blood pool imaging in athletes with lower limb pain and with a clinical suspicion of stress fracture. Two experienced nuclear medicine physicians evaluated 3-phase bone scans using 99mTc-methylene diphosphonate performed in 50 consecutive patients referred from a specialist sports injury clinic for suspected tibial stress fracture. The vascularity to the tibia as seen on the blood pool (second phase) images in the anterior/posterior views was compared with the lateral/medial view assessments. Stress fractures were presumed to be present when on the delayed images (third phase) there was a focal or fusiform area of increased tracer uptake involving the tibial cortex. Shin splints which are a recognized cause of lower limb pain in athletes mimicking stress fracture were diagnosed if increased tracer uptake was seen extending along the posterior tibial surface with no significant focal or fusiform area of uptake within this. Inter-reviewer agreement for the assessment of vascularity was also assessed using Cohen's Kappa scores. Twenty-four stress fractures in 24 patients and 66 shin splints in 40 patients were diagnosed. In 18 patients stress fracture and shin splints coexisted. In 10 patients no tibial pathology was identified. Of the 24 patients diagnosed with stress fractures, lateral/medial blood pool imaging was superior in the assessment of blood pool activity (P < 0.001) identifying increased vascularity in 21 cases compared with the anterior/posterior views positive in only 11 cases. The inter-reviewer agreement was near perfect for lateral/medial views, κ = 0.86 while very good for anterior/posterior views, κ = 0.68. In patients with suspected tibial stress fractures, lateral views of the tibia provide the optimal method for evaluation of vascularity. Prospective studies with quantitative or semi-quantitative assessment of skeletal vascularity could provide supplementary information relating to the pathophysiology of stress fractures, for example, the time scale of vascular changes after a tibial stress fracture, and potentially could have clinical relevance as to the assessment of the severity of stress fractures and their prognosis.

The effect of coloring liquid dipping time on the fracture load and color of zirconia ceramics

PubMed Central

2017-01-01

PURPOSE The aims of the study were to evaluate the fracture load of zirconia core material after dipping in coloring liquid at different time intervals and to compare the color of dipped blocks with that of prefabricated shaded blocks. MATERIALS AND METHODS 3-unit bridge frameworks were designed digitally. Sixty frameworks were fabricated using uncolored zirconia blocks by CAD/CAM and divided into 4 groups randomly (n = 15). Group 2 (G2) was subjected to coloring liquids for 2 minutes, Group 4 (G4) for 4 minutes, and Group 6 (G6) for 6 minutes. CFS group was not subjected to any coloring procedure. After coloring, color differences between the test groups and a prefabricated shaded zirconia group (CPZ, n = 15) were evaluated by using a spectrophotometer. Fracture test was conducted immediately after shade evaluation with a Testometric test device at a cross-head speed of 1 mm/sec. Statistical analysis for evaluating color and fracture load was performed by using one way ANOVA followed by Tukey HSD test (P ≤ .05). Weibull analysis was conducted for distribution of fracture load. RESULTS There was no difference in terms of fracture load and color between CFS (1176.681 N) and G2 (985.638 N) group and between CPZ (81.340) and G2 (81.140) group, respectively. Fracture load values of G4 (779.340 N) and G6 (935.491 N) groups were statistically significantly lower than that of CFS group (P ≤ .005). The color values of G4 (79.340) and G6 (79.673) groups were statistically different than that of CPZ group (P ≤ .005). CONCLUSION Prolonged immersion of zirconia in coloring liquid not only negatively affected the fracture load of the zirconia being tested in the current study but also deteriorated the desired shade of the restoration. PMID:28243394

[Actual relevance of Pauwels' classification of femoral neck fractures--a critical review].

PubMed

Schwarz, N

2010-03-01

The aim of this study was to evaluate the validity of Pauwels' classification of femoral neck fractures. A study of literature was performed. It has never been proven that the inclination of the fracture plane has a prognostic relevance. A number of papers prove the contrary, there are no publications where Pauwels' classification has been used successfully in selecting treatment modalities. Pauwels' theory of fracture inclination angle has not been transferred into clinical practice. This discrepancy probably goes back to the fact that the angle cannot be determined preoperatively, that in the majority of femoral neck fractures the angle is within the range of 40 to 60 degrees, that the theoretical angle variations do practically not exist, and that the shearing forces are reduced to an unknown amount by friction resistance due to the uneven fracture plane. The mechanical laws of the pseudarthrosis of the femoral neck cannot be extrapolated to acute fractures. The theory of Pauwels has apparently no clinical relevance for the majority of acute fractures, except for the rare transcervical fractures, and should not be considered any longer as a classification of acute femoral neck fractures due to the lack of prognostic and therapeutic relevance.

Caprock integrity susceptibility to permeable fracture creation

DOE PAGES

Frash, Luke; Carey, James William; Ickes, Timothy Lee; ...

2017-07-14

Caprock leakage is of crucial concern for environmentally and economically sustainable development of carbon dioxide sequestration and utilization operations. One potential leakage pathway is through fractures or faults that penetrate the caprock. In this study, we investigate the permeability induced by fracturing initially intact Marcellus shale outcrop specimens at stressed conditions using a triaxial direct-shear method. Measurements of induced permeability, fracture geometry, displacement, and applied stresses were all obtained at stressed conditions to investigate the coupled processes of fracturing and fluid flow as may occur in the subsurface. Fracture geometry was directly observed at stressed conditions using X-ray radiography video.more » Numerical simulation was performed to evaluate the stress distribution developed in the experiments. Our experiments show that permeability induced by fracturing is strongly dependent on the stresses at which the fractures are created, the magnitude of shearing displacement, and the duration of flow. The strongest permeability contrast was observed when comparing specimens fractured at low stress to others fractured at higher stress. Measureable fracture permeability decreased by up to 7 orders of magnitude over a corresponding triaxial confining stress range of 3.5 MPa to 30 MPa. These results show that increasing stress, depth, and time are all significant permeability inhibitors that may limit potential leakage through fractured caprock.« less

Caprock integrity susceptibility to permeable fracture creation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Frash, Luke; Carey, James William; Ickes, Timothy Lee

Caprock leakage is of crucial concern for environmentally and economically sustainable development of carbon dioxide sequestration and utilization operations. One potential leakage pathway is through fractures or faults that penetrate the caprock. In this study, we investigate the permeability induced by fracturing initially intact Marcellus shale outcrop specimens at stressed conditions using a triaxial direct-shear method. Measurements of induced permeability, fracture geometry, displacement, and applied stresses were all obtained at stressed conditions to investigate the coupled processes of fracturing and fluid flow as may occur in the subsurface. Fracture geometry was directly observed at stressed conditions using X-ray radiography video.more » Numerical simulation was performed to evaluate the stress distribution developed in the experiments. Our experiments show that permeability induced by fracturing is strongly dependent on the stresses at which the fractures are created, the magnitude of shearing displacement, and the duration of flow. The strongest permeability contrast was observed when comparing specimens fractured at low stress to others fractured at higher stress. Measureable fracture permeability decreased by up to 7 orders of magnitude over a corresponding triaxial confining stress range of 3.5 MPa to 30 MPa. These results show that increasing stress, depth, and time are all significant permeability inhibitors that may limit potential leakage through fractured caprock.« less

On the Versatility of Rheoreversible, Stimuli-responsive Hydraulic-Fracturing Fluids for Enhanced Geothermal Systems: Effect of Reservoir pH

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fernandez, Carlos A.; Shao, Hongbo; Bonneville, Alain

Abstract The primary challenge for the feasibility of enhanced geothermal systems (EGS) is to cost-effectively create high-permeability reservoirs inside deep crystalline bedrock. Although fracturing fluids are commonly used for oil/gas, standard fracturing methods are not developed or proven for EGS temperatures and pressures. Furthermore, the environmental impacts of currently used fracturing methods are only recently being determined. These authors recently reported an environmentally benign, CO2-activated, rheoreversible fracturing fluid that enhances permeability through fracturing due to in situ volume expansion and gel formation. The potential of this novel fracturing fluid is evaluated in this work towards its application at geothermal sitesmore » under different pH conditions. Laboratory-scale fracturing experiments using Coso Geothermal rock cores under different pH environments were performed followed by X-ray microtomography characterization. The results demonstrate that CO2-reactive aqueous solutions of environmentally amenable polyallylamine (PAA) consistently and reproducibly creates/propagates fracture networks through highly impermeable crystalline rock from Coso EGS sites at considerably lower effective stress as compared to conventional fracturing fluids. In addition, permeability was significantly enhanced in a wide range of formation-water pH values. This effective, and environmentally-friendly fracturing fluid technology represents a potential alternative to conventional fracturing fluids.« less

Evaluation of Microleakage and Marginal Ridge Fracture Resistance of Primary Molars Restored with Three Restorative Materials: A Comparative in vitro Study

PubMed Central

Yeolekar, Tapan Satish; Mukunda, KS; Kiran, NK

2015-01-01

ABSTRACT Composite restorations are popular because of their superior esthetics and acceptable clinical performance. But shrinkage is still a drawback. Polymerization shrinkage results in volumetric contraction, leading to deformation of the cusps, microleakage, decrease of marginal adaptation, enamel micro-cracks and postoperative sensitivity. A new class of ring opening resin composite based on silorane chemistry has been introduced with claims of less than 1% shrinkage during polymerization. The present study was conducted to evaluate and compare the ability of low shrink silorane based material, a packable composite and a compomer to resist microleakage in class II restorations on primary molars and evaluate marginal ridge fracture resistance of these materials. Sixty human primary molars were selected. Class II cavities were prepared and the teeth were divided into three groups of twenty each. Groups were as follows group I: low shrink composite resin (Filtek P90). Group II: packable composite (Filtek P60) and Group III: compomer (Compoglass F). Half of the teeth were used for microleakage and the rest for marginal ridge fracture resistance. For microleakage testing, dye penetration method was used with 1% methylene blue dye. Followed by evaluation and grading under stereomicroscope at 10* magnification. Fracture resistance was tested with universal testing machine. It was concluded that low shrink silorane based composite resin showed the least amount of microleakage, whereas compomer showed the highest microleakage. Packable composite resisted fracture of marginal ridge better than other composite resins. Marginal ridge fracture resistance of packable composite was comparable to the intact side. How to cite this article: Yeolekar TS, Chowdhary NR, Mukunda KS, Kiran NK. Evaluation of Microleakage and Marginal Ridge Fracture Resistance of Primary Molars Restored with Three Restorative Materials: A Comparative in vitro Study. Int J Clin Pediatr Dent 2015;8(2):108-113. PMID:26379377

Improving Self-Pierce Rivet Performance through Processing and Alloy Development

NASA Astrophysics Data System (ADS)

Van Hall, Stephen N.

Spot welding has been used to join steel sheet material in the past during automotive manufacturing. The increasing use of aluminum and mixed materials to achieve continually increasing fuel economy standards requires mechanical joining methods to provide adequate impact performance. One such mechanical joining process is self-pierce riveting (SPR). Self-pierce riveting has grown in popularity in recent years due to fast cycle times, high static strength and fatigue performance as well as the ability to join many different sheet material combinations. Self-pierce rivet utilization has become limited due to the material properties of the rivet in two main areas: the joining of high-strength sheet material and joining of multiple sheet material combinations using a single rivet geometry, referred to as commonization. Two specific case studies have been developed to assess the failures that occur and evaluate potential solutions: joining of press-hardened steel (PHS) to Al6111 and improved commonization ability using a two layer aluminum joint that is currently joined with a specialized rivet. Riveting trials have been performed on each of the two case studies using cold forged rivets produced from 10B37 steel that has been heat-treated through a quench and temper process to a range of hardness levels to evaluate the failures that occur within the rivet. The failures occur with two different modes: buckling of the rivet at hardness values below 550 HV when joining PHS and Al6111 and fractures that occur in the rivet tail at hardness values above 550 HV during joining in each of the case studies under evaluation. The fractures have been attributed to a high degree of hoop strain that forms when the rivets are flared beyond the design specifications. A method to replicate the rivet flaring procedure under laboratory conditions has been developed by flaring the rivets through various strain paths to induce a hoop strain and the resultant fractures. The flaring method shows the ability to replicate the types of fractures that were observed during joining attempts while monitoring applied force, crosshead displacement and strain at the point of fracture at the rivet tail using digital image correlation. Alternative alloys including 4130, 4340 and 5160 were evaluated alongside 10B37 for improved performance after quenching and tempering, austempering and after being intentionally decarburized to varying degrees. The heat-treatments were evaluated through microscopy, fractography, rivet flaring and joining attempts for each case study and alloy under investigation. All of the alternative alloys showed no significant performance gains after being quenched and tempered or austempered. However, hoop strain to failure during flaring was increased between 2-4x after the rivets had been intentionally decarburized. The intentionally decarburized rivets were evaluated through joining trials and provided successful joining for each of the case studies under investigation using 10B37 rivets. Rivets produced from 4340 and 5160 also showed instances of success during joining attempts. The Cockroft and Latham failure criterion was evaluated in regards to rivet flaring through the development of finite element simulations using Abaqus. The Cockroft and Latham failure criterion was able to successfully predict the location of riveting fractures through multiple strain paths, rivet geometries and microstructures. Cockroft and Latham values from tensile tests of 10B37 wire led to an underestimate of the strain to failure when compared to the rivet flaring process for quenched and tempered rivets but was very similar to the strain predicted for rivets that had been intentionally decarburized.

Feasibility of and Rationale for the Collection of Orthopaedic Trauma Surgery Quality of Care Metrics.

PubMed

Miller, Anna N; Kozar, Rosemary; Wolinsky, Philip

2017-06-01

Reproducible metrics are needed to evaluate the delivery of orthopaedic trauma care, national care, norms, and outliers. The American College of Surgeons (ACS) is uniquely positioned to collect and evaluate the data needed to evaluate orthopaedic trauma care via the Committee on Trauma and the Trauma Quality Improvement Project. We evaluated the first quality metrics the ACS has collected for orthopaedic trauma surgery to determine whether these metrics can be appropriately collected with accuracy and completeness. The metrics include the time to administration of the first dose of antibiotics for open fractures, the time to surgical irrigation and débridement of open tibial fractures, and the percentage of patients who undergo stabilization of femoral fractures at trauma centers nationwide. These metrics were analyzed to evaluate for variances in the delivery of orthopaedic care across the country. The data showed wide variances for all metrics, and many centers had incomplete ability to collect the orthopaedic trauma care metrics. There was a large variability in the results of the metrics collected among different trauma center levels, as well as among centers of a particular level. The ACS has successfully begun tracking orthopaedic trauma care performance measures, which will help inform reevaluation of the goals and continued work on data collection and improvement of patient care. Future areas of research may link these performance measures with patient outcomes, such as long-term tracking, to assess nonunion and function. This information can provide insight into center performance and its effect on patient outcomes. The ACS was able to successfully collect and evaluate the data for three metrics used to assess the quality of orthopaedic trauma care. However, additional research is needed to determine whether these metrics are suitable for evaluating orthopaedic trauma care and cutoff values for each metric.

Treatment of Pediatric Condylar Fractures: A 20-Year Experience

PubMed Central

Ghasemzadeh, Ali; Mundinger, Gerhard S.; Swanson, Edward W.; Utria, Alan F.; Dorafshar, Amir H.

2016-01-01

Background The purpose of this study was to define patterns of injury and treatment for condylar and subcondylar fractures and evaluate short-term outcomes in the pediatric population. Methods A retrospective chart review was performed on pediatric patients with mandibular condylar fractures who presented between 1990 and 2010. Computed tomographic imaging was reviewed for all patients to assess fracture characteristics. Mandibular fractures were codified using the Strasbourg Osteosynthesis Research Group and Lindahl classification methods. Results Sixty-four patients with 92 condylar fractures were identified. Of these patients, 29 had isolated condylar fracture and 35 had a condylar fracture associated with an additional mandibular arch fracture. The most common fracture patterns were diacapitular fracture in the Strasbourg Osteosynthesis Research Group system (n = 46) and vertical condylar head fracture in the Lindahl system (n = 14). Condylar fracture with additional mandibular arch fractures were treated with maxillomandibular fixation more often than patients with condylar fracture [n = 40 (74.1 percent) versus n = 14 (25.9 percent); p = 0.004]. No condylar fracture was treated in an open fashion. Forty-three patients returned for follow-up. The median follow-up period was 81 days (interquartile range, 35 to 294 days). Ten patients had complications (23.3 percent). The most common complication was malocclusion (n = 5). Nine of 10 patients with complications had condylar fracture with an additional mandibular arch fracture. Conclusions Closed treatment of condylar fractures yields satisfactory results in pediatric patients. Pediatric patients with condylar fractures combined with additional arch fractures experience a higher rate of unfavorable outcomes. PMID:26595021

Proton-pump inhibitors and risk of fractures: an update meta-analysis.

PubMed

Zhou, B; Huang, Y; Li, H; Sun, W; Liu, J

2016-01-01

To identify the relationship between proton-pump inhibitors (PPIs) and the risk of fracture, we conducted an update meta-analysis of observational studies. Results showed that PPI use was associated with a modestly increased risk of hip, spine, and any-site fracture. Many studies have investigated the association of proton-pump inhibitors (PPIs) with fracture risk, but the results have been inconsistent. To evaluate this question, we performed a meta-analysis of relevant observational studies. A systematic literature search up to February 2015 was performed in PubMed. We combined relative risks (RRs) for fractures using random-effects models and conducted subgroup and stratified analyses. Eighteen studies involving a total of 244,109 fracture cases were included in this meta-analysis. Pooled analysis showed that PPI use could moderately increase the risk of hip fracture [RR = 1.26, 95 % confidence intervals (CIs) 1.16–1.36]. There was statistically significant heterogeneity among studies (p < 0.001; I 2 = 71.9 %). After limiting to cohort studies, there was also a moderate increase in hip fracture risk without evidence of study heterogeneity. Pooling revealed that short-term use (<1 year) and longer use (>1 year) were similarly associated with increased risk of hip fracture. Furthermore, a moderately increased risk of spine (RR = 1.58, 95 % CI 1.38–1.82) and any-site fracture (RR = 1.33, 95 % CI 1.15–1.54) was also found among PPI users. In this update meta-analysis of observational studies, PPI use modestly increased the risk of hip, spine, and any-site fracture, but no evidence of duration effect in subgroup analysis.

Case-based fracture image retrieval.

PubMed

Zhou, Xin; Stern, Richard; Müller, Henning

2012-05-01

Case-based fracture image retrieval can assist surgeons in decisions regarding new cases by supplying visually similar past cases. This tool may guide fracture fixation and management through comparison of long-term outcomes in similar cases. A fracture image database collected over 10 years at the orthopedic service of the University Hospitals of Geneva was used. This database contains 2,690 fracture cases associated with 43 classes (based on the AO/OTA classification). A case-based retrieval engine was developed and evaluated using retrieval precision as a performance metric. Only cases in the same class as the query case are considered as relevant. The scale-invariant feature transform (SIFT) is used for image analysis. Performance evaluation was computed in terms of mean average precision (MAP) and early precision (P10, P30). Retrieval results produced with the GNU image finding tool (GIFT) were used as a baseline. Two sampling strategies were evaluated. One used a dense 40 × 40 pixel grid sampling, and the second one used the standard SIFT features. Based on dense pixel grid sampling, three unsupervised feature selection strategies were introduced to further improve retrieval performance. With dense pixel grid sampling, the image is divided into 1,600 (40 × 40) square blocks. The goal is to emphasize the salient regions (blocks) and ignore irrelevant regions. Regions are considered as important when a high variance of the visual features is found. The first strategy is to calculate the variance of all descriptors on the global database. The second strategy is to calculate the variance of all descriptors for each case. A third strategy is to perform a thumbnail image clustering in a first step and then to calculate the variance for each cluster. Finally, a fusion between a SIFT-based system and GIFT is performed. A first comparison on the selection of sampling strategies using SIFT features shows that dense sampling using a pixel grid (MAP = 0.18) outperformed the SIFT detector-based sampling approach (MAP = 0.10). In a second step, three unsupervised feature selection strategies were evaluated. A grid parameter search is applied to optimize parameters for feature selection and clustering. Results show that using half of the regions (700 or 800) obtains the best performance for all three strategies. Increasing the number of clusters in clustering can also improve the retrieval performance. The SIFT descriptor variance in each case gave the best indication of saliency for the regions (MAP = 0.23), better than the other two strategies (MAP = 0.20 and 0.21). Combining GIFT (MAP = 0.23) and the best SIFT strategy (MAP = 0.23) produced significantly better results (MAP = 0.27) than each system alone. A case-based fracture retrieval engine was developed and is available for online demonstration. SIFT is used to extract local features, and three feature selection strategies were introduced and evaluated. A baseline using the GIFT system was used to evaluate the salient point-based approaches. Without supervised learning, SIFT-based systems with optimized parameters slightly outperformed the GIFT system. A fusion of the two approaches shows that the information contained in the two approaches is complementary. Supervised learning on the feature space is foreseen as the next step of this study.

Near-tip-screenout hydraulic fracturing of oil wells in the Bach Ho field, offshore Vietnam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hung, L.V.; San, N.T.; Shelomentsev, A.G.

1995-10-01

The first hydraulic fracturing of wells in Vietnam were successfully performed Offshore in the Bach Ho (White Tiger) Oil Field. Near-tip-screenouts rather than tip-screenout treatments were performed. The goal of the project was to improve production from existing wells rather than drill new wells and reduce the cost per barrel produced. This case study involves wells with multiple perforated zones completed in the Oligocene sandstone. Zones were selectively fractured in order to optimize production. A detailed description candidate selection, design, execution and evaluation processes are presented. The Bach Ho field has been producing for 8 years but not at itsmore » potential due to various reasons including drilling and completion fluid damage. Although acidizing was an option for damage removal, hydraulic fracturing was selected as a way to bypass near-wellbore damage and generate a negative skin. Production simulators were used to quantify post-frac production. Due to suspected high closure stress, high strength proppant was selected and ramped in a high temperature fracturing fluid. Calibration treatments were conducted on several wells to quantify fluid leak-off, fracture height and Young`s modulus. Based on the results of the calibration treatment, fracture designs were modified. As predicted by computer simulation, near-tip-screenouts occurred as planned. The treatments were performed using a work boat with skid pumping/blending equipment, a computer monitoring/operation center and a laboratory. Strict QC procedures were followed to ensure the quality of all products. Post-frac well tests results and production data are presented. Overall, the fracturing campaign was very successful with wells showing negative skins and up to a five fold increase of production in agreement with systems analysis predictions.« less

[Treatment of trochanteric fractures of the femoral bone].

PubMed

Wierer, I; Pospísil, M; Holubár, J; Volf, V

1994-01-01

The authors present the evaluation of some most often methods of treatment of trochanteric fractures of femur. They analyze the group of 235 patients in the years 1987 - 1991 treated for fractures by the McLaughlin technique and by Ender nailing. The first method was performed on 121 people and the technique of Ender nailing on 97 people. The results and complications of these methods of osteosynthesis are presented in the paper. The experiences of the authors confirm the advantage of Ender nailing in treating fractures of the oldest injured patients. The Ender nailing method of osteosynthesis is the more advantageous, because the operation takes less time and is easier for patients. After Ender nailing, the possibility of functional rehabilitation and walking on crutches is greater. McLaughlin osteosynthesis of these fractures proved the more advantageous in younger injured patients.

Correlation between obesity and severity of distal radius fractures.

PubMed

Acosta-Olivo, C; Gonzalez-Saldivar, J C; Villarreal-Villarreal, G; Torres-Botello, A; Gomez-Garcia, E; Tamez-Mata, Y; Peña-Martinez, V

2017-04-01

The incidence of obesity has increased significantly worldwide. Our hypothesis was that patients with obesity have a more severe distal radius fracture and we realized a study to evaluate this correlation between obesity and severity of distal radius fractures caused by low-energy injuries. A total of 114 patients with distal radius fracture were examined in a cross-sectional, observational study. Fractures were classified according to the international AO-Müller/Orthopedic Trauma Association (AO/OTA) classification in order to determine the severity. The patient's Body Mass Index (BMI) was calculated and a Pearson correlation was performed. The patients were predominantly female, and left side was more frequently affected. Most of the fractures were AO/OTA type A (71 patients). The majority of the involved patients in our study were overweighed or obese. We do not observe a direct correlation between grade of obesity and distal radius fracture severity. Based on the results of this study obesity and severity of distal radius fractures do not correlate. Prognostic. Level IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

In vivo effect of shock-waves on the healing of fractured bone.

PubMed

Augat, P; Claes, L; Suger, G

1995-10-01

In a controlled animal experiment we attempted to clarify the question of whether there is a stimulating effect of extracorporeal shock-waves on the repair process of fractured long bones. As a fracture model we used an osteotomy in the diaphysis of the ovine tibia and an external fixation device. Shock-wave treatment at two levels of intensity and with four different numbers of applied shocks was performed with an electromagnetic acoustic source. Healing of the osteotomized bone was evaluated by biomechanical and radiological investigations on the whole bone as well as on bone sections from areas of the fracture gap and the periosteal fracture callus. We found a non-significant tendency to deterioration of the fracture healing with increasing shock-wave intensities. The study of treatment parameters led neither to significantly different biomechanical outcomes nor to altered radiological results in comparison to the untreated control group. RELEVANCE:--While we cannot comment upon the effectiveness of extracorporeal shock-waves in the delayed treatment of fractures or pseudarthrosis, our results suggest that shock-waves have no beneficial effect in acute fracture repair.

Perceived pain, fear of falling and physical function in women with osteoporosis.

PubMed

Hübscher, Markus; Vogt, Lutz; Schmidt, Katharina; Fink, Matthias; Banzer, Winfried

2010-07-01

The aim of this cross-sectional study was to evaluate pain intensity-related differences in physical performance and fear of falling in elderly women with osteoporosis. A sample of 82 osteoporotic women (73.8±8.1 years) with and without vertebral fractures was included. Numeric rating scale (NRS) measures (0=no pain, 10=unbearable) were applied to obtain actual pain intensity and to stratify between patients with mild (0-3), moderate (4-6) and severe (7-10) pain. Activity-related fear of falling was evaluated with the Falls Efficacy Scale-International Version (FES-I). Physical performance measures included maximum voluntary quadriceps strength, postural sway and gait speed measures. Controlling for age, fractures, and history of falls ANCOVA with Scheffe's post hoc test indicated significant slower walking velocities and greater postural sway for patients with severe pain. Furthermore, significant group differences could be detected for muscle strength and fear of falling. Patients with more intense pain (NRS≥5) were 6.4 times (odds ratio; 95%CI: 1.5-26.7) more likely to score below average in fall-related self-efficacy and all physical performance tests. Among women with osteoporosis, heightened back pain intensity increases fear of falling and decreases physical performance irrespective of vertebral fractures and history of falls. Copyright © 2010 Elsevier B.V. All rights reserved.

Omnidirectional Internal Fixation by Double Approaches for Treating Rüedi-Allgöwer Type III Pilon Fractures.

PubMed

Dai, Chong-Hua; Sun, Jun; Chen, Kun-Quan; Zhang, Hui-Bo

In the present study, we explored the effectiveness and complications of omnidirectional internal fixation using a double approach for treating Rüedi-Allgöwer type III pilon fractures. A retrospective analysis was performed of 19 cases of Rüedi-Allgöwer type III unilateral closed pilon fracture. With preoperative preparation and correct surgical timing, the reduction was performed using anteromedial and posterolateral approaches, and the fracture fragments were fixed by omnidirectional internal fixation. Imaging evaluation was performed using the Burwell-Charnley scoring system. The Johner-Wruhs scoring system was used to assess the functional status of the patients. A comprehensive evaluation of efficacy was performed using a 5-point Likert score. The complications were also recorded and analyzed. All patients were followed up for an average of 16.2 months. The operative incisions of 15 cases healed by primary intent and with delayed healing in 4. All patients had achieved bony union at an average of 16 weeks postoperatively. No deep infection, broken nail or withdrawn nail, exposed plate, or skin flap necrosis occurred. The Burwell-Charnley imaging evaluation showed that 14 patients had anatomic reduction of the articular surface and 5 had acceptable reduction. Using the Johner-Wruhs scoring system, the results were excellent for 8, good for 7, fair for 2, and poor for 2 patients; the combined rate of excellent and good results was 78.9%. The Likert score of efficacy self-reported by the patients was 3 to 4 points for 12 patients, 2 points for 4 patients, and 0 to 1 point for 3 patients. The Likert score of therapeutic efficacy reported by the physicians was 3 to 4 points for 10 patients, 2 points for 5 patients, and 0 to 1 point for 4 patients. Omnidirectional internal fixation using double approaches was an effective method to treat Rüedi-Allgöwer type III pilon fractures with satisfactory reduction and rigid fixation, good joint function recovery, and few complications. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Fracture mechanics evaluation of heavy welded structures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sprung, I.; Ericksson, C.W.; Zilberstein, V.A.

1982-05-01

This paper describes some applications of nondestructive examination (NDE) and engineering fracture mechanics to evaluation of flaws in heavy welded structures. The paper discusses not only widely recognized linear elastic fracture mechanics (LEFM) analysis, but also methods of the elastic-plastic fracture mechanics (EPFM), such as COD, J-integral, and Failure Assessment Diagram. Examples are given to highlight the importance of interaction between specialists providing input and the specialists performing the analysis. The paper points out that the critical parameters for as-welded structures when calculated by these methods are conservative since they are based on two pessimistic assumptions: that the magnitude ofmore » residual stress is always at the yield strength level, and that the residual stress always acts in the same direction as the applied (mechanical) stress. The suggestion is made that it would be prudent to use the COD or the FAD design curves for a conservative design. The appendix examines a J-design curve modified to include residual stresses.« less

EVALUATION OF PRESENTATION OF SIGNS AND SYMPTOMS OF FEMOROACETABULAR IMPINGEMENT AFTER EPIPHYSIOLYSIS OF THE PROXIMAL FEMUR.

PubMed

Krüger, Fábio Peng; de Britto, Paulo Sérgio Gérzon; Neto, Lauro Machado; Schwartsmann, Carlos Roberto

2011-01-01

The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

Outcome of Boxer’s Fractures Treated by a Soft Wrap and Buddy Taping: A Prospective Study

PubMed Central

Kämpfen, Stephan; Berli, Martin; Fritschy, Daniel; Della Santa, Dominique; Fusetti, Cesare

2007-01-01

Introduction The ideal treatment for a boxer’s fracture remains controversial, particularly the degree of volar dislocation considered acceptable for nonoperative treatment. Patients and Methods From December 2003 to December 2004, 25 patients who sustained a subcapital metacarpal fracture of the little finger with volar angulation between 30 to 75° were prospectively enrolled in the study. All patients were treated with a circular self-adherent wrap covering metacarpal bones II–V and buddy taping of the ring and little fingers for a period of 3 weeks while allowing immediate free range of motion. Results Final evaluation at a mean of 5 months revealed all patients to be satisfied without subjective functional impairment. All fractures healed, and the angulation of the fracture remained unchanged, but moderate shortening was observed. Active flexion of the metacarpophalangeal (MCP) joint was significantly lower on the fracture side, but as the median degree of MCP flexion was the same, this statistical difference was without clinical relevance. There was no loss in grip strength. A subjective long-term evaluation was performed by phone; at a median of 3 years, a QuickDash score gave a median of 0 point. Conclusion Treating a boxer’s fracture with angulation of up to 75° by soft wrap and buddy taping resulted in satisfied patients and good clinical results. PMID:18780055

Experimental insights into geochemical changes in hydraulically fractured Marcellus Shale

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marcon, Virginia; Joseph, Craig; Carter, Kimberly E.

Hydraulic fracturing applied to organic-rich shales has significantly increased the recoverable volume of methane available for U.S. energy consumption. Fluid-shale reactions in the reservoir may affect long-term reservoir productivity and waste management needs through changes to fracture mineral composition and produced fluid chemical composition. We performed laboratory experiments with Marcellus Shale and lab-generated hydraulic fracturing fluid at elevated pressures and temperatures to evaluate mineral reactions and the release of trace elements into solution. Results from the experiment containing fracturing chemicals show evidence for clay and carbonate dissolution, secondary clay and anhydrite precipitation, and early-stage (24-48 h) fluid enrichment of certainmore » elements followed by depletion in later stages (i.e. Al, Cd, Co, Cr, Cu, Ni, Sc, Zn). Other elements such as As, Fe, Mn, Sr, and Y increased in concentration and remained elevated throughout the duration of the experiment with fracturing fluid. Geochemical modeling of experimental fluid data indicates primary clay dissolution, and secondary formation of smectites and barite, after reaction with fracturing fluid. Changes in aqueous organic composition were observed, indicating organic additives may be chemically transformed or sequestered by the formation after hydraulic fracturing. The NaCl concentrations in our fluids are similar to measured concentrations in Marcellus Shale produced waters, showing that these experiments are representative of reservoir fluid chemistries and can provide insight on geochemical reactions that occur in the field. These results can be applied towards evaluating the evolution of hydraulically-fractured reservoirs, and towards understanding geochemical processes that control the composition of produced water from unconventional shales.« less

Experimental insights into geochemical changes in hydraulically fractured Marcellus Shale

DOE PAGES

Marcon, Virginia; Joseph, Craig; Carter, Kimberly E.; ...

2016-11-09

Hydraulic fracturing applied to organic-rich shales has significantly increased the recoverable volume of methane available for U.S. energy consumption. Fluid-shale reactions in the reservoir may affect long-term reservoir productivity and waste management needs through changes to fracture mineral composition and produced fluid chemical composition. We performed laboratory experiments with Marcellus Shale and lab-generated hydraulic fracturing fluid at elevated pressures and temperatures to evaluate mineral reactions and the release of trace elements into solution. Results from the experiment containing fracturing chemicals show evidence for clay and carbonate dissolution, secondary clay and anhydrite precipitation, and early-stage (24-48 h) fluid enrichment of certainmore » elements followed by depletion in later stages (i.e. Al, Cd, Co, Cr, Cu, Ni, Sc, Zn). Other elements such as As, Fe, Mn, Sr, and Y increased in concentration and remained elevated throughout the duration of the experiment with fracturing fluid. Geochemical modeling of experimental fluid data indicates primary clay dissolution, and secondary formation of smectites and barite, after reaction with fracturing fluid. Changes in aqueous organic composition were observed, indicating organic additives may be chemically transformed or sequestered by the formation after hydraulic fracturing. The NaCl concentrations in our fluids are similar to measured concentrations in Marcellus Shale produced waters, showing that these experiments are representative of reservoir fluid chemistries and can provide insight on geochemical reactions that occur in the field. These results can be applied towards evaluating the evolution of hydraulically-fractured reservoirs, and towards understanding geochemical processes that control the composition of produced water from unconventional shales.« less

Stress Analysis and Fracture in Nanolaminate Composites

NASA Technical Reports Server (NTRS)

Chamis, Christos C.

2008-01-01

A stress analysis is performed on a nanolaminate subjected to bending. A composite mechanics computer code that is based on constituent properties and nanoelement formulation is used to evaluate the nanolaminate stresses. The results indicate that the computer code is sufficient for the analysis. The results also show that when a stress concentration is present, the nanolaminate stresses exceed their corresponding matrix-dominated strengths and the nanofiber fracture strength.

Bioactive glass granules: a suitable bone substitute material in the operative treatment of depressed lateral tibial plateau fractures: a prospective, randomized 1 year follow-up study.

PubMed

Heikkilä, Jouni T; Kukkonen, Juha; Aho, Allan J; Moisander, Susanna; Kyyrönen, Timo; Mattila, Kimmo

2011-04-01

Purpose of this study was to compare bioactive glass and autogenous bone as a bone substitute material in tibial plateau fractures. We designed a prospective, randomized study consisting of 25 consecutive operatively treated patients with depressed unilateral tibial comminuted plateau fracture (AO classification 41 B2 and B3).14 patients (7 females, 7 males, mean age 57 years, range 25-82) were randomized in the bioglass group (BG) and 11 patients (6 females, 5 males, mean age 50 years, range 31-82) served as autogenous bone control group (AB). Clinical examination of the patients was performed at 3 and 12 months, patients' subjective and functional results were evaluated at 12 months. Radiological analysis was performed preoperatively, immediately postoperatively and at 3 and 12 months. The postoperative redepression for both studied groups was 1 mm until 3 months and remained unchanged at 12 months. No differences were identified in the subjective evaluation, functional tests and clinical examination between the two groups during 1 year follow-up. We conclude that bioactive glass granules can be clinically used as filler material instead of autogenous bone in the lateral tibial plateau compression fractures.

Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guyer, B.H.; Levinsohn, E.M.; Fredrickson, B.E.

1985-11-01

Eighteen CT examinations were performed in 10 patients for the evaluation of acute intraarticular fractures and their follow-up. Fractures comparable to those in the patients were created in cadavers. The normal anatomy and the traumatically altered anatomy of the calcaneus in the axial, coronal, and sagittal planes are demonstrated by CT and corresponding anatomic sections. Scanning was performed in the axial plane, with subsequent reconstruction in the coronal and sagittal planes. The axial scans show disruption of the inferior part of the posterior facet, calcaneocuboid joint involvement, and widening of the calcaneus. The coronal scans show disruption of the superiormore » part of the posterior facet, sustentaculum tali depression (involvement of middle and anterior facets), peroneal and flexor hallucis longus tendon impingement, and widening and height loss of the calcaneus. The sagittal scans show disruption of the posterior facet, calcaneocuboid joint involvement, and height loss of the calcaneus and allow the evaluation of Boehler's and Gissane's angles. All three planes show the position of major fracture fragments. Radiation dose to the foot was measured to be 0.1 rad (0.001 Gy) for plain film radiography (five exposures), 18 rad (0.18 Gy) for conventional tomography (20 cuts), and 2.6 rad (0.026 Gy) for axial CT examination.« less

Cognitive plasticity as a moderator of functional dependency in elderly patients hospitalized for bone fractures.

PubMed

Calero-García, M J; Calero, M D; Navarro, E; Ortega, A R

2015-01-01

Bone fractures in older adults involve hospitalization and surgical intervention, aspects that have been related to loss of autonomy and independence. Several variables have been studied as moderators of how these patients recover. However, the implications of cognitive plasticity for functional recovery have not been studied to date. The present study analyzes the relationship between cognitive plasticity--defined as the capacity for learning or improved performance under conditions of training or performance optimization--and functional recovery in older adults hospitalized following a bone fracture. The study comprised 165 older adults who underwent surgery for bone fractures at a hospital in southern Spain. Participants were evaluated at different time points thereafter, with instruments that measure activities of daily life (ADL), namely the Barthel Index (BI) and the Lawton Index, as well as with a learning potential (cognitive plasticity) assessment test (Auditory Verbal Learning Test of Learning Potential, AVLT-LP). Results show that most of the participants have improved their level of independence 3 months after the intervention. However, some patients continue to have medium to high levels of dependency and this dependency is related to cognitive plasticity. The results of this study reveal the importance of the cognitive plasticity variable for evaluating older adults hospitalized for a fracture. They indicate a possible benefit to be obtained by implementing programs that reduce the degree of long-term dependency or decrease the likelihood of it arising.

Clinical performance of a lithia disilicate-based core ceramic for three-unit posterior FPDs.

PubMed

Esquivel-Upshaw, Josephine F; Anusavice, Kenneth J; Young, Henry; Jones, Jack; Gibbs, Charles

2004-01-01

The purpose of this research project was to determine the clinical success rate of a lithia disilicate-based core ceramic for use in posterior fixed partial dentures (FPD) as a function of bite force, cement type, connector height, and connector width. Thirty ceramic FPD core frameworks were prepared using a heat-pressing technique and a lithia disilicate-based core ceramic. The maximum clenching force was measured for each patient prior to tooth preparation. Connector height and width were measured for each FPD. Patients were recalled yearly after cementation for 2 years and evaluated using 11 clinical criteria. All FPDs were examined by two independent clinicians, and rankings from 1 to 4 were made for each criterion (4 = excellent; 1 = unacceptable). Two of the 30 ceramic FPDs fractured within the 2-year evaluation period, representing a 93% success rate. One fracture was associated with a low occlusal force and short connector height (2.9 mm). The other fracture was associated with the greatest occlusal force (1,031 N) and adequate connector height. All criteria were ranked good to excellent during the 2-year recall for all remaining FPDs. The performance of the experimental core ceramic in posterior FPDs was promising, with only a 7% fracture rate after 2 years. Because of the limited sample size, it is not possible to identify the maximum clenching force that is allowable to prevent fracture caused by interocclusal forces.

Biomechanical investigation of different surgical strategies for the treatment of rib fractures using a three-dimensional human respiratory model.

PubMed

Shih, Kao-Shang; Truong, Thanh An; Hsu, Ching-Chi; Hou, Sheng-Mou

2017-11-02

Rib fracture is a common injury and can result in pain during respiration. Conservative treatment of rib fracture is applied via mechanical ventilation. However, ventilator-associated complications frequently occur. Surgical fixation is another approach to treat rib fractures. Unfortunately, this surgical treatment is still not completely defined. Past studies have evaluated the biomechanics of the rib cage during respiration using a finite element method, but only intact conditions were modelled. Thus, the purpose of this study was to develop a realistic numerical model of the human rib cage and to analyse the biomechanical performance of intact, injured and treated rib cages. Three-dimensional finite element models of the human rib cage were developed. Respiratory movement of the human rib cage was simulated to evaluate the strengths and limitations of different scenarios. The results show that a realistic human respiratory movement can be simulated and the predicted results were closely related to previous study (correlation coefficient>0.92). Fixation of two fractured ribs significantly decreased the fixation index (191%) compared to the injured model. This fixation may provide adequate fixation stability as well as reveal lower bone stress and implant stress compared with the fixation of three or more fractured ribs.

Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures.

PubMed

Stahl, Daniel; Ellington, Matthew; Brennan, Kindyle; Brennan, Michael

2017-04-01

To determine whether the presence of ipsilateral rib fractures affects the rate of a clavicle fracture being unstable (>100% displacement). A retrospective review from 2002-2013 performed at a single level 1 trauma center evaluated 243 midshaft clavicle fractures. Single Level 1 trauma center. These fractures were subdivided into those with ipsilateral rib fractures (CIR; n = 149) and those without ipsilateral rib fractures (CnIR; n = 94). The amount of displacement was measured on the initial injury radiograph and subsequent follow-up radiographs. Fractures were classified into either <100% displacement or >100% displacement, based on anteroposterior radiographs. Ipsilateral rib fractures were recorded based on which number rib was fractured and the total number of fractured ribs. One hundred sixteen (78%) of the CIR group and 51 (54%) of the CnIR group were found to have >100% displacement at follow-up (P = 0.0047). Seventy-two percent of the CIR group demonstrated progression from <100% to >100% displacement of the fracture compared with only 54% of the CnIR group (P < 0.05). The odds ratio for progression of the clavicle fracture to >100% was 4.08 (P = 0.000194) when ribs 1-4 were fractured and not significant for rib fractures 5-8 or 9-12. The presence of concomitant ipsilateral rib fractures significantly increases the rate of midshaft clavicle fractures being >100% displaced. In addition, a fracture involving the upper one-third of the ribs significantly increases the rate of the clavicle fracture being >100% displaced on early follow-up. Clavicle fractures with associated ipsilateral rib fractures tend to demonstrate an increased amount of displacement on follow-up radiographs compared with those without ipsilateral rib fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Incidence and clinical outcomes of tendon rupture following distal radius fracture.

PubMed

White, Brian D; Nydick, Jason A; Karsky, Dawnne; Williams, Bailee D; Hess, Alfred V; Stone, Jeffrey D

2012-10-01

To evaluate the incidence of tendon rupture after nonoperative and operative management of distal radius fractures, report clinical outcomes after tendon repair or transfer, and examine volar plate and dorsal screw prominence as a predictor of tendon rupture. We performed a retrospective chart review on patients treated for tendon rupture after distal radius fracture. We evaluated active range of motion, Disabilities of Arm, Shoulder, and Hand score, grip strength, and pain score, and performed radiographic evaluation of volar plate and dorsal screw prominence in both the study group and a matched control group. There were 6 tendon ruptures in 1,359 patients (0.4%) treated nonoperatively and 8 tendon ruptures in 999 patients (0.8%) treated with volar plate fixation. At the time of final follow-up, regardless of treatment, we noted that patients had minimal pain and excellent motion and grip strength. Mean Disabilities of the Shoulder, Arm, and Hand scores were 6 for patients treated nonoperatively and 4 for those treated with volar plating. We were unable to verify volar plate or dorsal screw prominence as independent risk factors for tendon rupture after distal radius fractures. However, we recommend continued follow-up and plate removal for symptomatic patients who have volar plate prominence or dorsal screw prominence. In the event of tendon rupture, we report excellent clinical outcomes after tendon repair or tendon transfer. Therapeutic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Influence of 1800 MHz GSM-like electromagnetic radiation exposure on fracture healing.

PubMed

Aslan, Ahmet; Kırdemır, Vecihi; Kocak, Ahmet; Atay, Tolga; Baydar, Metin Lütfi; Özerdemoglu, Remzi Arif; Aydogan, Nevres Hürriyet

2014-02-01

In this study, we aimed to investigate whether 1800 MHz frequency electromagnetic radiation (EMR) has an effect on bone healing. A total of 30 Wistar albino rats were divided into two equal groups. Fractures were created in the right tibias of all rats; next, intramedullary fixations with K-wire were performed. A control group (Group I) was kept under the same experimental conditions except without EMR exposure. Rats in Group II were exposed to an 1800 MHz frequency EMR for 30 min a day for 5 days a week. Next, radiological, mechanical, and histological examinations were performed to evaluate tibial fracture healing. Radiological, histological and mechanical scores were not significantly different between groups (respectively, p = 0.114, p = 0.184 and p = 0.083), and all of these scores were lower than those of the controls. EMR at 1800 MHz frequency emitted from cellular phones has no effect on bone fracture healing. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

Heterotopic ossification resection after open periarticular combat-related elbow fractures.

PubMed

Wilson, Kevin W; Dickens, Jonathan F; Heckert, Reed; Tintle, Scott M; Keeling, John J; Andersen, Romney C; Potter, Benjamin K

2013-01-01

A retrospective review was performed to evaluate the outcomes and complications following heterotopic ossification (HO) resection and lysis of adhesion procedures for posttraumatic contracture, after combat-related open elbow fractures. From 2004 to 2011, HO resection was performed on 30 blast-injured elbows at a mean 10 months after injury. Injuries included 8 (27%) Gustilo-Anderson type II fractures, 8 (27%) type III-A, 10 (33%) III-B, and 4 (13%) III-C. Mean preoperative flexion-extension range of motion (ROM) was 36.4°, compared with mean postoperative ROM of 83.6°. Mean gain of motion was 47.2°. Traumatic brain injury, need for flap, and nerve injury did not appear to have a significant effect on preoperative or postoperative ROM. Complications included one fracture, six recurrent contractures, and one nerve injury. The results and complications of HO resection for elbow contracture following high-energy, open injuries from blast trauma are generally comparable to those reported for HO resection following lower energy, closed injuries.

Influence of long-time stress relief treatments on the dynamic fracture toughness properties of ASME SA508 C1 2a and ASME SA533 GR B C12 pressure vessel steels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Logsdon, W.A.

1982-03-01

Dynamic fracture toughness tests were performed on materials which had been subjected to one of three long-time post weld type stress relief heat treatments: 48 hours at 1000/degree/F (538/degree/C), 24 hours at 1125/degree/F (607/degree/C), and 48 hours at 1125/degree/F (607/degree/C). Linear elastic K/sub Id/ results were obtained at low temperatures while J-integral techniques were utilized to evaluate dynamic fracture toughness over the transition and upper shelf temperature ranges. Tensile, Charpy impact, and drop weight nil-ductility transition tests as well as room temperature, air environment fatigue crack growth rate tests (SA508 Cl 2a only) were also performed. The fracture toughness ofmore » both materials exceeded the ASME specified minimum reference toughness K/sub IR/ curve. 17 refs.« less

Low evaluation rate for osteoporosis among patients presenting with a rib fracture.

PubMed

Kim, Whang; Gong, Hyun Sik; Lee, Seung Hoo; Park, Jin Woo; Kim, Kahyun; Baek, Goo Hyun

2017-12-01

This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. Increased emphasis or education for osteoporosis evaluation may be necessary in case of rib fractures. Rib fractures from a low-energy trauma are common in the elderly, and a history of rib fracture has been reported to increase the risk for a subsequent osteoporotic fracture. The purpose of this study was to evaluate how many of the patients presenting with an isolated rib fracture were being evaluated for osteoporosis and the risk for a subsequent fracture. We retrospectively reviewed all patients aged 50 years or older who were diagnosed with a rib fracture between January 2011 and April 2016 at a regional tertiary care university hospital near Seoul, South Korea. We excluded those who had been treated for osteoporosis or those with other concomitant fractures or fractures from a motor vehicle accident or cancer. We evaluated the frequency of dual energy X-ray absorptiometry (DXA) scan examinations in these patients. There were 231 patients with isolated rib fractures (132 men and 99 women). The mean age was 65 years. Rib fractures were most commonly diagnosed at the emergency department and most of the patients were referred to the department of thoracic surgery for follow-up evaluations. Of these 231 patients, 29 (12%) had DXA examinations after the injury, and only 9 (4%) of them did so within 6 months. Physicians specializing in orthopedic surgery, family medicine, internal medicine, rehabilitation medicine, and emergency medicine were ordering the examination. This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. This study suggests that increased emphasis or education for osteoporosis evaluation may be necessary for physicians who are often referred to for care of rib fractures.

Treatment for proximal humeral fractures with percutaneous plating: our first results.

PubMed

Imarisio, D; Trecci, A; Sabatini, L; Scagnelli, R

2013-06-01

Proximal humeral fractures are common lesions; there is no generally accepted strategy about the treatment for displaced and unstable two- to four-part fractures. We have nowadays many different surgical solutions, ranging from percutaneous pinning to shoulder arthroplasty. Percutaneous plating can be a good solution to treat some of these fractures using a minimally invasive technique and performing stable fixation that can allow early mobilization. Purpose of this paper is to evaluate the results of our first cases of percutaneous plating in proximal humeral fractures in order to assess the theoretical advantages and the incidence of possible complications. From June 2009 to February 2012, we treated 29 proximal humeral fractures with a percutaneous plating (NCB-PH plate) through an anterolateral deltoid split. For each patient, we evaluated the clinical outcome according to Constant score and the radiographic results, paying attention to fracture healing, loss of reduction, hardware complications, and head necrosis. The clinical evaluation gave a mean Constant score value of 79 points. Comparing each value to the unaffected shoulder, we could find these results: 7 excellent, 10 good, 8 fair, and 4 poor. No axillary nerve lesions were clinically detected. The radiographic evaluation showed a complete bone healing in all cases within the first 3 months. No head necrosis was detected, as well as screws loosening. In two cases, the X-ray at 2 months revealed a little loss of reduction in varus. Two patients had an anterior pain; in one of these two cases, the plate was removed. In our series, we had no cases of head necrosis, screws cutout, fracture collapse, hardware mobilization, and we think this could be the real advantage of the percutaneous technique compared to the open one, thanks to the reduced biological damage. We had some poor results, related more to patient's age than to other factors. The safety of the technique for the axillary nerve is demonstrated in the literature and confirmed by our experience. Percutaneous plating of proximal humeral fractures with NCB-PH plate has demonstrated to be a good strategy in managing these lesions without increasing complications.

Investigation of Bone Health Subsequent to Vitamin D Supplementation in Children Following Burn Injury.

PubMed

Mayes, Theresa; Gottschlich, Michele M; Khoury, Jane; Kagan, Richard J

2015-12-01

The effect of supplemental vitamin D on fracture occurrence following burn injuries is unclear. The objective of this study was to evaluate postintervention incidence of fractures in children during the rehabilitative phase postburn (PB) following participation in a randomized clinical trial of vitamin D supplementation. Follow-up for fracture evaluation was obtained in 39 of 50 patients randomized to daily enteral vitamin D2, D3, or placebo throughout the acute burn course. Serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, D2, D3, calcitonin, and bone alkaline phosphatase (BAP) measurements were obtained PB day 7, midpoint, discharge, and 1-year PB. Urinary calcium was obtained PB day 7 and midpoint. Dual-energy x-ray absorptiometry (DXA) was performed at discharge and 1-year PB. Fractures were reported in 6 of 39 respondents. Four fractures occurred in the placebo group, 2 in the D2 group, and none in the D3 group. Serum vitamin D, calcitonin, BAP, and urinary calcium were similar between fracture groups. The group with fracture morbidity had larger burn size (83.8% ± 4.9% vs 53.0% ± 2.9%, P < .0001), greater full-thickness burn (69.7% ± 9.4% vs 39.4% ± 4.1%, P = .02), and increased incidence of inhalation injury (33% vs 6%, P = .04). Decreased bone mineral density z score was noted at discharge in the placebo fracture compared with no-fracture group (P < .05). This preliminary report suggests there may be benefit of vitamin D3 in reducing postdischarge fracture risk. Results reaffirm the importance of monitoring bone health in pediatric patients postburn. © 2015 American Society for Parenteral and Enteral Nutrition.

Stabilization of Olecranon Fractures by Tension Band Wiring or Plate Osteosynthesis: A Retrospective Study of 41 Cases.

PubMed

Fournet, Alexandre; Boursier, Jean-François; Corbeau, Solène; Decambron, Adeline; Viateau, Véronique; Fayolle, Pascal; Bedu, Anne-Sophie; Leperlier, Dimitri; Manassero, Mathieu

2018-01-01

 This article aimed to describe olecranon fracture in dogs and cats and their stabilization with tension band wiring or plate osteosynthesis, and to evaluate complications associated with each technique.  Medical records of cats and dogs that had been surgically treated for olecranon fractures with either tension band wiring or plate osteosynthesis were retrospectively reviewed. The surgical technique, complications and long-term outcomes were assessed.  Forty-one olecranon fractures were included. Fractures were articular, comminuted and open in 90, 31 and 27% of cases, respectively. Tension band wiring and plate osteosynthesis were performed in 22 and 19 fractures, respectively. Complications occurred more commonly after tension band wiring (74%) compared with plate osteosynthesis (27%) ( p  = 0.002) and these were probably related to it being used in comminuted fractures ( p  = 0.01) or to errors in technique. Minor complications included Kirschner wires migration ( n  = 5), pain ( n  = 3), osteomyelitis ( n  = 3), skin breakdown ( n  = 3) and seroma ( n  = 1). Implant failure requiring further fixation ( n  = 4) was observed only in the tension band wiring group. Other major complications included skin wound debridement and closure ( n  = 1) and chronic lameness requiring implant removal ( n  = 7). Long-term functional outcomes were excellent regardless of the technique used.  Plate osteosynthesis should be performed for olecranon fracture repair if technically feasible. Schattauer GmbH Stuttgart.

Bovine xenograft application for treatment of a metatarsal nonunion fracture in an alpaca (Vicugna pacos).

PubMed

Longo, F; Finotti, L; Bellini, L; Zavan, B; Busetto, R; Isola, M

2016-05-01

A 15-year-old female huacaya alpaca (Vicugna pacos) was referred because of a non-weight-bearing lameness (4/4) in the left pelvic limb caused by a grade three open metatarsal fracture. The referring veterinarian treated the fracture with conservative management using bandages, but it progressively evolved to a non-union. Clinical examination revealed external wounds on the medial and lateral surfaces of the metatarsus. Radiographs confirmed an open, nonarticular, displaced, diaphyseal fracture of the left metatarsus. Cancellous bone was sourced from bovine proximal and distal femur epiphyses, followed by a thermal shock procedure to achieve decellularisation, to produce a xenograft. Open reduction and internal fixation of the fracture using locking plates was performed. Alignment of the fracture fragments was corrected and the xenograft was placed at the debrided fracture site to stimulate and harness osteogenesis in situ. Clinical and radiographic follow-up was performed up to 40 weeks postoperatively. Clinical evaluations revealed that the alpaca gradually increased weight bearing following bandage removal 10 days after surgery. Serial radiographs showed correct alignment of the left metatarsus, progressive bone modelling and, complete bone union at 12 weeks. Ten months postoperatively the alpaca showed no signs of lameness and resumed normal activity. For management of a metatarsal non-union, a combination of bovine xenograft application and angular stable internal fixation progressed toward an excellent long-term recovery.

Fracture discrimination by combined bone mineral density (BMD) and microarchitectural texture analysis.

PubMed

Touvier, J; Winzenrieth, R; Johansson, H; Roux, J P; Chaintreuil, J; Toumi, H; Jennane, R; Hans, D; Lespessailles, E

2015-04-01

The use of bone mineral density (BMD) for fracture discrimination may be improved by considering bone microarchitecture. Texture parameters such as trabecular bone score (TBS) or mean Hurst parameter (H) could help to find women who are at high risk of fracture in the non-osteoporotic group. The purpose of this study was to combine BMD and microarchitectural texture parameters (spine TBS and calcaneus H) for the detection of osteoporotic fractures. Two hundred and fifty five women had a lumbar spine (LS), total hip (TH), and femoral neck (FN) DXA. Additionally, texture analyses were performed with TBS on spine DXA and with H on calcaneus radiographs. Seventy-nine women had prevalent fragility fractures. The association with fracture was evaluated by multivariate logistic regressions. The diagnostic value of each parameter alone and together was evaluated by odds ratios (OR). The area under curve (AUC) of the receiver operating characteristics (ROC) were assessed in models including BMD, H, and TBS. Women were also classified above and under the lowest tertile of H or TBS according to their BMD status. Women with prevalent fracture were older and had lower TBS, H, LS-BMD, and TH-BMD than women without fracture. Age-adjusted ORs were 1.66, 1.70, and 1.93 for LS, FN, and TH-BMD, respectively. Both TBS and H remained significantly associated with fracture after adjustment for age and TH-BMD: OR 2.07 [1.43; 3.05] and 1.47 [1.04; 2.11], respectively. The addition of texture parameters in the multivariate models didn't show a significant improvement of the ROC-AUC. However, women with normal or osteopenic BMD in the lowest range of TBS or H had significantly more fractures than women above the TBS or the H threshold. We have shown the potential interest of texture parameters such as TBS and H in addition to BMD to discriminate patients with or without osteoporotic fractures. However, their clinical added values should be evaluated relative to other risk factors.

Prevalence and characteristics of rib fractures in ex-preterm infants.

PubMed

Lucas-Herald, Angela; Butler, Sandra; Mactier, Helen; McDevitt, Helen; Young, David; Ahmed, Syed Faisal

2012-12-01

This study aimed to identify the prevalence and characteristics of rib fractures in ex-preterm infants. Infants born at <37 weeks' gestation and admitted before 2011 to 3 regional neonatal units were identified from admission registers. For 2 centers, these data were available from 2000 onward and, for another center, from 2005. Electronic records were searched to identify chest radiographs performed up to age 1 year. Chest radiograph reports were then reviewed for evidence of rib fractures, and the case notes of all affected individuals were scrutinized. Of the 3318 eligible preterm infants, 1446 had a total of 9386 chest radiographs. Of these infants, 26 (1.8%) were identified as having a total of 62 rib fractures. Their median (range) gestation at birth was 26 weeks (23-34). The median chronological age of these infants at the time of the radiograph was 14 weeks (5 weeks to 8 months). The median corrected gestational age at the time of the radiograph was 39 weeks (34 weeks to 4 months). Of the 62 fractures, 27 (36%) were sited posteriorly, and 15 (53%) of the infants with posterior rib fractures were diagnosed with osteopathy of prematurity. Classic risk including conjugated hyperbilirubinemia and diuretics, were present in 23 of 26 (88%) infants. A full skeletal survey was performed in 8 of 26 (31%). Investigations for nonaccidental injury occurred in 4 of 26 (15%) cases. Evidence of rib fractures is present in ~2% of ex-preterm infants. The evaluation of these fractures in infancy requires a detailed neonatal history irrespective of the site of rib fracture.

Morphological Changes Of The Root Surface And Fracture Resistance After Treatment Of Root Fracture By CO2 Laser And Glass Ionomer Or Mineral Trioxide Aggregates

NASA Astrophysics Data System (ADS)

Badr, Y. A.; Abd El-Gawad, L. M.; Ghaith, M. E.

2009-09-01

This in vitro study evaluates the morphological changes of the root surface and fracture resistance after treatment of root cracks by CO2 laser and glass Ionomer or mineral trioxide aggregates (MTA). Fifty freshly extracted human maxillary central incisor teeth with similar dimension were selected. Crowns were sectioned at the cemento-enamel junction, and the lengths of the roots were adjusted to 13 mm. A longitudinal groove with a dimension of 1×5 mm2 and a depth of 1.5 mm was prepared by a high speed fissure bur on the labial surface of the root. The roots were divided into 5 groups: the 10 root grooves in group 1 were remained unfilled and were used as a control group. The 10 root grooves in group 2 were filled with glass Ionomer, 10 root grooves in group 3 were filled with MTA, the 10 root grooves in group 4 were filled with glass Ionomer and irradiated by CO2 laser and the 10 root grooves in group 5 were filled with MTA and irradiated with CO2 laser. Scanning electron microscopy was performed for two samples in each group. Tests for fracture strength were performed using a universal testing machine and a round tip of a diameter of 4 mm. The force was applied vertically with a constant speed of 1 mm min 1. For each root, the force at the time of fracture was recorded in Newtons. Results were evaluated statistically with ANOVA and Turkey's Honestly Significant Difference (HSD) tests. SEM micrographs revealed that the melted masses and the plate-like crystals formed a tight Chemical bond between the cementum and glass Ionomer and melted masses and globular like structure between cementum and MTA. The mean fracture resistance was the maximum fracture resistance in group 5 (810.8 N). Glass Ionomer and MTA with the help of CO2 laser can be an alternative to the treatment of tooth crack or fracture. CO2 laser increase the resistance of the teeth to fracture.

Effect of core ceramic grinding on fracture behaviour of bilayered zirconia veneering ceramic systems under two loading schemes.

PubMed

Jian, Yu-Tao; Tang, Tian-Yu; Swain, Michael V; Wang, Xiao-Dong; Zhao, Ke

2016-12-01

The aim of this in vitro study was to evaluate the effect of core ceramic grinding on the fracture behaviour of bilayered zirconia under two loading schemes. Interfacial surfaces of sandblasted zirconia disks (A) were ground with 80 (B), 120 (C) and 220 (D) grit diamond discs, respectively. Surface roughness and topographic analysis were performed using a confocal scanning laser microscope (CSLM) and a scanning electron microscopy (SEM). Relative monoclinic content was evaluated using X-ray diffraction analysis (XRD) then reevaluated after simulated veneer firing. Biaxial fracture strength (σ) and Weibull modulus (m) were calculated either with core in compression (subgroup Ac-Dc) or in tension (subgroup At-Dt). Facture surfaces were examined by SEM and energy dispersive X-ray spectroscopy (EDS). Maximum tensile stress at fracture was estimated by finite element analysis. Statistical data analysis was performed using Kruskal-Wallis and one-way ANOVA at a significance level of 0.05. As grit size of the diamond disc increased, zirconia surface roughness decreased (p<0.001). Thermal veneering treatment reversed the transformation of monoclinic phase observed after initial grinding. No difference in initial (p=0.519 for subgroups Ac-Dc) and final fracture strength (p=0.699 for subgroups Ac-Dc; p=0.328 for subgroups At-Dt) was found among the four groups for both loading schemes. While coarse grinding slightly increased final fracture strength reliability (m) for subgroups Ac-Dc. Two different modes of fracture were observed according to which material was on the bottom surface. Components of the liner porcelain remained on the zirconia surface after fracture for all groups. Technician grinding changed surface topography of zirconia ceramic material, but was not detrimental to the bilayered system strength after veneer application. Coarse grinding slightly improved the fracture strength reliability of the bilayered system tested with core in compression. It is recommended that veneering porcelain be applied directly after routine lab grinding of zirconia ceramic, and its application on rough zirconia cores may be preferred to enhance bond strength. Copyright © 2016. Published by Elsevier Ltd.

Zoom Reconstruction Tool: Evaluation of Image Quality and Influence on the Diagnosis of Root Fracture.

PubMed

Queiroz, Polyane Mazucatto; Santaella, Gustavo Machado; Capelozza, Ana Lúcia Alvares; Rosalen, Pedro Luiz; Freitas, Deborah Queiroz; Haiter-Neto, Francisco

2018-04-01

This study evaluated the image quality and the diagnosis of root fractures when using the Zoom Reconstruction tool (J Morita, Kyoto, Japan). A utility wax phantom with a metal sample inside was used for objective evaluation, and a mandible with 27 single-rooted teeth (with and without obturation and with and without vertical or horizontal fractures) was used for diagnostic evaluation. The images were acquired in 3 protocols: protocol 1, field of view (FOV) of 4 × 4 cm and a voxel size of 0.08 mm; protocol 2, FOV of 10 × 10 cm and a voxel size of 0.2 mm; and protocol 3, Zoom Reconstruction of images from protocol 2 (FOV of 4 × 4 cm and a voxel size of 0.08 mm). The objective evaluation was achieved by measuring the image noise, and the diagnosis of fractures was performed by 3 evaluators. The area under the receiver operating characteristic curve was used to calculate accuracy, and analysis of variance compared the accuracy and image quality of the protocols. Regarding quality, protocol 1 was superior to protocol 2 (P < .0001) and Zoom Reconstruction (P < .0001). Additionally, images of protocol 2 presented less noise than the Zoom Reconstruction image (P < .0001); however, for diagnosis, Zoom Reconstruction was superior in relation to protocol 2 (P = .011) and did not differ from protocol 1 (P = .228) for the diagnosis of a vertical root fracture in filled teeth. The Zoom Reconstruction tool allows better accuracy for vertical root fracture detection in filled teeth, making it possible to obtain a higher-resolution image from a lower-resolution examination without having to expose the patient to more radiation. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The effect of various backfilling techniques on the fracture resistance of simulated immature teeth performed apical plug with Biodentine.

PubMed

Topçuoğlu, Hüseyin Sinan; Kesim, Bertan; Düzgün, Salih; Tuncay, Öznur; Demirbuga, Sezer; Topçuoğlu, Gamze

2015-07-01

To evaluate the fracture resistance of simulated immature teeth that had been backfilled using different materials after using Biodentine as the apical plug material. Seventy-five single-rooted teeth were divided into five groups (n = 15). The 15 teeth in group 1 served as a negative control group and received no treatment. The remaining 60 teeth were instrumented to a #6 Peeso reamer to obtain a standard internal diameter of 1.5 mm. The apical 4 mm of 60 teeth was filled with Biodentine. The backfilling was then performed on each group as follows: group 2--no backfilling (positive control), group 3--gutta-percha, group 4--fiber post, and group 5--Biodentine. Specimens were then subjected to fracture testing. The force required to fracture each specimen was recorded, and the data were statistically analyzed. The mean fracture values of groups 1 and 4 were significantly higher than groups 2, 3, and 5 (P < 0.05). The values of groups 3 and 5 were significantly higher than group 2 (P < 0.05). The backfilling with fiber post after an apical Biodentine plug provided the highest fracture resistance among all experimental groups. © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation for distal tibial fractures in adults: a meta-analysis].

PubMed

Zhang, Qing-xi; Gao, Fu-qiang; Sun, Wei; Wang, Yun-ting; Yang, Yu-run; Li, Zirong

2015-08-01

To perform a meta-analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults. Pubmed database (from 1968 to March 2014), Cochrane library and CNKI database (from 1998 to March 2014) were searched. Case-control study on minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults were chosen,and postoperative infection, operative time, blood loss, fracture nonunion rate, delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration. Totally 5 studies (366 patients) were enrolled. Meta-analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR = 0.23,95% CI (0.06,0.92), P = 0.04]; fracture nonunion rate in MIPPO was lower than in ORIF group [OR = 0.16, 95% CI (0.03,0.76), P = 0.02]; operative time in MIPPO was shorter than in ORIF group, and had significant difference [MD = -14.42, 95% CI (-27.79, -1.05), P < 0.05]; blood loss in MIPPO was less than in ORIF group [MD= -87.17,95%CI (-99.20, -75.15), P < 0.05]; there was no obviously meaning in delayed union between two groups. For distal tibial fractures in adults, MIPPO has, advantages of short operative time, less blood loss, lower incidence of infection and fracture non-uniom, but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF, and the best treatment should choose according to patient's condition.

Reinforcement of a PMMA resin for interim fixed prostheses with silica nanoparticles.

PubMed

Topouzi, Marianthi; Kontonasaki, Eleana; Bikiaris, Dimitrios; Papadopoulou, Lambrini; Paraskevopoulos, Konstantinos M; Koidis, Petros

2017-05-01

Fractures in long span provisional/interim restorations are a common complication. Adequate fracture toughness is necessary to resist occlusal forces and crack propagation, so these restorations should be constructed with materials of improved mechanical properties. The aim of this study was to investigate the possible reinforcement of neat silica nanoparticles and trietoxyvinylsilane-modified silica nanoparticles in a PMMA resin for fixed interim restorations. Composite PMMA-Silica nanoparticles powders were mixed with PMMA liquid and compact bar shaped specimens were fabricated according to the British standard BS EN ISO 127337:2005. The single-edge notched method was used to evaluate fracture toughness (three-point bending test), while the dynamic thermomechanical properties (Storage Modulus, Loss Modulus, tanδ) of a series of nanocomposites with different amounts of nanoparticles (0.25%, 0.50%, 0.75%, 1% w.t.) were evaluated. Statistical analysis was performed and the statistically significant level was set to p<0.05. The fracture toughness of all experimental composites was remarkably higher compared to control. There was a tendency to decrease of fracture toughness, by increasing the concentration of the filler. No statistically significant differences were detected among the modified/unmodified silica nanoparticles. Dynamic mechanical properties were also affected. By increasing the silica nanoparticles content an increase in Storage Modulus was recorded, while Glass Transition Temperature was shifted at higher temperatures. Under the limitations of this in-vitro study, it can be suggested that both neat silica nanoparticles and trietoxyvinylsilane-modified silica nanoparticles, especially at low concentrations, may enhance the overall performance of fixed interim prostheses, as can effectively increase the fracture toughness, the elastic modulus and the Glass Transition Temperature of PMMA resins used in fixed provisional restorations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fracture analysis of CAD-CAM high-density polymers used for interim implant-supported fixed, cantilevered prostheses.

PubMed

Yilmaz, Burak; Alp, Gülce; Seidt, Jeremy; Johnston, William M; Vitter, Roger; McGlumphy, Edwin A

2018-01-06

The load-to-fracture performance of computer-assisted design and computer-assisted manufacturing (CAD-CAM) high-density polymer (HDP) materials in cantilevers is unknown. The purposes of this in vitro study were to evaluate the load-to-fracture performance of CAD-CAM-fabricated HDPs and to compare that with performance of autopolymerized and injection-molded acrylic resins. Specimens from 8 different brands of CAD-CAM HDPs, including Brylic Solid (BS); Brylic Gradient (BG); AnaxCAD Temp EZ (AE); AnaxCAD Temp Plus (AP); Zirkonzahn Temp Basic (Z); GDS Tempo-CAD (GD); Polident (Po); Merz M-PM-Disc (MAT); an autopolymerized acrylic resin, Imident (Conv) and an injection-molded acrylic resin, SR-IvoBase High Impact (Inj) were evaluated for load-to-fracture analysis (n=5). CAD-CAM specimens were milled from poly(methyl methacrylate) (PMMA) blocks measuring 7 mm in buccolingual width, 8 mm in occlusocervical thickness, and 30 mm in length. A wax pattern was prepared in the same dimensions used for CAD-CAM specimens, flasked, and boiled out. Autopolymerizing acrylic resin was packed and polymerized in a pressure container for 30 minutes. An identical wax pattern was flasked and boiled out, and premeasured capsules were injected (SR-IvoBase) and polymerized under hydraulic pressure for 35 minutes for the injection-molded PMMA. Specimens were thermocycled 5000 times (5°C to 55°C) and fixed to a universal testing machine to receive static loads on the 10-mm cantilever, vertically at a 1 mm/min crosshead speed until fracture occurred. Maximum load-to-fracture values were recorded. ANOVA was used to analyze the maximum force values. Significant differences among materials were analyzed by using the Ryan-Einot-Gabriel-Welsch multiple range test (α=.05). Statistically significant differences were found among load-to-fracture values of different HDPs (P<.001). GD and Po materials had significantly higher load-to-fracture values than other materials (P<.001), and no statistically significant differences were found between GD and Po. The lowest load-to-fracture values were observed for autopolymerized and BG materials, which were significantly lower than those of GD, Po, AE, AP, Z, MAT, Inj, and BS. The load-to-fracture value of autopolymerized acrylic resin was not significantly different from that of BG CAD-CAM polymer. GD and Po CAD-CAM materials had the highest load-to-fracture values. AE, AP, Z, MAT, and BS CAD-CAM polymers and injection-molded acrylic resin had similar load-to-fracture values, which were higher than those of BG and autopolymerized acrylic resin. Autopolymerized acrylic resin load-to-fracture value was similar to that of BG CAD-CAM polymer, which is colored in a gradient pattern. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

A novel fixation system for sacroiliac dislocation fracture: internal fixation system design and biomechanics analysis.

PubMed

Dawei, Tian; Na, Liu; Jun, Lei; Wei, Jin; Lin, Cai

2013-02-01

Although there were many different types of fixation techniques for sacroiliac dislocation fracture, the treat remained challenging in posterior pelvic ring injury. The purpose of this study was to evaluate the biomechanical effects of a novel fixation system we designed. 12 human cadavers (L3-pelvic-femora) were used to compare biomechanical stability after reconstruction on the same specimens in four conditions: (1) intact, (2) cable system, (3) plate-pedicle screw system, and (4) cable system and plate-pedicle screw combination system (combination system). Biomechanical testing was performed on a material testing machine for evaluating the stiffness of the pelvic fixation construct in compression and torsion. The cable system and plate-pedicle screw system alone may be insufficient to resist vertical shearing and rotational loads; however the combination system for unstable sacroiliac dislocation fractures provided significantly greater stability than single plate-pedicle or cable fixation system. The novel fixation system for unstable sacroiliac dislocation fractures produced sufficient stability in axial compression and axial rotation test in type C pelvic ring injuries. It may also offer a better solution for sacroiliac dislocation fractures. Copyright © 2012 Elsevier Ltd. All rights reserved.

Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

PubMed Central

Rak, Vaclav; Ira, Daniel; Masek, Michal

2009-01-01

Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients) of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A) were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B) in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17%) in group A and 1/34 (3%) in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Böhler's angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55%) in group A and in 30/34 (85%) in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the contraindications to surgery. PMID:19838350

Early Experience with Biodegradable Fixation of Pediatric Mandibular Fractures

PubMed Central

Mazeed, Ahmed Salah; Shoeib, Mohammed Abdel-Raheem; Saied, Samia Mohammed Ahmed; Elsherbiny, Ahmed

2014-01-01

This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-l/dl-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3–12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact. PMID:26269728

Emotional and psychological distress of persons involved in the care of patients with Alzheimer disease predicts falls and fractures in their care recipients.

PubMed

Maggio, Dario; Ercolani, Sara; Andreani, Sonia; Ruggiero, Carmelinda; Mariani, Elena; Mangialasche, Francesca; Palmari, Nicola; Mecocci, Patrizia

2010-01-01

Elderly patients with dementia have a higher risk of falls and fractures as compared to cognitively intact elderly subjects. To investigate whether psychological distress of the caregiver might predispose older persons with Alzheimer disease (AD) to falls and fractures, we performed a prospective cohort study. A consecutive series of 110 subjects with dementia underwent baseline and follow-up clinical and functional evaluations. The burden of the caregivers was recorded at baseline. Any intervening fall or fracture was ascertained at the 1-year follow-up. The caregiver burden was significantly higher in persons involved in the care of patients with AD who subsequently fell. In a multivariate regression model, the caregiver burden score predicted falls and fractures. Part of the increased risk of falls and fractures in AD might be due to the distress of caregivers, a factor potentially amenable to treatment. Copyright 2010 S. Karger AG, Basel.

Real Time Navigation-Assisted Orbital Wall Reconstruction in Blowout Fractures.

PubMed

Shin, Ho Seong; Kim, Se Young; Cha, Han Gyu; Han, Ba Leun; Nam, Seung Min

2016-03-01

Limitation in performing restoration of orbital structures is the narrow, deep, and dark surgical field, which makes it difficult to view the operative site directly. To avoid perioperative complications from this limitation, the authors have evaluated the usefulness of computer-assisted navigation techniques in surgical treatment of blowout fracture. Total 37 patients (14 medial orbital wall fractures and 23 inferior orbital wall fractures) with facial deformities had surgical treatment under the guide of navigation system between September 2012 and January 2015. All 37 patients were treated successfully and safely with navigation-assisted surgery without any complications, including diplopia, retrobulbar hematoma, globe injury, implant migration, and blindness. Blowout fracture can be treated safely under guidance of a surgical navigation system. In orbital surgery, navigation-assisted technology could give rise to improvements in the functional and aesthetic outcome and checking the position of the instruments on the surgical site in real time, without injuring important anatomic structures.

Vitamin D and nutritional status are related to bone fractures in alcoholics.

PubMed

González-Reimers, Emilio; Alvisa-Negrín, Julio; Santolaria-Fernández, Francisco; Candelaria Martín-González, M; Hernández-Betancor, Iván; Fernández-Rodríguez, Camino M; Viña-Rodríguez, J; González-Díaz, Antonieta

2011-01-01

Bone fractures are common in alcoholics. To analyse which factors (ethanol consumption; liver function impairment; bone densitometry; hormone changes; nutritional status, and disrupted social links and altered eating habits) are related to bone fractures in 90 alcoholic men admitted to our hospitalization unit because of organic problems. Bone homoeostasis-related hormones were measured in patients and age- and sex-matched controls. Whole-body densitometry was performed by a Hologic QDR-2000 (Waltham, MA, USA) densitometer, recording bone mineral density (BMD) and fat and lean mass; nutritional status and liver function were assessed. The presence of prevalent fractures was assessed by anamnesis and chest X-ray film. Forty-nine patients presented at least one fracture. We failed to find differences between patients with and without fractures regarding BMD parameters. Differences regarding fat mass were absent, but lean mass was lower among patients with bone fracture. The presence of fracture was significantly associated with impaired subjective nutritional evaluation (χ² = 5.79, P = 0.016), lower vitamin D levels (Z = 2.98, P = 0.003) and irregular eating habits (χ² = 5.32, P = 0.02). Reduced lean mass and fat mass, and altered eating habits were more prevalent among patients with only rib fractures (n = 36) than in patients with multiple fractures and/or fractures affecting other bones (n = 13). These last were more closely related to decompensated liver disease. Serum vitamin D levels showed a significant relationship with handgrip strength (ρ = 0.26, P = 0.023) and lean mass at different parts of the body, but not with fat mass. By logistic regression analysis, only vitamin D and subjective nutritional evaluation were significantly, independently related with fractures. Prevalent fractures are common among heavy alcoholics. Their presence is related more closely to nutritional status, lean mass and vitamin D levels than to BMD. Lean mass is more reduced, nutritional status is more impaired and there is a trend to more altered eating habits among patients with rib fractures, whereas multiple fractures depend more heavily on advanced liver disease.

Integrated nutritional intervention in the elderly after hip fracture. A process evaluation.

PubMed

Breedveld-Peters, José J L; Reijven, Petronella L M; Wyers, Caroline E; van Helden, Svenhjalmar; Arts, J J Chris; Meesters, Berry; Prins, Martin H; van der Weijden, Trudy; Dagnelie, Pieter C

2012-04-01

Within a multicentre randomized controlled trial aimed at improving the nutritional status and increase the speed of recovery of elderly hip fracture patients, we performed a process evaluation to investigate the feasibility of the intervention within the present Dutch health care system. Patients in the intervention group received nutritional counseling during 10 contacts. Oral nutritional supplements were advised as needed until three months after hip fracture surgery. The intervention was evaluated with respect to dieticians' adherence to the study protocol, content of nutritional counseling, and patients' adherence to recommendations given. We included 66 patients (mean age of 76, range 55-92 years); 74% women. Eighty-three percent of patients received all 10 contacts as planned, but in 62% of the patients one or more telephone calls had to be replaced by face to face contacts. Nutritional counseling was complete in 91% of contacts. Oral nutritional supplementation was needed for a median period of 76 days; 75% of the patients took the oral nutritional supplements as recommended. Nutritional counseling in elderly hip fracture patients through face to face contacts and telephone calls is feasible. However, individual tailoring of the intervention is recommended. The majority of hip fracture patients needed >2 months oral nutritional supplements to meet their nutritional requirements. The trial was registered at clincialtrails.gov as NCT00523575. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Closed retrograde multiple intramedullary Kirschner wires fixation for humeral shaft fractures with the limb flexed over an articulated support

PubMed Central

Sié, Essoh J.B.; Kacou, Aka D.; Traoré, A.; Mobiot, C.; Bamba, I.; Lambin, Y.

2014-01-01

Objective To evaluate the results of multiple closed intramedullary Kirschner wiring via a supracondylar entry point for humeral shaft fractures. Patients and methods The charts of 37 patients with humeral shaft fractures treated with the Hackethal's technique between January 2007 and December 2011 were reviewed retrospectively. The operation was performed with the patient lying in supine (n = 22) or lateral (n = 15) position. The elbow was flexed over an articulated support with the arm kept in a vertical position. Thirty-three patients were available for final evaluation with a mean follow-up delay of 14 (range, 6–24) months. We were concerned about fracture union, range of motion of the shoulder and the elbow, and complications. Final evaluation used the criteria by Qidwai. Results Bone union rate was 94%. Restriction of ranges of motion of the shoulder more than 20° was noticed in two patients due to protruding wires. Three patients developed limitation of elbow extension owing to backing out of the wires. The overall results were excellent (n = 26; 79%), good (n = 4; 12%), and poor (n = 3; 9%). Conclusion Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction. PMID:25983469

Experimental Hydromechanical Characterization and Numerical Modelling of a Fractured and Porous Sandstone

NASA Astrophysics Data System (ADS)

Souley, Mountaka; Lopez, Philippe; Boulon, Marc; Thoraval, Alain

2015-05-01

The experimental device previously used to study the hydromechanical behaviour of individual fractures on a laboratory scale, was adapted to make it possible to measure flow through porous rock mass samples in addition to fracture flows. A first series of tests was performed to characterize the hydromechanical behaviour of the fracture individually as well as the porous matrix (sandstone) comprising the fracture walls. A third test in this series was used to validate the experimental approach. These tests showed non-linear evolution of the contact area on the fracture walls with respect to effective normal stress. Consequently, a non-linear relationship was noted between the hydraulic aperture on the one hand, and the effective normal stress and mechanical opening on the other hand. The results of the three tests were then analysed by numerical modelling. The VIPLEF/HYDREF numerical codes used take into account the dual-porosity of the sample (fracture + rock matrix) and can be used to reproduce hydromechanical loading accurately. The analyses show that the relationship between the hydraulic aperture of the fracture and the mechanical closure has a significant effect on fracture flow rate predictions. By taking simultaneous measurements of flow in both fracture and rock matrix, we were able to carry out a global evaluation of the conceptual approach used.

A Single-Center Review of Facial Fractures as the Result of High-Speed Projectile Injuries

PubMed Central

Liu, Farrah C.; Halsey, Jordan N.; Hoppe, Ian C.; Ciminello, Frank S.; Lee, Edward S.; Granick, Mark S.

2018-01-01

Purpose: Gunshot injuries to the face that result in fractures of the underlying skeleton present a challenge in management. The goal of this study was to evaluate patterns of facial fractures as a result of gunshot injuries and strategies for management. Methods: A retrospective review of facial fractures resulting from gunshot injuries in a level 1 trauma center was performed for the years 2000 to 2012. Data were collected for patient demographics, fracture distribution, concomitant injuries, and surgical management strategies. Results: A total of 190 patients sustained facial fractures from a gunshot injury. The average age was 29.9 years, and 90% were male. Sixteen injuries were self-inflicted. The most common fractures were of the mandible and the orbit. Uncontrolled hemorrhage was noted on presentation in 68 patients; 100 patients were intubated on arrival. The average Glasgow Coma Scale score on arrival was 11.9. Concomitant injuries included skull fracture, intracranial hemorrhage, and intrathoracic injury. Surgical management was required in 89 patients. Nine patients required soft-tissue coverage. Thirty patients expired. Conclusion: Gunshot injuries to the face resulting in fractures of the underlying skeleton have high instances of morbidity and mortality. Life-threatening concomitant injuries can complicate management of facial fractures in this population. PMID:29713397

Continuum Damage Modeling for Dynamic Fracture Toughness of Metal Matrix Composites

NASA Astrophysics Data System (ADS)

Lee, Intaek; Ochi, Yasuo; Bae, Sungin; Song, Jungil

Short fiber reinforced metal-matrix composites (MMCs) have widely adopted as structural materials and many experimental researches have been performed to study fracture toughness of it. Fracture toughness is often referred as the plane strain(maximum constraint) fracture toughness KIc determined by the well-established standard test method, such as ASTM E399. But the application for dynamic fracture toughness KId has not been popular yet, because of reliance in capturing the crack propagating time. This paper deals with dynamic fracture toughness testing and simulation using finite element method to evaluate fracture behaviors of MMCs manufactured by squeeze casting process when material combination is varied with the type of reinforcement (appearance, size), volume fraction and combination of reinforcements, and the matrix alloy. The instrumented Charphy impact test was used for KId determination and continuum damage model embedded in commercial FE program is used to investigate the dynamic fracture toughness with the influence of elasto-visco-plastic constitutive relation of quasi-brittle fracture that is typical examples of ceramics and some fibre reinforced composites. With Compared results between experimental method and FE simulation, the determination process for KId is presented. FE simulation coupled with continuum damage model is emphasized single shot simulation can predict the dynamic fracture toughness, KId and real time evolution of that directly.

Martial arts fall training to prevent hip fractures in the elderly.

PubMed

Groen, B E; Smulders, E; de Kam, D; Duysens, J; Weerdesteyn, V

2010-02-01

Hip fractures are a common and serious consequence of falls. Training of proper fall techniques may be useful to prevent hip fractures in the elderly. The results suggested that martial arts fall techniques may be trainable in older individuals. Better performance resulted in a reduced impact force. Hip fractures are a common and serious consequence of falls. Fall training may be useful to prevent hip fractures in the elderly. This pilot study determined whether older individuals could learn martial arts (MA) fall techniques and whether this resulted in a reduced hip impact force during a sideways fall. Six male and nineteen female healthy older individuals completed a five-session MA fall training. Before and after training, force and kinematic data were collected during volitional sideways falls from kneeling position. Two MA experts evaluated the fall performance. Fear of falling was measured with a visual analog scale (VAS). After fall training, fall performance from a kneeling position was improved by a mean increase of 1.6 on a ten-point scale (P < 0.001). Hip impact force was reduced by a mean of 8% (0.20 N/N, P = 0.016). Fear of falling was reduced by 0.88 on a VAS scale (P = 0.005). MA techniques may be trainable in older individuals, and a better performance may reduce the hip impact force in a volitional sideways fall from a kneeling position. The additional reduction of fear of falling might result in the prevention of falls and related injuries.

Vision-based real-time position control of a semi-automated system for robot-assisted joint fracture surgery.

PubMed

Dagnino, Giulio; Georgilas, Ioannis; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2016-03-01

Joint fracture surgery quality can be improved by robotic system with high-accuracy and high-repeatability fracture fragment manipulation. A new real-time vision-based system for fragment manipulation during robot-assisted fracture surgery was developed and tested. The control strategy was accomplished by merging fast open-loop control with vision-based control. This two-phase process is designed to eliminate the open-loop positioning errors by closing the control loop using visual feedback provided by an optical tracking system. Evaluation of the control system accuracy was performed using robot positioning trials, and fracture reduction accuracy was tested in trials on ex vivo porcine model. The system resulted in high fracture reduction reliability with a reduction accuracy of 0.09 mm (translations) and of [Formula: see text] (rotations), maximum observed errors in the order of 0.12 mm (translations) and of [Formula: see text] (rotations), and a reduction repeatability of 0.02 mm and [Formula: see text]. The proposed vision-based system was shown to be effective and suitable for real joint fracture surgical procedures, contributing a potential improvement of their quality.

Synchrotron quantification of fracturing during maturation of shales

NASA Astrophysics Data System (ADS)

Figueroa Pilz, Fernando; Fauchille, Anne-Laure; Dowey, Patrick; Courtois, Loic; Bay, Brian; Ma, Lin; Taylor, Kevin; Mecklenburgh, Julian; Lee, Peter

2017-04-01

To understand both the hydrocarbon migration within and from shale rocks, and during hydraulic fracturing, is needed to evaluate and predict its environmental footprint. As a consequence, the time characterization of fracture networks in shale is particularly important. Time resolved synchrotron X-ray tomography was used to quantify the initiation and propagation of fractures during the simulated maturation of an organic-rich Kimmeridge Clay shale from the µm to mm scales. Scanning electron microscopy (SEM) observations were performed before and after maturation in order to compare the microstructure evolution and better understand the fracture location. Fracture and strain development during heating was quantified in 3D by Digital Volume Correlation (DVC) (Bay et al., 1999). The combination of DVC, X-Ray tomography and SEM obtained direct 4D strain measurements of the anisotropic mechanical behaviour of Kimmeridge shale with the temperature during an accelerated thermal maturation (Figueroa Pilz et al.). Such a combination has rarely been investigated in 4D at these scales in the past. In the study conditions, the results demonstrated the anisotropy in thermal expansion and the aperture fracture pathways through organic matter and clay matrix.

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe.

PubMed

Ben Nun, Alon; Orlovsky, Michael; Best, Lael Anson

2006-08-01

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.

Performance of hydraulic fracturing and matrix acidizing in horizontal wellbores -- Offshore Qatar

DOE Office of Scientific and Technical Information (OSTI.GOV)

Edwards, M.G.R.; Pongratz, R.

Considerable debate in the Middle East has centered upon what was previously felt to be two separate methods of enhancing revenues and daily production; hydraulic fracturing and horizontal drilling. In an effort to maximize return on investment, these two issues have been successfully combined in other areas of the world. In order to establish the suitability of this technology in this area, two horizontal wells with over 3,050m (10,000ft) of lateral section were drilled into the Cretaceous Kharaib formation, overlying the North Field, Offshore Qatar. A massive stimulation program was performed in order to evaluate the most feasible stimulation methodmore » from both a technical and economical perspective for further field development considerations.Three propped hydraulic fracturing treatments were performed using 183, 500kg (403, 700lb) of 20/40 mesh sand, and seventeen acid matrix treatments placing over 3,217,250l (850,000gals) of HCL into the lateral sections of both wells. This paper describes the performance, operation and logistical support required to complete this offshore operation with join a minimal time frame. The use of a mobile offshore jack-up platform, whereby a land based fracturing spread was placed onto the deck of a converted drilling rig is described.« less

Tongue Blade Bite Test Predicts Mandible Fractures

PubMed Central

Neiner, John; Free, Rachael; Caldito, Gloria; Moore-Medlin, Tara; Nathan, Cherie-Ann

2015-01-01

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility. PMID:27162567

Use of rectangular grid miniplates for fracture fixation at the mandibular angle.

PubMed

Hochuli-Vieira, Eduardo; Ha, Thi Khanh Linh; Pereira-Filho, Valfrido Antonio; Landes, Constantin Alexander

2011-05-01

The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws. This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated. The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months. The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentary contact. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Antibiotics and Facial Fractures: Evidence-Based Recommendations Compared with Experience-Based Practice

PubMed Central

Mundinger, Gerhard S.; Borsuk, Daniel E.; Okhah, Zachary; Christy, Michael R.; Bojovic, Branko; Dorafshar, Amir H.; Rodriguez, Eduardo D.

2014-01-01

Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents (n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices. PMID:25709755

Step test performance and risk of stress fractures among female army trainees.

PubMed

Cowan, David N; Bedno, Sheryl A; Urban, Nadia; Lee, Dara S; Niebuhr, David W

2012-06-01

Stress fractures and other musculoskeletal injuries are major sources of morbidity among female military trainees. Several risk factors have been postulated, particularly pre-existing fitness, usually assessed with post-entry run time for ≥ 1.0 mile. Physical fitness is not formally evaluated prior to Army entry. If a valid and simple test that identified women at increased risk of stress fracture were available and could be applied prior to entry, it would facilitate cost-benefit studies of deferral or interventions. These analyses were undertaken to determine if a 5-minute step test conducted before entry identified women at increased risk. A prospective study was conducted of weight-qualified women entering the Army in 2005-2006, with analyses completed in 2011. At the pre-entry examination, information was collected on age, BMI, smoking, race, and activity level. Everyone took the step test. All outpatient medical encounters were captured, and stress fractures and other musculoskeletal injuries identified. Women with stress fractures and those with other musculoskeletal injuries were evaluated separately. 1568 women were included in the study; 109 developed stress fractures and 803 other musculoskeletal injury. Women who failed the step test had a 76% higher stress fracture incidence and a 35% higher incidence of other musculoskeletal injuries. There was effect modification between age and test failure for stress fracture. A step test that can be administered before military entry identifies women with increased incidence of stress fracture and other musculoskeletal injury. This test could be used pre-entry to defer or target high-risk recruits for tailored fitness training before or after military entrance. Copyright © 2012 American Journal of Preventive Medicine. All rights reserved.

Evaluation of the fracture resistance of computer-aided design/computer-aided manufacturing monolithic crowns prepared in different cement thicknesses.

PubMed

Sagsoz, N Polat; Yanıkoglu, N

2018-04-01

The purpose of this study was to evaluate the fracture resistance of monolithic computer-aided design/computer-aided manufacturing (CAD/CAM) crowns that are prepared with different cement thickness. For this investigation, a human maxillary premolar tooth was selected. Master model preparation was performed with a demand bur under water spray. Master die was taken to fabricate 105 epoxy resin replicas. The crowns were milled using a CEREC 4 CAD/CAM system (Software Version, 4.2.0.57192). CAD/CAM crowns were made using resin nanoceramic, feldspathic glass ceramic, lithium disilicate, and leucite-reinforced ceramics. Each group was subdivided into three groups in accordance with three different cement thicknesses (30, 90, and 150 μm). Crowns milled out. Then RelyX ™ U200 was used as a luting agent to bond the crowns to the prepared samples. After one hour cementations, the specimens were stored in water bath at 37°C for 1 week before testing. Seven unprepared and unrestored teeth were kept and tested as a control group. A universal test machine was used to assume the fracture resistance of all specimens. The compressive load (N) that caused fracture was recorded for each specimen. Fracture resistance data were statistically analyzed by one-way ANOVA and two-factor interaction modeling test (α = 0.001). There are statistically significant differences between fracture resistances of CAD/CAM monolithic crown materials (P < 0.001). It is seen that cement thickness is not statistically significant for fracture resistance of CAD/CAM monolithic crowns (P > 0.001). CAD/CAM monolithic crown materials affected fracture resistance. Cement thickness (30, 90, and 150 μm) was not effective on fracture resistance of CAD/CAM monolithic crowns.

Potential Experimental Topics for EGS Collab Experiment 3

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnston, Henry; Mattson, Earl; Blankenship, Douglas

To facilitate the success of FORGE, the DOE GTO has initiated a new research effort, the EGS Collab project, which will utilize readily accessible underground facilities that can refine our understanding of rock mass response to stimulation and provide a test bed at intermediate (~10 m) scale for the validation of thermal-hydrological-mechanical-chemical modeling approaches as well as novel monitoring tools. The first two EGS Experiments 1 and 2 are planned be performed under different stress/fracture conditions, and will evaluate different stimulation processes: Experiment 1 will focus on hydrofracturing of a competent rock mass, while Experiment 2 will concentrate on hydroshearingmore » of a rock mass that contains natural fractures. Experiment 3 is scheduled to begin in 2019 will build off the lessons learned in Experiments 1 and 2 and will investigate alternate stimulation and operation methods to improve heat extraction in an EGS reservoir. This paper evaluates potential experiments that could potentially be conducted in Experiment 3. The two technical parameters defining energy extracted from EGS reservoirs with the highest economic uncertainty and risk are the production well flow rates and the reservoir thermal drawdown rate. A review of historical and currently on-going EGS studies has identified that over 1/2 of the projects have identified heat extraction challenges during their operation associated with these two parameters as well as some additional secondary issues. At present, no EGS reservoir has continuously produced flow rates on the order of 80 kg/s. Short circuiting (i.e. early thermal breakthrough) has been identified in numerous cases. In addition, working fluid loss (i.e. the difference between the injected fluid mass and the extracted fluid mass as compared to the injected mass) has been as high as 90%. Finally, the engineering aspects of operating a true EGS multi-fracture reservoir such as repairing/modifying fractures and controlling working fluid fluxes within multiple fractures for the effective EGS fracture management has not been sufficiently studied. To examine issues such as these, EGS Collab Experiment 3 may be conducted in the testbeds prepared for Experiments 1 and 2 by improving the previously performed stimulations, or conducted at a new site performing new stimulations with alternate method. Potential experiments may include using different stimulation and working fluids, evaluating different stimulation methods, using proppants to enhance permeability, and other high-risk high-reward methods that can be evaluated at the 10-m scale environment.« less

Cyclic fatigue resistance of ProTaper Universal instruments when subjected to static and dynamic tests.

PubMed

Lopes, Hélio P; Britto, Izabelle M O; Elias, Carlos N; Machado de Oliveira, Julio C; Neves, Mônica A S; Moreira, Edson J L; Siqueira, José F

2010-09-01

This study evaluated the number of cycles to fracture of ProTaper Universal S2 instruments when subjected to static and dynamic cyclic fatigue tests. ProTaper Universal S2 instruments were used until fracture in an artificial curved canal under rotational speed of 300 rpm in either a static or a dynamic test model. Afterward, the length of the fractured segments was measured and fractured surfaces and helical shafts analyzed by scanning electron microscopy (SEM). The number of cycles to fracture was significantly increased when instruments were tested in the dynamic model (P<.001). Instrument separation occurred at the point of maximum flexure within the artificial canals, i.e., the midpoint of the curved canal segment. SEM analysis revealed that fractured surfaces exhibited characteristics of the ductile mode. Plastic deformation was not observed in the helical shaft of fractured instruments. The number of cycles to fracture ProTaper Universal S2 instruments significantly increased with the use of instruments in a dynamic cyclic fatigue test compared with a static model. These findings reinforce the need for performing continuous pecking motions during rotary instrumentation of curved root canals. Copyright (c) 2010 Mosby, Inc. All rights reserved.

Constant-load delayed fracture test of atmospherically corroded high strength steels

NASA Astrophysics Data System (ADS)

Akiyama, Eiji; Matsukado, Katsuhiro; Li, Songjie; Tsuzaki, Kaneaki

2011-07-01

Constant load tests of circumferentially notched round bar specimens of high strength steels after cyclic corrosion test and outdoor exposure have been performed to demonstrate that delayed fracture occurs when the hydrogen content from the environment, H E, exceeds the critical hydrogen content for delayed fracture, H C. During the constant load tests the humidity around the specimen was increased in stepwise manner to increase hydrogen entry. After fracture the specimen was kept at the humidity long enough to homogenize hydrogen in the specimen and to obtain more quantitative hydrogen content by thermal desorption analysis. H E of the fractured specimens was higher than H C, and H E of the specimens not fractured was lower than H C. This result confirms that the balance between H C and H E determines the occurrence of delayed fracture and that hydrogen-content-based evaluation of susceptibility to delayed fracture is reasonable. To certify the increase of H E with increase in humidity, electrochemical hydrogen permeation test was carried out. The hydrogen permeation current density was increased especially at 98%RH. Enhancement of hydrogen entry with increase in CCT number was also shown by the test.

Minimizing complications associated with coronal approach by application of various modifications in surgical technique for treating facial trauma: A prospective study.

PubMed

Kumar, V Santosh; Rao, N Koteswara; Mohan, Kodali Rama; Krishna, Leela; Prasad, B Srinivasa; Ranganadh, N; Lakshmi, Vijaya

2016-01-01

Coronal incision is a popular and versatile surgical approach to the anterior cranial vault and upper and middle third facial skeleton. The flap itself permits widespread exposure of the fractures in this region. The bicoronal flap was first described by Hartley and Kenyon (neurosurgeons) to gain access to the anterior cranium in 1907. It extension as an access flap to the upper and lateral aspect of the face was pioneered by Tessier (1971). Esthetically, it is pleasing as the surgical scar is hidden within the hair. To evaluate the versatility of coronal incision using various modifications advocated in incision, exposure to fractured site, and closure of flap in treating the upper and middle third facial fractures. A total of ten patients diagnosed with upper and middle third facial fractures requiring open reduction and internal fixation/correction of contour defect were selected after preoperative clinical and radiographic (computed tomography scan) evaluation. All the cases were operated by coronal approach to gain the access to the fracture/defect site for reduction/correction of the defect. Advantages and complication are evaluated. Excellent access and anatomical reduction by this approach with least number of complications; if it is performed with healthy knowledge of anatomy of the scalp and temporal region. Certain minimal complications have also been noted using various modifications used in the procedure. Despite of prolonged surgical time for the exposure, it is very advantages in treating upper and middle third facial fractures due to wide access and discreet scar (minimal).

An Inset CT Specimen for Evaluating Fracture in Small Samples of Material

PubMed Central

Yahyazadehfar, M.; Nazari, A.; Kruzic, J.J.; Quinn, G.D.; Arola, D.

2013-01-01

In evaluations on the fracture behavior of hard tissues and many biomaterials, the volume of material available to study is not always sufficient to apply a standard method of practice. In the present study an inset Compact Tension (inset CT) specimen is described, which uses a small cube of material (approximately 2×2×2 mm3) that is molded within a secondary material to form the compact tension geometry. A generalized equation describing the Mode I stress intensity was developed for the specimen using the solutions from a finite element model that was defined over permissible crack lengths, variations in specimen geometry, and a range in elastic properties of the inset and mold materials. A validation of the generalized equation was performed using estimates for the fracture toughness of a commercial dental composite via the “inset CT” specimen and the standard geometry defined by ASTM E399. Results showed that the average fracture toughness obtained from the new specimen (1.23 ± 0.02 MPa•m0.5) was within 2% of that from the standard. Applications of the inset CT specimen are presented for experimental evaluations on the crack growth resistance of dental enamel and root dentin, including their fracture resistance curves. Potential errors in adopting this specimen are then discussed, including the effects of debonding between the inset and molding material on the estimated stress intensity distribution. Results of the investigation show that the inset CT specimen offers a viable approach for studying the fracture behavior of small volumes of structural materials. PMID:24268892

Applications of Computer-Assisted Navigation for the Minimally Invasive Reduction of Isolated Zygomatic Arch Fractures.

PubMed

Li, Zhi; Yang, Rong-Tao; Li, Zu-Bing

2015-09-01

Computer-assisted navigation has been widely used in oral and maxillofacial surgery. The purpose of this study was to describe the applications of computer-assisted navigation for the minimally invasive reduction of isolated zygomatic arch fractures. All patients identified as having isolated zygomatic arch fractures presenting to the authors' department from April 2013 through November 2014 were included in this prospective study. Minimally invasive reductions of isolated zygomatic arch fractures were performed on these patients under the guidance of computer-assisted navigation. The reduction status was evaluated by postoperative computed tomography (CT) 1 week after the operation. Postoperative complications and facial contours were evaluated during follow-up. Functional recovery was evaluated by the difference between the preoperative maximum interincisal mouth opening and that at the final follow-up. Twenty-three patients were included in this case series. The operation proceeded well in all patients. Postoperatively, all patients displayed uneventful healing without postoperative complication. Postoperative CT showed exact reduction in all cases. Satisfactory facial contour and functional recovery were observed in all patients. The preoperative maximal mouth opening ranged from 8 to 25 mm, and the maximal mouth opening at the final follow-up ranged from 36 to 42 mm. Computer-assisted navigation can be used not only for guiding zygomatic arch fracture reduction, but also for assessing reduction. Computer-assisted navigation is an effective and minimally invasive technique that can be applied in the reduction of isolated zygomatic arch fractures. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The prognostic value of the hawkins sign and diagnostic value of MRI after talar neck fractures.

PubMed

Chen, Hao; Liu, Wenzhou; Deng, Lianfu; Song, Weidong

2014-12-01

The early diagnosis of avascular necrosis of the talus (AVN) and prediction of ankle function for talar fractures are important. The Hawkins sign, as a radiographic predictor, could exclude the possibility of developing ischemic bone necrosis after talar neck fractures, but its relationship with ankle function remains unclear. The purpose of this study was to illustrate the prognostic effect of the Hawkins sign on ankle function after talar neck fractures and to study the value of early MRI in detecting the AVN changes after talus fractures. Cases of talar neck fractures between November 2008 and November 2013 were evaluated. The occurrences of the Hawkins sign and AVN were studied. X-ray imaging was performed at multiple time points from the 4th to the 12th week after the fractures, and MRI examinations were used in the Hawkins sign negative group, with the time span ranging from 1.5 to 12 months. AOFAS scores of the Hawkins sign positive and negative groups were compared during the follow-up. Forty-four cases (48 feet) were evaluated. The occurrence of positive Hawkins sign was 50%, 30%, and 33.3%, the incidence of AVN was 0%, 10%, and 50%, respectively, in type I, type II, and type III and IV talus fractures, respectively. The AOFAS scores showed no statistically significant difference between Hawkins sign positive group and negative group in type I and II fractures. The Hawkins sign positive group had better AOFAS scores than the negative group in type III and IV fractures. However, there was no statistically significant difference between Hawkins sign positive and negative groups when AVN cases were excluded in type III and IV fractures. The Hawkins sign was a reliable predictor excluding the possibility of AVN. It did not have predictive value on the ankle function in low-energy fractures and may predict better ankle function in high-energy fractures. MRI can diagnose AVN during an earlier period, and we believe Hawkins sign negative patients should undergo MRI examinations 12 weeks after the fractures, especially in high-energy traumatic cases. Level III, comparative case series. © The Author(s) 2014.

Review of reactor pressure vessel evaluation report for Yankee Rowe Nuclear Power Station (YAEC No. 1735)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheverton, R.D.; Dickson, T.L.; Merkle, J.G.

1992-03-01

The Yankee Atomic Electric Company has performed an Integrated Pressurized Thermal Shock (IPTS)-type evaluation of the Yankee Rowe reactor pressure vessel in accordance with the PTS Rule (10 CFR 50. 61) and a US Regulatory Guide 1.154. The Oak Ridge National Laboratory (ORNL) reviewed the YAEC document and performed an independent probabilistic fracture-mechnics analysis. The review included a comparison of the Pacific Northwest Laboratory (PNL) and the ORNL probabilistic fracture-mechanics codes (VISA-II and OCA-P, respectively). The review identified minor errors and one significant difference in philosophy. Also, the two codes have a few dissimilar peripheral features. Aside from these differences,more » VISA-II and OCA-P are very similar and with errors corrected and when adjusted for the difference in the treatment of fracture toughness distribution through the wall, yield essentially the same value of the conditional probability of failure. The ORNL independent evaluation indicated RT{sub NDT} values considerably greater than those corresponding to the PTS-Rule screening criteria and a frequency of failure substantially greater than that corresponding to the primary acceptance criterion'' in US Regulatory Guide 1.154. Time constraints, however, prevented as rigorous a treatment as the situation deserves. Thus, these results are very preliminary.« less

Review of reactor pressure vessel evaluation report for Yankee Rowe Nuclear Power Station (YAEC No. 1735)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheverton, R.D.; Dickson, T.L.; Merkle, J.G.

1992-03-01

The Yankee Atomic Electric Company has performed an Integrated Pressurized Thermal Shock (IPTS)-type evaluation of the Yankee Rowe reactor pressure vessel in accordance with the PTS Rule (10 CFR 50. 61) and a US Regulatory Guide 1.154. The Oak Ridge National Laboratory (ORNL) reviewed the YAEC document and performed an independent probabilistic fracture-mechnics analysis. The review included a comparison of the Pacific Northwest Laboratory (PNL) and the ORNL probabilistic fracture-mechanics codes (VISA-II and OCA-P, respectively). The review identified minor errors and one significant difference in philosophy. Also, the two codes have a few dissimilar peripheral features. Aside from these differences,more » VISA-II and OCA-P are very similar and with errors corrected and when adjusted for the difference in the treatment of fracture toughness distribution through the wall, yield essentially the same value of the conditional probability of failure. The ORNL independent evaluation indicated RT{sub NDT} values considerably greater than those corresponding to the PTS-Rule screening criteria and a frequency of failure substantially greater than that corresponding to the ``primary acceptance criterion`` in US Regulatory Guide 1.154. Time constraints, however, prevented as rigorous a treatment as the situation deserves. Thus, these results are very preliminary.« less

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya

PubMed Central

Elarabi, Mohammed S.

2018-01-01

Background The purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns. Material and Methods A retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients. Results The male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%). Conclusions In summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption. Key words:Tauma, mandible, zygomatic complex, maxilla, treatment, complications. PMID:29476683

Mathematical modeling and simulation analysis of hydraulic fracture propagation in three-layered poro-elastic media

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moon, H.Y.; Advani, S.H.; Lee, T.S.

1992-11-01

Hydraulic fracturing plays a pivotal role in the enhancement of oil and gas production recovery from low permeability reservoirs. The process of hydraulic fracturing entails the generation of a fracture by pumping fluids blended with special chemicals and proppants into the payzone at high injection rates and pressures to extend and wedge fractures. The mathematical modeling of hydraulically induced fractures generally incorporates coupling between the formation elasticity, fracture fluid flow, and fracture mechanics equations governing the formation structural responses, fluid pressure profile, and fracture growth. Two allied unsymmetric elliptic fracture models are developed for fracture configuration evolutions in three-layered rockmore » formations. The first approach is based on a Lagrangian formulation incorporating pertinent energy components associated with the formation structural responses and fracture fluid flow. The second model is based on a generalized variational principle, introducing an energy rate related functional. These models initially simulate a penny-shaped fracture, which becomes elliptic if the crack tips encounters (upper and/or lower) barriers with differential reservoir properties (in situ stresses, 16 elastic moduli, and fracture toughness-contrasts and fluid leak-off characteristics). The energy rate component magnitudes are determined to interpret the governing hydraulic fracture mechanisms during fracture evolution. The variational principle is extended to study the phenomenon and consequences of fluid lag in fractures. Finally, parametric sensitivity and energy rate investigations to evaluate the roles of controllable hydraulic treatment variables and uncontrollable reservoir property characterization parameters are performed. The presented field applications demonstrate the overall capabilities of the developed models. These studies provide stimulation treatment guidelines for fracture configuration design, control, and optimization.« less

Fractures and the increased risk of suicide.

PubMed

Chang, C-F; Lai, E C-C; Yeh, M-K

2018-06-01

Aims A high rate of suicide has been reported in patients who sustain fractures, but the association remains uncertain in the context of other factors. The aim of this study was to examine the association between fractures and the risk of suicide in this contextual setting. Patients and Methods We performed a case-control study of patients aged 40 years or older who died by suicide between 2000 and 2011. We included patients' demographics, physical and mental health problems, and socioeconomic factors. We performed conditional logistic regression to evaluate the associations between fractures and the risk of suicide. Results We included a total of 34 794 patients who died by suicide and 139 176 control patients. We found that fractures as a homogenous group (adjusted odds ratios (aOR), 1.48; 95% confidence interval (CI) 1.43 to 1.53), and specifically pelvic (aOR 2.04; 95% CI 1.68 to 2.47) and spinal fractures (aOR 1.53; 95% CI 1.43 to 1.64), were associated with a higher risk of suicide. In addition, we found that patients who had a lower income, had never married, had lower levels of educational attainment, or had coexistent physical and mental conditions such as anxiety, mood disorders, and psychosis-related disorders had a higher risk of suicide. Conclusion Fractures, specifically those of the hip and spine, were associated with an increased risk of suicide. The findings suggest that greater clinical attention should be given to this risk in patients with fractures, especially for those with additional risk factors. Cite this article: Bone Joint J 2018;100-B:780-6.

Oral motor and electromyographic characterization of adults with facial fractures: a comparison between different fracture severities.

PubMed

da Silva, Amanda Pagliotto; Sassi, Fernanda Chiarion; Bastos, Endrigo; Alonso, Nivaldo; de Andrade, Claudia Regina Furquim

2017-05-01

To characterize the oral motor system of adults with facial injuries and to compare the oral motor performance/function between two different groups. An observational, descriptive, cross-sectional study was conducted in 38 patients presenting with facial trauma who were assigned to the Division of Orofacial Myology of a Brazilian School Hospital. Patients were divided into two groups: Group 1 (G1) consisted of 19 patients who were submitted to open reduction of at least one facial fracture, and Group 2 (G2) consisted of 19 individuals who were submitted to closed fracture reduction with maxillomandibular fixation. For comparison purposes, a group of 19 healthy volunteers was recruited. All participants underwent a clinical assessment that included an oral motor evaluation, assessment of the mandibular range of motions, and electromyographic assessment of the masticatory muscles. Clinical assessment of the oral motor organs indicated that G1 and G2 presented deficits related to the posture, position, and mobility of the oral motor organs. Patients also presented limited mandibular ranges of movement. Deficits were greater for individuals in G1, especially for maximal incisor opening. Additionally, patients in G1 and G2 presented a similar electromyographic profile of the masticatory muscles (i.e., patients with facial fractures presented lower overall muscle activity and significant asymmetrical activity of the masseter muscle during maximum voluntary teeth clenching). Patients in G1 and G2 presented similar functional deficits after fracture treatment. The severity of facial fractures did not influence muscle function/performance 4 months after the correction of fractures.

Oral motor and electromyographic characterization of adults with facial fractures: a comparison between different fracture severities

PubMed Central

da Silva, Amanda Pagliotto; Sassi, Fernanda Chiarion; Bastos, Endrigo; Alonso, Nivaldo; de Andrade, Claudia Regina Furquim

2017-01-01

OBJECTIVES: To characterize the oral motor system of adults with facial injuries and to compare the oral motor performance/function between two different groups. METHODS: An observational, descriptive, cross-sectional study was conducted in 38 patients presenting with facial trauma who were assigned to the Division of Orofacial Myology of a Brazilian School Hospital. Patients were divided into two groups: Group 1 (G1) consisted of 19 patients who were submitted to open reduction of at least one facial fracture, and Group 2 (G2) consisted of 19 individuals who were submitted to closed fracture reduction with maxillomandibular fixation. For comparison purposes, a group of 19 healthy volunteers was recruited. All participants underwent a clinical assessment that included an oral motor evaluation, assessment of the mandibular range of motions, and electromyographic assessment of the masticatory muscles. RESULTS: Clinical assessment of the oral motor organs indicated that G1 and G2 presented deficits related to the posture, position, and mobility of the oral motor organs. Patients also presented limited mandibular ranges of movement. Deficits were greater for individuals in G1, especially for maximal incisor opening. Additionally, patients in G1 and G2 presented a similar electromyographic profile of the masticatory muscles (i.e., patients with facial fractures presented lower overall muscle activity and significant asymmetrical activity of the masseter muscle during maximum voluntary teeth clenching). CONCLUSION: Patients in G1 and G2 presented similar functional deficits after fracture treatment. The severity of facial fractures did not influence muscle function/performance 4 months after the correction of fractures. PMID:28591339

Ability of Ultrasonography in Detection of Different Extremity Bone Fractures; a Case Series Study

PubMed Central

Bozorgi, Farzad; Shayesteh Azar, Massoud; Montazer, Seyed Hossein; Chabra, Aroona; Heidari, Seyed Farshad; Khalilian, Alireza

2017-01-01

Introduction: Despite radiography being the gold standard in evaluation of orthopedic injuries, using bedside ultrasonography has several potential supremacies such as avoiding exposure to ionizing radiation, availability in pre-hospital settings, being extensively accessible, and ability to be used on the bedside. The aim of the present study is to evaluate the diagnostic accuracy of ultrasonography in detection of extremity bone fractures. Methods: This study is a case series study, which was prospectively conducted on multiple blunt trauma patients, who were 18 years old or older, had stable hemodynamic, Glasgow coma scale 15, and signs or symptoms of a possible extremity bone fracture. After initial assessment, ultrasonography of suspected bones was performed by a trained emergency medicine resident and prevalence of true positive and false negative findings were calculated compared to plain radiology. Results: 108 patients with the mean age of 44.6 ± 20.4 years were studied (67.6% male). Analysis was done on 158 sites of fracture, which were confirmed with plain radiography. 91 (57.6%) cases were suspected to have upper extremity fracture(s) and 67 (42.4%) to have lower ones. The most frequent site of injuries were forearm (36.7%) in upper limbs and leg (27.8%) in lower limbs. Prevalence of true positive and false negative cases for fractures detected by ultrasonography were 59 (64.8%) and 32 (35.52%) for upper and 49 (73.1%) and 18 (26.9%) for lower extremities, respectively. In addition, prevalence of true positive and false negative detected cases for intra-articular fractures were 24 (48%) and 26 (52%), respectively. Conclusion The present study shows the moderate sensitivity (68.3%) of ultrasonography in detection of different extremity bone fractures. Ultrasonography showed the best sensitivity in detection of femur (100%) and humerus (76.2%) fractures, respectively. It had low sensitivity in detection of in intra-articular fractures. PMID:28286822

Ability of Ultrasonography in Detection of Different Extremity Bone Fractures; a Case Series Study.

PubMed

Bozorgi, Farzad; Shayesteh Azar, Massoud; Montazer, Seyed Hossein; Chabra, Aroona; Heidari, Seyed Farshad; Khalilian, Alireza

2017-01-01

Despite radiography being the gold standard in evaluation of orthopedic injuries, using bedside ultrasonography has several potential supremacies such as avoiding exposure to ionizing radiation, availability in pre-hospital settings, being extensively accessible, and ability to be used on the bedside. The aim of the present study is to evaluate the diagnostic accuracy of ultrasonography in detection of extremity bone fractures. This study is a case series study, which was prospectively conducted on multiple blunt trauma patients, who were 18 years old or older, had stable hemodynamic, Glasgow coma scale 15, and signs or symptoms of a possible extremity bone fracture. After initial assessment, ultrasonography of suspected bones was performed by a trained emergency medicine resident and prevalence of true positive and false negative findings were calculated compared to plain radiology. 108 patients with the mean age of 44.6 ± 20.4 years were studied (67.6% male). Analysis was done on 158 sites of fracture, which were confirmed with plain radiography. 91 (57.6%) cases were suspected to have upper extremity fracture(s) and 67 (42.4%) to have lower ones. The most frequent site of injuries were forearm (36.7%) in upper limbs and leg (27.8%) in lower limbs. Prevalence of true positive and false negative cases for fractures detected by ultrasonography were 59 (64.8%) and 32 (35.52%) for upper and 49 (73.1%) and 18 (26.9%) for lower extremities, respectively. In addition, prevalence of true positive and false negative detected cases for intra-articular fractures were 24 (48%) and 26 (52%), respectively. The present study shows the moderate sensitivity (68.3%) of ultrasonography in detection of different extremity bone fractures. Ultrasonography showed the best sensitivity in detection of femur (100%) and humerus (76.2%) fractures, respectively. It had low sensitivity in detection of in intra-articular fractures.

Prospective evaluation of risk of vertebral fractures using quantitative ultrasound measurements and bone mineral density in a population-based sample of postmenopausal women: results of the Basel Osteoporosis Study.

PubMed

Hollaender, R; Hartl, F; Krieg, M-A; Tyndall, A; Geuckel, C; Buitrago-Tellez, C; Manghani, M; Kraenzlin, M; Theiler, R; Hans, D

2009-03-01

Prospective studies have shown that quantitative ultrasound (QUS) techniques predict the risk of fracture of the proximal femur with similar standardised risk ratios to dual-energy x-ray absorptiometry (DXA). Few studies have investigated these devices for the prediction of vertebral fractures. The Basel Osteoporosis Study (BOS) is a population-based prospective study to assess the performance of QUS devices and DXA in predicting incident vertebral fractures. 432 women aged 60-80 years were followed-up for 3 years. Incident vertebral fractures were assessed radiologically. Bone measurements using DXA (spine and hip) and QUS measurements (calcaneus and proximal phalanges) were performed. Measurements were assessed for their value in predicting incident vertebral fractures using logistic regression. QUS measurements at the calcaneus and DXA measurements discriminated between women with and without incident vertebral fracture, (20% height reduction). The relative risks (RRs) for vertebral fracture, adjusted for age, were 2.3 for the Stiffness Index (SI) and 2.8 for the Quantitative Ultrasound Index (QUI) at the calcaneus and 2.0 for bone mineral density at the lumbar spine. The predictive value (AUC (95% CI)) of QUS measurements at the calcaneus remained highly significant (0.70 for SI, 0.72 for the QUI, and 0.67 for DXA at the lumbar spine) even after adjustment for other confounding variables. QUS of the calcaneus and bone mineral density measurements were shown to be significant predictors of incident vertebral fracture. The RRs for QUS measurements at the calcaneus are of similar magnitude as for DXA measurements.

Application of an innovative computerized virtual planning system in acetabular fracture surgery: A feasibility study.

PubMed

Wang, Huixiang; Wang, Fang; Newman, Simon; Lin, Yanping; Chen, Xiaojun; Xu, Lu; Wang, Qiugen

2016-08-01

Acetabular fracture surgery is amongst the most challenging tasks in the field of trauma surgery and careful preoperative planning is crucial for success. The aim of this paper is to describe the preliminary outcome of the utilization of an innovative computerized virtual planning system for acetabular fractures. 3D models of acetabular fractures and surrounding soft tissues from six patients were constructed from preoperative CT scans. A novel highly-automatic segmentation technique was performed on the 3D model to separate each fracture fragment, then 3D virtual reduction was performed. Additionally, the models were used to assess potential surgical approaches with reference to both the fracture and the surrounding soft tissues. The time required for virtual planning was recorded. After surgery, the virtual plan was compared to the real surgery with respect to surgical approach and reduction sequence. A Likert scale questionnaire was completed by the surgeons to evaluate their satisfaction with the system. Virtual planning was successfully completed in all cases. The planned surgical approach was followed in all cases with the planned reduction sequence followed completely in five cases and partially in one. The mean time required for virtual planning was 38.7min (range 21-57, SD=15.5). The mean time required for planning of B-type fractures was 25.0min (range 21-30, SD=4.6), of C-type fracture 52.3min (range 49-57, SD=4.2). The results of the questionnaire demonstrated a high level of satisfaction with the planning system. This study demonstrates that the virtual planning system is feasible in clinical settings with high satisfaction and acceptability from the surgeons. It provides a viable option for the planning of acetabular fracture surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice.

PubMed

Harvey, N C; Glüer, C C; Binkley, N; McCloskey, E V; Brandi, M-L; Cooper, C; Kendler, D; Lamy, O; Laslop, A; Camargos, B M; Reginster, J-Y; Rizzoli, R; Kanis, J A

2015-09-01

Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX. Copyright © 2015 Elsevier Inc. All rights reserved.

Functional recovery of older people with hip fracture: does malnutrition make a difference?

PubMed

Li, Hsiao-Juan; Cheng, Huey-Shinn; Liang, Jersey; Wu, Chi-Chuan; Shyu, Yea-Ing Lotus

2013-08-01

To report a study of the effects of protein-energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention. It is not clear whether protein-energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture. A randomized experimental design. Data were collected between 2002-2006 from older people with hip fracture (N = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture. The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein-energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein-energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non-malnourished patients. Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture. © 2012 Blackwell Publishing Ltd.

Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice

PubMed Central

Harvey, N.C.; Glüer, C.C.; Binkley, N.; McCloskey, E.V.; Brandi, M-L.; Cooper, C.; Kendler, D.; Lamy, O.; Laslop, A.; Camargos, B.M.; Reginster, J-Y.; Rizzoli, R.; Kanis, J.A.

2015-01-01

Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g. diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX. PMID:25988660

Small-scale fracture toughness of ceramic thin films: the effects of specimen geometry, ion beam notching and high temperature on chromium nitride toughness evaluation

NASA Astrophysics Data System (ADS)

Best, James P.; Zechner, Johannes; Wheeler, Jeffrey M.; Schoeppner, Rachel; Morstein, Marcus; Michler, Johann

2016-12-01

For the implementation of thin ceramic hard coatings into intensive application environments, the fracture toughness is a particularly important material design parameter. Characterisation of the fracture toughness of small-scale specimens has been a topic of great debate, due to size effects, plasticity, residual stress effects and the influence of ion penetration from the sample fabrication process. In this work, several different small-scale fracture toughness geometries (single-beam cantilever, double-beam cantilever and micro-pillar splitting) were compared, fabricated from a thin physical vapour-deposited ceramic film using a focused ion beam source, and then the effect of the gallium-milled notch on mode I toughness quantification investigated. It was found that notching using a focused gallium source influences small-scale toughness measurements and can lead to an overestimation of the fracture toughness values for chromium nitride (CrN) thin films. The effects of gallium ion irradiation were further studied by performing the first small-scale high-temperature toughness measurements within the scanning electron microscope, with the consequence that annealing at high temperatures allows for diffusion of the gallium to grain boundaries promoting embrittlement in small-scale CrN samples. This work highlights the sensitivity of some materials to gallium ion penetration effects, and the profound effect that it can have on fracture toughness evaluation.

Training safer orthopedic surgeons. Construct validation of a virtual-reality simulator for hip fracture surgery.

PubMed

Akhtar, Kashif; Sugand, Kapil; Sperrin, Matthew; Cobb, Justin; Standfield, Nigel; Gupte, Chinmay

2015-01-01

Virtual-reality (VR) simulation in orthopedic training is still in its infancy, and much of the work has been focused on arthroscopy. We evaluated the construct validity of a new VR trauma simulator for performing dynamic hip screw (DHS) fixation of a trochanteric femoral fracture. 30 volunteers were divided into 3 groups according to the number of postgraduate (PG) years and the amount of clinical experience: novice (1-4 PG years; less than 10 DHS procedures); intermediate (5-12 PG years; 10-100 procedures); expert (> 12 PG years; > 100 procedures). Each participant performed a DHS procedure and objective performance metrics were recorded. These data were analyzed with each performance metric taken as the dependent variable in 3 regression models. There were statistically significant differences in performance between groups for (1) number of attempts at guide-wire insertion, (2) total fluoroscopy time, (3) tip-apex distance, (4) probability of screw cutout, and (5) overall simulator score. The intermediate group performed the procedure most quickly, with the lowest fluoroscopy time, the lowest tip-apex distance, the lowest probability of cutout, and the highest simulator score, which correlated with their frequency of exposure to running the trauma lists for hip fracture surgery. This study demonstrates the construct validity of a haptic VR trauma simulator with surgeons undertaking the procedure most frequently performing best on the simulator. VR simulation may be a means of addressing restrictions on working hours and allows trainees to practice technical tasks without putting patients at risk. The VR DHS simulator evaluated in this study may provide valid assessment of technical skill.

Comparison of qualitative and quantitative evaluation of diffusion-weighted MRI and chemical-shift imaging in the differentiation of benign and malignant vertebral body fractures.

PubMed

Geith, Tobias; Schmidt, Gerwin; Biffar, Andreas; Dietrich, Olaf; Dürr, Hans Roland; Reiser, Maximilian; Baur-Melnyk, Andrea

2012-11-01

The objective of our study was to compare the diagnostic value of qualitative diffusion-weighted imaging (DWI), quantitative DWI, and chemical-shift imaging in a single prospective cohort of patients with acute osteoporotic and malignant vertebral fractures. The study group was composed of patients with 26 osteoporotic vertebral fractures (18 women, eight men; mean age, 69 years; age range, 31 years 6 months to 86 years 2 months) and 20 malignant vertebral fractures (nine women, 11 men; mean age, 63.4 years; age range, 24 years 8 months to 86 years 4 months). T1-weighted, STIR, and T2-weighted sequences were acquired at 1.5 T. A DW reverse fast imaging with steady-state free precession (PSIF) sequence at different delta values was evaluated qualitatively. A DW echo-planar imaging (EPI) sequence and a DW single-shot turbo spin-echo (TSE) sequence at different b values were evaluated qualitatively and quantitatively using the apparent diffusion coefficient. Opposed-phase sequences were used to assess signal intensity qualitatively. The signal loss between in- and opposed-phase images was determined quantitatively. Two-tailed Fisher exact test, Mann-Whitney test, and receiver operating characteristic analysis were performed. Sensitivities, specificities, and accuracies were determined. Qualitative DW-PSIF imaging (delta = 3 ms) showed the best performance for distinguishing between benign and malignant fractures (sensitivity, 100%; specificity, 88.5%; accuracy, 93.5%). Qualitative DW-EPI (b = 50 s/mm(2) [p = 1.00]; b = 250 s/mm(2) [p = 0.50]) and DW single-shot TSE imaging (b = 100 s/mm(2) [p = 1.00]; b = 250 s/mm(2) [p = 0.18]; b = 400 s/mm(2) [p = 0.18]; b = 600 s/mm(2) [p = 0.39]) did not indicate significant differences between benign and malignant fractures. DW-EPI using a b value of 500 s/mm(2) (p = 0.01) indicated significant differences between benign and malignant vertebral fractures. Quantitative DW-EPI (p = 0.09) and qualitative opposed-phase imaging (p = 0.06) did not exhibit significant differences, quantitative DW single-shot TSE imaging (p = 0.002) and quantitative chemical-shift imaging (p = 0.01) showed significant differences between benign and malignant fractures. The DW-PSIF sequence (delta = 3 ms) had the highest accuracy in differentiating benign from malignant vertebral fractures. Quantitative chemical-shift imaging and quantitative DW single-shot TSE imaging had a lower accuracy than DW-PSIF imaging because of a large overlap. Qualitative assessment of opposed-phase, DW-EPI, and DW single-shot TSE sequences and quantitative assessment of the DW-EPI sequence were not suitable for distinguishing between benign and malignant vertebral fractures.

Effects of salmon calcitonin on fracture healing in ovariectomized rats.

PubMed

Li, Xiaolin; Luo, Xinle; Yu, Nansheng; Zeng, Bingfang

2007-01-01

To explore the effects of salmon calcitonin on the healing process of osteoporotic fractures in ovariectomized rats. We performed this study in The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China, during the period March 2002 to December 2004. We used 120 female adult Wistar rats in this experiment, among which 90 underwent ovariectomy (OVX) and the other 30 had sham-operation. All rats had their left tibias fractured 3 months later. The 90 OVX rats were randomly divided into 3 groups with 30 in each, while the 30 sham-operated rats served as control group. After the fracture the rats had subcutaneous injection of normal saline, salmon calcitonin and estrogen, respectively. X-ray film, histological examination, bone mineral density (BMD) measurement and biomechanics testing were carried out to evaluate the fracture healing. Compared with OVX rats treated with normal saline, the rats with salmon calcitonin had significantly higher BMD values in the left tibia, higher max torque, shear stress of the left tibia 8 weeks after fracture (p<0.05), and presented with stronger callus formation, shorter fracture healing time and faster normalization of microstructure of bone trabeculae. Salmon calcitonin can, not only increase BMD in osteoporotic bone, but also enhance the bone biomechanical properties and improve the process of fracture healing in fractured osteoporotic bone.

Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol.

PubMed

Raduan Neto, Jorge; de Moraes, Vinicius Ynoe; Gomes Dos Santos, João B; Faloppa, Flávio; Belloti, João Carlos

2014-03-05

Various treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported). The study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student's t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error results in 36 patients per group. Results from this study protocol will improve the current evidence regarding to the surgical treatment these fractures. ISCRTN09599740.

Functional outcomes of conservatively treated clavicle fractures

PubMed Central

Bajuri, Mohd Yazid; Maidin, S; Rauf, A; Baharuddin, M; Harjeet, S

2011-01-01

OBJECTIVE: The main aim of the study was to analyze the outcomes of clavicle fractures in adults treated non-surgically and to evaluate the clinical effects of displacement, fracture patterns, fracture location, fracture comminution, shortening and fracture union on shoulder function. METHODS: Seventy clavicle fractures were non-surgically treated in the Orthopedics Department at the Tuanku Ja'afar General Hospital, a tertiary care hospital in Seremban, Malaysia, an average of six months after injury. The clavicle fractures were treated conservatively with an arm sling and a figure-eight splint for three weeks. No attempt was made to reduce displaced fractures, and the patients were allowed immediate free-shoulder mobilization, as tolerated. They were prospectively evaluated clinically and radiographically. Shoulder function was evaluated using the Constant scoring technique. RESULTS: There were statistically significant functional outcome impairments in non-surgically treated clavicle fractures that correlated with the fracture type (comminution), the fracture displacement (21 mm or more), shortening (15 mm or more) and the fracture union (malunion). CONCLUSION: This article reveals the need for surgical intervention to treat clavicle fractures and improve shoulder functional outcomes. PMID:21655759

Pelvic X-ray misses out on detecting sacral fractures in the elderly - Importance of CT imaging in blunt pelvic trauma.

PubMed

Schicho, Andreas; Schmidt, Stefan A; Seeber, Kevin; Olivier, Alain; Richter, Peter H; Gebhard, Florian

2016-03-01

Patients aged 75 years and older with blunt pelvic trauma are frequently seen in the ER. The standard diagnostic tool in these patients is the plain a.p.-radiograph of the pelvis. Especially lesions of the posterior pelvic ring are often missed due to e.g. bowel gas projection and enteric overlay. With a retrospective study covering these patients over a 3 year period in our level I trauma centre, we were able to evaluate the rate of missed injuries in the a.p.-radiograph whenever a corresponding CT scan was performed. Age, gender, and accompanying fractures of the pelvic ring were recorded. The intrinsic test characteristics and the performance in the population were calculated according to standard formulas. Thus, 233 consecutive patients with blunt pelvic trauma with both conventional radiographic examination and computed tomography (CT) were included. Thereof, 56 (23%) showed a sacral fracture in the CT scan. Of 233 pelvic X-ray-images taken, 227 showed no sacral fracture. 51 (21.7%) of these were false negative, yielding a sensitivity of just 10.5%. Average age of patients with sacral fractures was 85.1±6.1 years, with 88% being female. Sacral fractures were often accompanied by lesions of the anterior pelvic ring with pubic bone fractures in 75% of sacrum fracture cases. Second most concomitant fractures are found at the acetabulum (23.3%). Plain radiographic imaging is especially likely to miss out fractures of the posterior pelvic ring, which nowadays can be of therapeutic consequence. Besides the physicians experience in the ED, profound knowledge of insensitivity of plain radiographs in finding posterior pelvic ring lesions is crucial for a reliable diagnostic routine. Since the high mortality caused by prolonged immobilisation due to pelvic ring injuries, all fractures should be identified. We therefore provide a diagnostic algorithm for blunt pelvic trauma in the elderly. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cryogenic Fracture Toughness Evaluation of an Investment Cast Al-Be Alloy for Structural Applications

NASA Technical Reports Server (NTRS)

Gamwell, W. R.; McGill, P. B.

2006-01-01

Aluminum-Beryllium metal matrix composite materials are useful due to their desirable performance characteristics for aerospace applications. Desirable characteristics of this material includes light-weight, dimensional stability, stiffness, good vibration damping characteristics, low coefficient of thermal expansion, and workability, This material is 3.5 times stiffer and 22% lighter than conventional aluminum alloys. electro-optical systems, advanced sensor and guidance components for flight and satellite systems, components for light-weight high-performance aircraft engines, and structural components for helicopters. Aluminum-beryllium materials are now available in the form of near net shape investment castings. In this materials properties characterization study, the cryogenic tensile and fracture properties of an investment casting alloy, Beralcast 363, were determined. Tensile testing was performed at 21 C (70 F), -73.3 C (-100 F), -195.5 C (-320 F) and -252.8 C (-423 F), and fracture (K(sub lc) and da/dN) testing was performed at -73.3 C (-100 F), -195.5 C (-320 F) and -252.8 C (-423 F). Their use is attractive for weight critical structural applications such as advanced

Outcome of limb fracture repair in rabbits: 139 cases (2007-2015).

PubMed

Sasai, Hiroshi; Fujita, Daisuke; Seto, Eiko; Denda, Yuki; Imai, Yutaro; Okamoto, Kanako; Okamura, Kensaku; Furuya, Masaru; Tani, Hiroyuki; Sasai, Kazumi

2018-02-15

OBJECTIVE To evaluate outcome of limb fracture repair in rabbits. DESIGN Retrospective case series. ANIMALS 139 client-owned rabbits with limb fractures treated between 2007 and 2015. PROCEDURES Medical records were reviewed for information on fracture location, fracture treatment, and time to fracture healing. RESULTS 25 rabbits had fractures involving the distal aspects of the limbs (ie, metacarpal or metatarsal bones, phalanges, and calcaneus or talus). Fractures were treated in 23 of these 25 rabbits (external coaptation, n = 17; external skeletal fixation, 4; and intramedullary pinning, 2) and healed in all 23, with a median healing time of 28 days (range, 20 to 45 days). One hundred ten rabbits had long bone fractures, and fractures were treated in 100 of the 110 (external skeletal fixation, n = 89; bone plating, 1; intramedullary pinning, 3; and external coaptation, 7). The percentage of fractures that healed was significantly lower for open (14/18) than for closed (26/26) tibial fractures and was significantly lower for femoral (19/26) and treated humeral (4/6) fractures than for radial (23/24) or closed tibial (26/26) fractures. Micro-CT was used to assess fracture realignment during external skeletal fixator application and to evaluate fracture healing. CONCLUSIONS AND CLINICAL RELEVANCE The prognosis for rabbits with limb fractures was good, with fractures healing in most rabbits following fracture repair (109/123). Micro-CT was useful in assessing fracture realignment and evaluating fracture healing.

Thermal behavior of crumb-rubber modified asphalt concrete mixtures

NASA Astrophysics Data System (ADS)

Epps, Amy Louise

Thermal cracking is one of the primary forms of distress in asphalt concrete pavements, resulting from either a single drop in temperature to an extreme low or from multiple temperature cycles above the fracture temperature of the asphalt-aggregate mixture. The first mode described is low temperature cracking; the second is thermal fatigue. The addition of crumb-rubber, manufactured from scrap tires, to the binder in asphalt concrete pavements has been suggested to minimize both types of thermal cracking. Four experiments were designed and completed to evaluate the thermal behavior of crumb-rubber modified (CRM) asphalt-aggregate mixtures. Modified and unmodified mixture response to thermal stresses was measured in four laboratory tests. The Thermal Stress Restrained Specimen Test (TSRST) and the Indirect Tensile Test (IDT) were used to compare mixture resistance to low temperature cracking. Modified mixtures showed improved performance, and cooling rate did not affect mixture resistance according to the statistical analysis. Therefore results from tests with faster rates can predict performance under slower field rates. In comparison, predicted fracture temperatures and stresses (IDT) were generally higher than measured values (TSRST). In addition, predicted fracture temperatures from binder test results demonstrated that binder testing alone is not sufficient to evaluate CRM mixtures. Thermal fatigue was explored in the third experiment using conventional load-induced fatigue tests with conditions selected to simulate daily temperature fluctuations. Test results indicated that thermal fatigue may contribute to transverse cracking in asphalt pavements. Both unmodified and modified mixtures had a finite capacity to withstand daily temperature fluctuations coupled with cold temperatures. Modified mixtures again exhibited improved performance. The fourth experiment examined fracture properties of modified and unmodified mixtures using a common fracture toughness test. Results showed no effect from modification, but the small experiment size may have masked this effect. Reliability concepts were introduced to include risk and uncertainty in a comparison of mixture response measured in the laboratory and estimated environmental conditions. This comparison provided evidence that CRM mixtures exhibit improved resistance to both types of thermal cracking at high levels of reliability. In conclusion, a mix design and analysis framework for evaluating thermal behavior was recommended.

Probabilistic pipe fracture evaluations for leak-rate-detection applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rahman, S.; Ghadiali, N.; Paul, D.

1995-04-01

Regulatory Guide 1.45, {open_quotes}Reactor Coolant Pressure Boundary Leakage Detection Systems,{close_quotes} was published by the U.S. Nuclear Regulatory Commission (NRC) in May 1973, and provides guidance on leak detection methods and system requirements for Light Water Reactors. Additionally, leak detection limits are specified in plant Technical Specifications and are different for Boiling Water Reactors (BWRs) and Pressurized Water Reactors (PWRs). These leak detection limits are also used in leak-before-break evaluations performed in accordance with Draft Standard Review Plan, Section 3.6.3, {open_quotes}Leak Before Break Evaluation Procedures{close_quotes} where a margin of 10 on the leak detection limit is used in determining the crackmore » size considered in subsequent fracture analyses. This study was requested by the NRC to: (1) evaluate the conditional failure probability for BWR and PWR piping for pipes that were leaking at the allowable leak detection limit, and (2) evaluate the margin of 10 to determine if it was unnecessarily large. A probabilistic approach was undertaken to conduct fracture evaluations of circumferentially cracked pipes for leak-rate-detection applications. Sixteen nuclear piping systems in BWR and PWR plants were analyzed to evaluate conditional failure probability and effects of crack-morphology variability on the current margins used in leak rate detection for leak-before-break.« less

Influence of fibre and filler reinforcement of plastic brackets: an in vitro study.

PubMed

Faltermeier, Andreas; Rosentritt, Martin; Faltermeier, Rupert; Müssig, Dieter

2007-06-01

In spite of their popularity in fulfilling aesthetic requirements, plastic brackets still present some disadvantages because of their low elastic modulus, decreased fracture toughness, and reduced wear resistance. Fibre-reinforced composites are well established in dentistry and consist of a polymer matrix in which reinforcing fibres are embedded. Stress is transferred from the polymer matrix to the fibres which present a high tensile strength. Hence, the mechanical properties of polymers could be improved. The purpose of this study was to compare fracture strength, fracture toughness and flexural strength of an experimental fibre-reinforced bracket material, an SiO(2) filler-reinforced bracket and an unfilled plastic bracket material (control group). Experimental brackets and specialized bars were manufactured. Tests were performed after thermal cycling (5 degrees C/55 degrees C) the samples in an artificial oral environment of a device to simulate mastication. Statistical evaluation was undertaken. The median, 25th and 75th percentiles were calculated and a Mann-Whitney U-test was performed. In this study two findings were obvious. (1) Filler reinforcement of plastic brackets improved fracture strength and fracture toughness in comparison with the unfilled bracket material. (2) Glass fibre reinforcement of orthodontic bracket materials resulted in the greatest enhancement of the mechanical properties in comparison with the other test groups. Therefore, the application of glass fibres in plastic brackets is a successful method to enhance fracture strength.

Peroneal tendon displacement accompanying intra-articular calcaneal fractures.

PubMed

Toussaint, Rull James; Lin, Darius; Ehrlichman, Lauren K; Ellington, J Kent; Strasser, Nicholas; Kwon, John Y

2014-02-19

Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate. A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated. Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p < 0.001). Only twelve (10.2%) of the 118 cases of peroneal tendon displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases. Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.

Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.

PubMed

Beaman, Douglas N; Gellman, Richard

2014-12-01

Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns. (1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used? During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6-22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation. All of the ankle arthrodeses healed at an average of 4.4 months (range, 3-5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion. Primary ankle arthrodesis combined with fracture reduction for the severely comminuted tibial pilon fracture reliably healed and restored acceptable function in this highly selective patient group. Ring external fixation may be a useful adjunct to internal fixation, and this concept should be further studied. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Specimen-specific modeling of hip fracture pattern and repair.

PubMed

Ali, Azhar A; Cristofolini, Luca; Schileo, Enrico; Hu, Haixiang; Taddei, Fulvia; Kim, Raymond H; Rullkoetter, Paul J; Laz, Peter J

2014-01-22

Hip fracture remains a major health problem for the elderly. Clinical studies have assessed fracture risk based on bone quality in the aging population and cadaveric testing has quantified bone strength and fracture loads. Prior modeling has primarily focused on quantifying the strain distribution in bone as an indicator of fracture risk. Recent advances in the extended finite element method (XFEM) enable prediction of the initiation and propagation of cracks without requiring a priori knowledge of the crack path. Accordingly, the objectives of this study were to predict femoral fracture in specimen-specific models using the XFEM approach, to perform one-to-one comparisons of predicted and in vitro fracture patterns, and to develop a framework to assess the mechanics and load transfer in the fractured femur when it is repaired with an osteosynthesis implant. Five specimen-specific femur models were developed from in vitro experiments under a simulated stance loading condition. Predicted fracture patterns closely matched the in vitro patterns; however, predictions of fracture load differed by approximately 50% due to sensitivity to local material properties. Specimen-specific intertrochanteric fractures were induced by subjecting the femur models to a sideways fall and repaired with a contemporary implant. Under a post-surgical stance loading, model-predicted load sharing between the implant and bone across the fracture surface varied from 59%:41% to 89%:11%, underscoring the importance of considering anatomic and fracture variability in the evaluation of implants. XFEM modeling shows potential as a macro-level analysis enabling fracture investigations of clinical cohorts, including at-risk groups, and the design of robust implants. © 2013 Published by Elsevier Ltd.

Rib Radiography versus Chest Computed Tomography in the Diagnosis of Rib Fractures.

PubMed

Sano, Atsushi

2018-05-01

 The accurate diagnosis of rib fractures is important in chest trauma. Diagnostic images following chest trauma are usually obtained via chest X-ray, chest computed tomography, or rib radiography. This study evaluated the diagnostic characteristics of rib radiography and chest computed tomography.  Seventy-five rib fracture patients who underwent both chest computed tomography and rib radiography between April 2008 and December 2013 were included. Rib radiographs, centered on the site of pain, were taken from two directions. Chest computed tomography was performed using a 16-row multidetector scanner with 5-mm slice-pitch without overlap, and axial images were visualized in a bone window.  In total, 217 rib fractures were diagnosed in 75 patients. Rib radiography missed 43 rib fractures in 24 patients. The causes were overlap with organs in 15 cases, trivial fractures in 21 cases, and injury outside the imaging range in 7 cases. Left lower rib fractures were often missed due to overlap with the heart, while middle and lower rib fractures were frequently not diagnosed due to overlap with abdominal organs. Computed tomography missed 21 rib fractures in 17 patients. The causes were horizontal fractures in 10 cases, trivial fractures in 9 cases, and insufficient breath holding in 1 case.  In rib radiography, overlap with organs and fractures outside the imaging range were characteristic reasons for missed diagnoses. In chest computed tomography, horizontal rib fractures and insufficient breath holding were often responsible. We should take these challenges into account when diagnosing rib fractures. Georg Thieme Verlag KG Stuttgart · New York.

Quality assessment of reservoirs by means of outcrop data and "discrete fracture network" models: The case history of Rosario de La Frontera (NW Argentina) geothermal system

NASA Astrophysics Data System (ADS)

Maffucci, R.; Bigi, S.; Corrado, S.; Chiodi, A.; Di Paolo, L.; Giordano, G.; Invernizzi, C.

2015-04-01

We report the results of a systematic study carried out on the fracture systems exposed in the Sierra de La Candelaria anticline, in the central Andean retrowedge of northwestern Argentina. The aim was to elaborate a kinematic model of the anticline and to assess the dimensional and spatial properties of the fracture network characterizing the Cretaceous sandstone reservoir of the geothermal system of Rosario de La Frontera. Special regard was devoted to explore how tectonics may affect fluid circulation at depth and control fluids' natural upwelling at surface. With this aim we performed a Discrete Fracture Network model in order to evaluate the potential of the reservoir of the studied geothermal system. The results show that the Sierra de La Candelaria regional anticline developed according to a kinematic model of transpressional inversion compatible with the latest Andean regional WNW-ESE shortening, acting on a pre-orogenic N-S normal fault. A push-up geometry developed during positive inversion controlling the development of two minor anticlines: Termas and Balboa, separated by further NNW-SSE oblique-slip fault in the northern sector of the regional anticline. Brittle deformation recorded at the outcrop scale is robustly consistent with the extensional and transpressional events recognized at regional scale. In terms of fluid circulation, the NNW-SSE and NE-SW fault planes, associated to the late stage of the positive inversion, are considered the main structures controlling the migration paths of hot fluids from the reservoir to the surface. The results of the fracture modeling performed show that fractures related to the same deformation stage, are characterized by the highest values of secondary permeability. Moreover, the DFN models performed in the reservoir volume indicates that fracture network enhances its permeability: its secondary permeability is of about 49 mD and its fractured portion represents the 0.03% of the total volume.

Impact performance of two bamboo-based laminated composites

Treesearch

Huanrong Liu; Zehui Jiang; Zhengjun Sun; Yan Yan; Zhiyong Cai; Xiubiao Zhang

2017-01-01

The present work aims to determine the impact performance of two bamboo-based laminated composites [bamboo/poplar laminated composite (BPLC) and bamboo/ glass fiber laminated composite (BGFLC)] using lowvelocity impact tests by a drop tower. In addition, fracture characteristics were evaluated using computed tomography (CT). Results showed that BPLC presented better...

Contribution of MRI to clinically equivocal penile fracture cases.

PubMed

Türkay, Rüştü; Yenice, Mustafa Gürkan; Aksoy, Sema; Şeker, Gökhan; Şahin, Selçuk; İnci, Ercan; Tuğcu, Volkan; Taşcı, Ali İhsan

2016-11-01

Penile fracture is a surgical emergency defined as rupture of the tunica albuginea. Although most cases can be diagnosed with clinical evaluation, it has been stated in the literature that diagnosis in as many as 15% of cases can be challenging. In uncertain cases, imaging can help determine diagnosis. Present study included 20 cases where diagnosis could not be made with certainty and magnetic resonance imaging (MRI) was performed. MR images were examined for tunical rupture and accompanying pathologies. When rupture was observed, localization and length of rupture were noted. All patients underwent degloving surgery. All imaging findings were compared to surgical findings. MRI revealed 19 tunical ruptures. In 1 case, hematoma was seen with no sign of penile fracture. No urethral injuries were found. All MRI findings were confirmed during surgery. Performing MRI in clinically equivocal cases can provide crucial data to make precise diagnosis and improve patient management.

Retardation of mobile radionuclides in granitic rock fractures by matrix diffusion

NASA Astrophysics Data System (ADS)

Hölttä, P.; Poteri, A.; Siitari-Kauppi, M.; Huittinen, N.

Transport of iodide and sodium has been studied by means of block fracture and core column experiments to evaluate the simplified radionuclide transport concept. The objectives were to examine the processes causing retention in solute transport, especially matrix diffusion, and to estimate their importance during transport in different scales and flow conditions. Block experiments were performed using a Kuru Grey granite block having a horizontally planar natural fracture. Core columns were constructed from cores drilled orthogonal to the fracture of the granite block. Several tracer tests were performed using uranine, 131I and 22Na as tracers at water flow rates 0.7-50 μL min -1. Transport of tracers was modelled by applying the advection-dispersion model based on the generalized Taylor dispersion added with matrix diffusion. Scoping calculations were combined with experiments to test the model concepts. Two different experimental configurations could be modelled applying consistent transport processes and parameters. The processes, advection-dispersion and matrix diffusion, were conceptualized with sufficient accuracy to replicate the experimental results. The effects of matrix diffusion were demonstrated on the slightly sorbing sodium and mobile iodine breakthrough curves.

Fracture Mechanics Analyses of Reinforced Carbon-Carbon Wing-Leading-Edge Panels

NASA Technical Reports Server (NTRS)

Raju, Ivatury S.; Phillips, Dawn R.; Knight, Norman F., Jr.; Song, Kyongchan

2010-01-01

Fracture mechanics analyses of subsurface defects within the joggle regions of the Space Shuttle wing-leading-edge RCC panels are performed. A 2D plane strain idealized joggle finite element model is developed to study the fracture behavior of the panels for three distinct loading conditions - lift-off and ascent, on-orbit, and entry. For lift-off and ascent, an estimated bounding aerodynamic pressure load is used for the analyses, while for on-orbit and entry, thermo-mechanical analyses are performed using the extreme cold and hot temperatures experienced by the panels. In addition, a best estimate for the material stress-free temperature is used in the thermo-mechanical analyses. In the finite element models, the substrate and coating are modeled separately as two distinct materials. Subsurface defects are introduced at the coating-substrate interface and within the substrate. The objective of the fracture mechanics analyses is to evaluate the defect driving forces, which are characterized by the strain energy release rates, and determine if defects can become unstable for each of the loading conditions.

Evaluation of Stress Corrosion Cracking Susceptibility Using Fracture Mechanics Techniques, Part 1. [environmental tests of aluminum alloys, stainless steels, and titanium alloys

NASA Technical Reports Server (NTRS)

Sprowls, D. O.; Shumaker, M. B.; Walsh, J. D.; Coursen, J. W.

1973-01-01

Stress corrosion cracking (SSC) tests were performed on 13 aluminum alloys, 13 precipitation hardening stainless steels, and two titanium 6Al-4V alloy forgings to compare fracture mechanics techniques with the conventional smooth specimen procedures. Commercially fabricated plate and rolled or forged bars 2 to 2.5-in. thick were tested. Exposures were conducted outdoors in a seacoast atmosphere and in an inland industrial atmosphere to relate the accelerated tests with service type environments. With the fracture mechanics technique tests were made chiefly on bolt loaded fatigue precracked compact tension specimens of the type used for plane-strain fracture toughness tests. Additional tests of the aluminum alloy were performed on ring loaded compact tension specimens and on bolt loaded double cantilever beams. For the smooth specimen procedure 0.125-in. dia. tensile specimens were loaded axially in constant deformation type frames. For both aluminum and steel alloys comparative SCC growth rates obtained from tests of precracked specimens provide an additional useful characterization of the SCC behavior of an alloy.

Isolated tympanic plate fracture frequency and its relationship to mandibular trauma.

PubMed

Altay, Canan; Erdoğan, Nezahat; Batkı, Ozan; Eren, Erdem; Altay, Sedat; Karasu, Sebnem; Mete, Berna; Uluç, Engin

2014-11-01

This study evaluated the prevalence of isolated tympanic fractures and their correlation with mandibular fractures by using maxillofacial computed tomography (CT). We retrospectively evaluated the maxillofacial CT of 1590 patients who presented to our emergency department with maxillofacial trauma between December 2010 and December 2012. Maxillofacial CT was used as the criterion standard for evaluating patients with maxillofacial fractures. The CT images were evaluated by using an electronic picture archiving and communications system and interpreted independently by 2 radiologists. The maxillofacial CT images revealed mandibular fractures in 167 of the patients and isolated tympanic plate fractures in 35 of these 167 patients. Four patients (11%) had a bilateral tympanic plate fracture, and 31 patients (89%) had unilateral tympanic plate fracture. Of all the tympanic plate fractures, 19 (54%) were on the right side and 16 (46%) were on the left side (P > .05). In our results, a significant correlation between the presence of a right-sided tympanic plate fracture and fracture of the ipsilateral condylar process was found (P = .036). However, a statistically significant difference between the presence of a tympanic plate fracture and other mandible fractures, additional soft-tissue findings, or the number of fractures was not determined (P > .05). Sex had no impact on the presence of tympanic plate fracture (P > .05). The frequency of isolated tympanic plate fractures in maxillofacial trauma is low, but it is an important anatomic location. Condyle fractures are significantly associated with isolated tympanic plate fractures. The presence of these injuries should raise suspicion of a concomitant isolated tympanic plate fracture. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Numerical simulation and fracture identification of dual laterolog in organic shale

NASA Astrophysics Data System (ADS)

Maojin, Tan; Peng, Wang; Qiong, Liu

2012-09-01

Fracture is one of important spaces in shale oil and shale gas reservoirs, and fractures identification and evaluation are an important part in organic shale interpretation. According to the fractured shale gas reservoir, a physical model is set up to study the dual laterolog logging responses. First, based on the principle of dual laterolog, three-dimensional finite element method (FEM) is used to simulate the dual laterolog responses in various formation models with different fractures widths, different fracture numbers, different fractures inclination angle. All the results are extremely important for the fracture identification and evaluation in shale reservoirs. Appointing to different base rock resistivity models, the fracture models are constructed respectively through a number of numerical simulation, and the fracture porosity can be calculated by solving the corresponding formulas. A case study about organic shale formation is analyst and discussed, and the fracture porosity is calculated from dual laterolog. The fracture evaluation results are also be validated right by Full borehole Micro-resistivity Imaging (FMI). So, in case of the absence of borehole resistivity imaging log, the dual laterolog resistivity can be used to estimate the fracture development.

Ketorolac administration does not delay early fracture healing in a juvenile rat model: a pilot study.

PubMed

Cappello, Teresa; Nuelle, Julia A V; Katsantonis, Nicolas; Nauer, Rachel K; Lauing, Kristen L; Jagodzinski, Jason E; Callaci, John J

2013-06-01

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective at controlling pain in children, especially in the treatment of fractures. Adult animal and adult clinical studies demonstrate conflicting evidence for the inhibitory relationship between NSAIDs and fracture healing. Published pediatric orthopaedic clinical studies do not demonstrate an inhibitory effect of ketorolac on bone healing. Little is known about the effects of any NSAID on bone formation in juvenile animals. This study investigates the effects of the NSAID ketorolac on fracture healing in a juvenile rat model. Unilateral surgically induced and stabilized tibial shaft fractures were created in 45 juvenile (3 to 4 wk old) male Sprague-Dawley rats. Either ketorolac (5 mg/kg; n=24) or saline (0.9% normal saline; n=21) was then administered to the rats 6 d/wk by intraperitoneal injections. Animals were then randomly assigned into time groups and euthanized at 7 days (n=8 ketorolac, n=7 saline), 14 days (n=8 ketorolac, n=7 saline), or 21 days (n=8 ketorolac, n=7 saline) postfracture. Biomechanical analysis was performed using a custom-designed 4-point bending loading apparatus. Statistics for tibial stiffness and strength data were performed using software package Systat 11. Specimens were also evaluated histologically using hematoxylin and eosin staining. Strength and stiffness of all fractured tibiae increased over time from day 7 to day 21 regardless of treatment type. No statistical difference was found between the fractured tibiae strength or stiffness in the ketorolac or control-treated specimens at the same time point. In addition, the quality of the fracture callus was similar in both groups at each of the time points. In this study of a juvenile rat model with a stabilized tibia fracture, fracture callus strength, stiffness, and histologic characteristics were not affected by the administration of ketorolac during the first 21 days of fracture healing. The absence of inhibitory effects of ketorolac on early juvenile rat fracture healing supports the clinical practice of utilizing NSAIDs for analgesia in children with long bone fractures.

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

PubMed Central

Cappello, Teresa; Nuelle, Julia A.V.; Katsantonis, Nicolas; Nauer, Rachel K.; Lauing, Kristen L.; Jagodzinski, Jason E.; Callaci, John J.

2014-01-01

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective at controlling pain in children, especially in the treatment of fractures. Adult animal and adult clinical studies demonstrate conflicting evidence for the inhibitory relationship between NSAIDs and fracture healing. Published pediatric orthopaedic clinical studies do not demonstrate an inhibitory effect of ketorolac on bone healing. Little is known about the effects of any NSAID on bone formation in juvenile animals. This study investigates the effects of the NSAID ketorolac on fracture healing in a juvenile rat model. Methods Unilateral surgically induced and stabilized tibial shaft fractures were created in 45 juvenile (3 to 4wk old) male Sprague-Dawley rats. Either ketorolac (5 mg/kg; n=24) or saline (0.9% normal saline; n=21) was then administered to the rats 6 d/wk by intraperitoneal injections. Animals were then randomly assigned into time groups and euthanized at 7 days (n=8 ketorolac, n=7 saline), 14 days (n=8 ketorolac, n=7 saline), or 21 days (n=8 ketorolac, n=7 saline) postfracture. Biomechanical analysis was performed using a custom-designed 4-point bending loading apparatus. Statistics for tibial stiffness and strength data were performed using software package Systat 11. Specimens were also evaluated histologically using hematoxylin and eosin staining. Results Strength and stiffness of all fractured tibiae increased over time from day 7 to day 21 regardless of treatment type. No statistical difference was found between the fractured tibiae strength or stiffness in the ketorolac or control-treated specimens at the same time point. In addition, the quality of the fracture callus was similar in both groups at each of the time points. Conclusions In this study of a juvenile rat model with a stabilized tibia fracture, fracture callus strength, stiffness, and histologic characteristics were not affected by the administration of ketorolac during the first 21 days of fracture healing. Clinical Relevance The absence of inhibitory effects of ketorolac on early juvenile rat fracture healing supports the clinical practice of utilizing NSAIDs for analgesia in children with long bone fractures. PMID:23653032

Effects of the Ratio between Pigment and Bleaching Gel on the Fracture Resistance and Dentin Microhardness of endodontically treated Teeth.

PubMed

Galloza, Marina Og; Jordão-Basso, Keren Cf; Bandeca, Matheus C; Costa, Samuel O; Borges, Alvaro H; Tonetto, Mateus R; Tirintan, Fabio C; Keine, Kátia C; Kuga, Milton C

2017-11-01

The aim of this study was to evaluate the effects of bleaching gel using 35% hydrogen peroxide (HP), associated with red carmine pigment (RC), in the 3:1 or 1:1 ratio, on fracture resistance and dentin microhardness of endodontically treated teeth. A total of 40 lower incisors were endodontically treated and divided into four groups (n = 10), according to the bleaching protocol: G1 (HP3), 35% HP + RC (3:1); G2 (HP1), 35% HP + RC (1:1); G3 (positive), 38% HP; and G4 (negative), unbleached. Four dental bleaching sessions were performed. The dental crowns were restored after the last session and submitted to the fracture resistance test. Totally, 60 specimens from the endodontically treated lower incisor crowns were prepared to evaluate the effects on dentin microhardness. The analysis was measured (in Knoop) prior to and after the last dental bleaching session using similar bleaching protocols. G2 presented the lowest fracture resistance (p < 0.05). The other groups were similar to each other (p > 0.05). No difference was observed in the reduction of dentin microhardness among the groups (p > 0.05). A 1:1 ratio (bleaching gel:pigment) caused a significant fracture resistance reduction in relation to the other protocols. No effect on the dentin microhardness reduction was observed. The pigment addition to the bleaching agent accelerates the bleaching chemical reaction. However, no studies have evaluated the ideal proportion to optimize tooth bleaching.

Identifying the Risk of Swallowing-Related Pulmonary Complications in Older Patients With Hip Fracture.

PubMed

Meals, Clifton; Roy, Siddharth; Medvedev, Gleb; Wallace, Matthew; Neviaser, Robert J; O'Brien, Joseph

2016-01-01

To identify and potentially modify the risk of pulmonary complications in a group of older patients with hip fracture, the authors obtained speech and language pathology consultations for these patients. Then they performed a retrospective chart review of all patients 65 years and older who were admitted to their institution between June 2011 and July 2013 with acute hip fracture, were treated surgically, and had a speech and language pathology evaluation in the immediate perioperative period. The authors identified 52 patients who met the study criteria. According to the American Society of Anesthesiologists (ASA) classification system, at the time of surgery, 1 patient (2%) was classified as ASA I, 12 patients (23%) were ASA II, 26 (50%) were ASA III, and 12 (23%) were ASA IV. Based on a speech and language pathology evaluation, 22 patients (42%) were diagnosed with dysphagia. Statistical analysis showed that ASA III status and ASA IV status were meaningful predictors of dysphagia and that dysphagia itself was a strong risk factor for pulmonary aspiration, pneumonia, and aspiration pneumonitis. Evaluation by a speech and language pathologist, particularly of patients classified as ASA III or ASA IV, may be an efficient means of averting pulmonary morbidity that is common in older patients with hip fracture. Copyright 2016, SLACK Incorporated.

Impaired fracture healing with high non-union rates remains irreversible after traumatic brain injury in leptin-deficient mice

PubMed Central

Graef, F.; Seemann, R.; Garbe, A.; Schmidt-Bleek, K.; Schaser, K-D.; Keller, J.; Duda, G.; Tsitsilonis, S.

2017-01-01

Patients with traumatic brain injury (TBI) and long-bone fractures can show increased callus formation. This effect has already been reproduced in wild-type (wt) mice. However, the mechanisms remain poorly understood. Leptin is significantly increased following TBI, while its role in bone healing remains unclear. The aim of this study was to evaluate fracture healing in leptin-deficient ob/ob mice and to measure any possible impact of TBI on callus formation. 138 female, 12 weeks old, ob/ob mice were divided into four groups: Control, fracture, TBI and combined trauma. Osteotomies were stabilized with an external fixator; TBI was induced with Controlled Cortical Impact Injury. Callus bridging was weekly evaluated with in vivo micro-CT. Biomechanical testing was performed ex vivo. Micro-CT showed high non-union rates after three and four weeks in the fracture and combined trauma group. No differences were observed in callus volume, density and biomechanical properties at any time point. This study shows that bony bridging is impaired in the present leptin-deficient trauma model. Furthermore, the phenomenon of increased callus formation after TBI could not be reproduced in ob/ob mice, as in wt mice. Our findings suggest that the increased callus formation after TBI may be dependent on leptin signaling. PMID:28574414

Comparison of Multidetector Computed Tomography and Flat-Panel Computed Tomography Regarding Visualization of Cortical Fractures, Cortical Defects, and Orthopedic Screws: A Phantom Study.

PubMed

Neubauer, Jakob; Benndorf, Matthias; Lang, Hannah; Lampert, Florian; Kemna, Lars; Konstantinidis, Lukas; Neubauer, Claudia; Reising, Kilian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Goerke, Sebastian M

2015-08-01

To compare the visualization of cortical fractures, cortical defects, and orthopedic screws in a dedicated extremity flat-panel computed tomography (FPCT) scanner and a multidetector computed tomography (MDCT) scanner.We used feet of European roe deer as phantoms for cortical fractures, cortical defects, and implanted orthopedic screws. FPCT and MDCT scans were performed with equivalent dose settings. Six observers rated the scans according to number of fragments, size of defects, size of defects opposite orthopedic screws, and the length of different screws. The image quality regarding depiction of the cortical bone was assessed. The gold standard (real number of fragments) was evaluated by autopsy.The correlation of reader assessment of fragments, cortical defects, and screws with the gold standard was similar for FPCT and MDCT. Three readers rated the subjective image quality of the MDCT to be higher, whereas the others showed no preferences.Although the image quality was rated higher in the MDCT than in the FPCT by 3 out of 6 observers, both modalities proved to be comparable regarding the visualization of cortical fractures, cortical defects, and orthopedic screws and of use to musculoskeletal radiology regarding fracture detection and postsurgical evaluation in our experimental setting.

Assessing the monitoring performance using a synthetic microseismic catalogue for hydraulic fracturing

NASA Astrophysics Data System (ADS)

Ángel López Comino, José; Kriegerowski, Marius; Cesca, Simone; Dahm, Torsten; Mirek, Janusz; Lasocki, Stanislaw

2016-04-01

Hydraulic fracturing is considered among the human operations which could induce or trigger seismicity or microseismic activity. The influence of hydraulic fracturing operations is typically expected in terms of weak magnitude events. However, the sensitivity of the rock mass to trigger seismicity varies significantly for different sites and cannot be easily predicted prior to operations. In order to assess the sensitivity of microseismity to hydraulic fracturing operations, we perform a seismic monitoring at a shale gas exploration/exploitation site in the central-western part of the Peribaltic synclise at Pomerania (Poland). The monitoring will be continued before, during and after the termination of hydraulic fracturing operations. The fracking operations are planned in April 2016 at a depth 4000 m. A specific network setup has been installed since summer 2015, including a distributed network of broadband stations and three small-scale arrays. The network covers a region of 60 km2. The aperture of small scale arrays is between 450 and 950 m. So far no fracturing operations have been performed, but seismic data can already be used to assess the seismic noise and background microseismicity, and to investigate and assess the detection performance of our monitoring setup. Here we adopt a recently developed tool to generate a synthetic catalogue and waveform dataset, which realistically account for the expected microseismicity. Synthetic waveforms are generated for a local crustal model, considering a realistic distribution of hypocenters, magnitudes, moment tensors, and source durations. Noise free synthetic seismograms are superposed to real noise traces, to reproduce true monitoring conditions at the different station locations. We estimate the detection probability for different magnitudes, source-receiver distances, and noise conditions. This information is used to estimate the magnitude of completeness at the depth of the hydraulic fracturing horizontal wells. Our technique is useful to evaluate the efficiency of the seismic network and validate detection and location algorithms, taking into account the signal to noise ratio. The same dataset may be used at a later time, to assess the performance of other seismological analysis, such as hypocentral location, magnitude estimation and source parameters inversion. This work is funded by the EU H2020 SHEER project.

Hydraulic properties of 3D rough-walled fractures during shearing: An experimental study

NASA Astrophysics Data System (ADS)

Yin, Qian; Ma, Guowei; Jing, Hongwen; Wang, Huidong; Su, Haijian; Wang, Yingchao; Liu, Richeng

2017-12-01

This study experimentally analyzed the influence of shear processes on nonlinear flow behavior through 3D rough-walled rock fractures. A high-precision apparatus was developed to perform stress-dependent fluid flow tests of fractured rocks. Then, water flow tests on rough-walled fractures with different mechanical displacements were conducted. At each shear level, the hydraulic pressure ranged from 0 to 0.6 MPa, and the normal load varied from 7 to 35 kN. The results show that (i) the relationship between the volumetric flow rate and hydraulic gradient of rough-walled fractures can be well fit using Forchheimer's law. Notably, both the linear and nonlinear coefficients in Forchheimer's law decrease during shearing; (ii) a sixth-order polynomial function is used to evaluate the transmissivity based on the Reynolds number of fractures during shearing. The transmissivity exhibits a decreasing trend as the Reynolds number increases and an increasing trend as the shear displacement increases; (iii) the critical hydraulic gradient, critical Reynolds number and equivalent hydraulic aperture of the rock fractures all increase as the shear displacement increases. When the shear displacement varies from 0 to 15 mm, the critical hydraulic gradient ranges from 0.3 to 2.2 for a normal load of 7 kN and increases to 1.8-8.6 for a normal load of 35 kN; and (iv) the Forchheimer law results are evaluated by plotting the normalized transmissivity of the fractures during shearing against the Reynolds number. An increase in the normal load shifts the fitted curves downward. Additionally, the Forchheimer coefficient β decreases with the shear displacement but increases with the applied normal load.

Computer-assisted virtual preoperative planning in orthopedic surgery for acetabular fractures based on actual computed tomography data.

PubMed

Wang, Guang-Ye; Huang, Wen-Jun; Song, Qi; Qin, Yun-Tian; Liang, Jin-Feng

2016-12-01

Acetabular fractures have always been very challenging for orthopedic surgeons; therefore, appropriate preoperative evaluation and planning are particularly important. This study aimed to explore the application methods and clinical value of preoperative computer simulation (PCS) in treating pelvic and acetabular fractures. Spiral computed tomography (CT) was performed on 13 patients with pelvic and acetabular fractures, and Digital Imaging and Communications in Medicine (DICOM) data were then input into Mimics software to reconstruct three-dimensional (3D) models of actual pelvic and acetabular fractures for preoperative simulative reduction and fixation, and to simulate each surgical procedure. The times needed for virtual surgical modeling and reduction and fixation were also recorded. The average fracture-modeling time was 45 min (30-70 min), and the average time for bone reduction and fixation was 28 min (16-45 min). Among the surgical approaches planned for these 13 patients, 12 were finally adopted; 12 cases used the simulated surgical fixation, and only 1 case used a partial planned fixation method. PCS can provide accurate surgical plans and data support for actual surgeries.

Impact of Injury Mechanisms on Patterns and Management of Facial Fractures.

PubMed

Greathouse, S Travis; Adkinson, Joshua M; Garza, Ramon; Gilstrap, Jarom; Miller, Nathan F; Eid, Sherrine M; Murphy, Robert X

2015-07-01

Mechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board-approved review of our network's trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson χ2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence: Therapeutic, III.

Retrospective analysis of two hundred thirty-five pediatric mandibular fracture cases.

PubMed

Eskitascioglu, Teoman; Ozyazgan, Irfan; Coruh, Atilla; Gunay, Galip K; Yuksel, Esabil

2009-11-01

Maxillofacial fractures are encountered less commonly during childhood period due to anatomic, social, cultural, and environmental factors. Although the incidence of all maxillofacial fractures is 1% to 15% among pediatric and adolescent patients, this rate drops to less than 1% in children below 5 years age. Two hundred thirty-five cases (

Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

PubMed Central

Sammy, Ian Ayenga; Chatha, Hridesh; Lecky, Fiona; Bouamra, Omar; Fragoso-Iñiguez, Marisol; Sattout, Abdo; Hickey, Michael; Edwards, John E

2017-01-01

Background First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. Methods Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. Results There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). Conclusion First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries. PMID:28119351

Rheological and Performance Research on a Regenerable Polyvinyl Alcohol Fracturing Fluid

PubMed Central

Shang, Xiaosen; Ding, Yunhong; Wang, Yonghui; Yang, Lifeng

2015-01-01

A regenerable polyvinyl alcohol/organic boron fracturing fluid system with 1.6 wt% polyvinyl alcohol (PVOH) and 1.2 wt% organic boron (OBT) was studied, and its main regeneration mechanism is the reversible cross-linking reaction between B(OH)4 - and hydroxyl groups of PVOH as the change of pH. Results of rheology evaluations show that both the apparent viscosity and the thermal stability of the fracturing fluid decreased with the regeneration number of times increasing. In addition, the apparent viscosity of the fluid which was without regeneration was more sensitive to the shear action compared with that of the fluid with regeneration once or twice. When the fracturing fluid was without regeneration, the elasticity was dominating due to the three-dimensional network structure of the formed gel; the viscosity gradually occupied the advantage when the fracturing fluid was regenerated once or twice. The settling velocity of proppant was accelerated by both the regeneration process and the increasing temperature, but it was decelerated when the proppant ratio increased. Results of core damage tests indicate that less permeability damage was caused by the PVOH/OBT fracturing fluid compared with that caused by the guar gum fracturing fluid after gel breaking. PMID:26641857

Rheological and Performance Research on a Regenerable Polyvinyl Alcohol Fracturing Fluid.

PubMed

Shang, Xiaosen; Ding, Yunhong; Wang, Yonghui; Yang, Lifeng

2015-01-01

A regenerable polyvinyl alcohol/organic boron fracturing fluid system with 1.6 wt% polyvinyl alcohol (PVOH) and 1.2 wt% organic boron (OBT) was studied, and its main regeneration mechanism is the reversible cross-linking reaction between B(OH)4- and hydroxyl groups of PVOH as the change of pH. Results of rheology evaluations show that both the apparent viscosity and the thermal stability of the fracturing fluid decreased with the regeneration number of times increasing. In addition, the apparent viscosity of the fluid which was without regeneration was more sensitive to the shear action compared with that of the fluid with regeneration once or twice. When the fracturing fluid was without regeneration, the elasticity was dominating due to the three-dimensional network structure of the formed gel; the viscosity gradually occupied the advantage when the fracturing fluid was regenerated once or twice. The settling velocity of proppant was accelerated by both the regeneration process and the increasing temperature, but it was decelerated when the proppant ratio increased. Results of core damage tests indicate that less permeability damage was caused by the PVOH/OBT fracturing fluid compared with that caused by the guar gum fracturing fluid after gel breaking.

Lateral compression open cap splint with circummandibular wiring for management of pediatric mandibular fractures: a retrospective audit of 10 cases.

PubMed

Bhola, Nitin; Jadhav, Anendd; Borle, Rajiv; Khemka, Gaurav; Adwani, Nitin; Bhattad, Mayur

2014-03-01

Mandibular fractures are relatively less frequent in children when compared to adults. Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning and in their functional needs. We currently describe our experience with lateral compression open cap splint with circummandibular wiring as a treatment modality which involves fewer risks in treating pediatric symphysis/parasymphysis/body mandibular fractures. A retrospective analysis of pediatric patients with mandibular symphysis/parasymphysis/body fractures operated from January 2007 to January 2012 was performed. Clinical photographs and orthopantomogram assessment at the time of presentation, after treatment, and at 6 months postoperatively were evaluated. All the 10 patients were followed up until the period of 6 months, and none of them had any major complications. Postoperatively, there was satisfactory healing and union of fracture fragments in all the patients. Only one patient developed infection at submental region. The 6-month follow-up showed good occlusion, without interference in teeth eruption and no signs of temporomandibular joint problems. Lateral compression open cap splints for treatment of pediatric mandibular symphysis/parasymphysis/body fractures are reliable treatment modalities with regard to occlusion-guided fracture reduction.

Evaluation of production tests in oil wells stimulated by massive acid fracturing offshore Qatar

DOE Office of Scientific and Technical Information (OSTI.GOV)

McDonald, S.W.

This paper presents the evaluation of pressure-buildup data from production tests in wells that have been stimulated by massive acid fracturing. Fracture type curves are used in combination with conventional semilog analysis techniques. Fracture characteristics are calculated from a match of the early-time pressure data with the type curves, and reservoir characteristics are calculated from a conventional semilog plot of late-time data. Unexpectedly high formation permeabilities are evaluated, and fracture half-lengths are much shorter than design values.

CT incidence of Morel-Lavallee lesions in patients with pelvic fractures: a 4-year experience at a level 1 trauma center.

PubMed

Beckmann, Nicholas M; Cai, Chunyan

2016-12-01

The aim of this study is to determine the incidence and location of Morel-Lavallee lesions (MLLs) on pelvic CTs performed in evaluation of pelvic fractures and determine if correlation exists between MLLs and mechanism of injury or pelvic ring injury pattern. A retrospective review was performed of pelvic CTs on 1493 consecutive patients presenting with pelvic fractures at our level 1 trauma center. MLLs occurred in 182 of 1493 patients presenting with pelvic fractures. Statistical significance in MLL incidence was found across mechanism of injuries with MLLs being seen most frequently in MCC/ATV accidents and crush injuries. A little over half of MLLs occurred over the lateral thigh with almost all other MLLs occurring over the posterior (flank or lumbar) region. MLLs were much more common in vertical shear and spinopelvic dissociation pelvic ring fracture patterns compared to lateral compression and AP compression patterns. In lateral compression injuries, MLLs most commonly occurred over the thigh. In all other pelvic ring injury patterns, MLLs were predominately posterior. MLL's are not as rare as previously believed. The lateral thigh and lumbar/flank regions should be closely inspected on pelvic trauma patients to identify MLLs, particularly in patients with a spinopelvic dissociation injury pattern.

Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture: six cases related to triangular fibrocartilage complex injury.

PubMed

Lee, Seoung-joon; Rathod, Chasanal Mohan; Park, Kwang-Won; Hwang, Jin-Ho

2012-05-01

Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture even after union is a matter of concern. There could be various reasons for this persistent pain like arthritis, instability, fractures and non-union. We correlate our findings of physical examination and wrist arthroscopy as triangular fibrocartilage complex injury to be one of the causes of this persistent pain. Six subjects who had persistent ulnocarpal joint pain and tenderness after triquetral dorsal chip fracture, despite 2 months of conservative treatment, were subjected to physical tests. If the physical examination yields positive results, then magnetic resonance imaging followed by arthroscopic treatment was performed. The six patients were then evaluated using the visual analogue scale, the Mayo modified wrist score, and the grip strength test. Triangular fibrocartilage complex (TFCC) injury was observed in all six cases and partial TFCC resection and synovectomy were performed. Analysis of the visual analogue scale, Mayo modified wrist score, and grip strength test data revealed statistically significant improvements (P < 0.05). In addition to several causes reported in the published literature, TFCC injury can be a cause of persistent ulnar pain after treatment of triquetral dorsal chip fracture. Arthroscopic partial TFCC resection can be considered to be a suitable treatment for such cases.

Intra-Laminar Fracture Toughness of Glass Fiber Reinforced Polymer By Using Theory, Experimentation and FEA

NASA Astrophysics Data System (ADS)

Firojkhan, Pathan; Tanpure, Kshitijit; Dawale, Ajinkya; Patil, Shital

2018-04-01

Fiber reinforced polymer (FRP) composites are widely use in aerospace, marine, auto-mobile and civil engineering applications because of their high strength-to-weight and stiffness-to-weight ratios, corrosion resistance and potentially high durability. The purpose of this research is to experimentally investigate the mechanical and fracture properties of glass-fiber reinforced polyester composite material, 450 g/m 2 randomly distributed glass-fiber mat also known as woven strand mat with polyester resin as a matrix. The samples have been produced by the conventional hand layup process and the specimens were prepared as per the ASTM standards. The tensile test was performed on the composite specimens using Universal testing machine (UTM) which are used for the finite element simulation of composite Layered fracture model. The mechanical properties were evaluated from the stress vs. strain curve obtained from the test result. Later, fracture tests were performed on the CT specimen. In case of CT specimen the load vs. Displacement plot obtained from the experimental results was used to determine the fracture properties of the composite. The failure load of CT specimen using FEA is simulated which gives the Stress intensity factor by using FEA. Good agreement between the FEA and experimental results was observed.

Increased intake of vegetables, but not fruits, may be associated with reduced risk of hip fracture: A meta-analysis.

PubMed

Luo, Si yang; Li, Yan; Luo, Hong; Yin, Xin hai; Lin, Du ren; Zhao, Ke; Huang, Guang lei; Song, Ju kun

2016-01-25

Association between dietary intake of vegetables and fruits and risk of hip fracture has been reported for many years. However, the findings remain inconclusive. We conducted a meta-analysis to evaluate the relationship between intake of vegetables and fruits, and risk of hip fracture. Literature search for relevant studies was performed on PubMed and Embase databases. Five observational studies were included in the meta-analysis. Summary hazard ratio (HR) with corresponding 95% confidence interval (CI) was calculated from pooled data using the random-effects model irrespective of heterogeneity. Sensitivity and subgroup analysis were performed to explore possible reasons for heterogeneity. The summary HR for hip fracture in relation to high intake vs. low intake of only vegetables, only fruits, and combined intake of fruits and vegetables, was 0.75 (95% CI, 0.61-0.92), 0.87 (95% CI, 0.74-1.04), and 0.79 (95% CI, 0.61-1.03), respectively. Subgroup analyses based on study design, geographical location, number of cases, and gender showed similar results. Increased intake of vegetables, but not fruits, was found to be associated with a lower risk of hip fracture. Large prospective clinical trials with robust methodology are required to confirm our findings.

Concomitant intra-articular glenohumeral injuries in displaced fractures of the lateral clavicle.

PubMed

Beirer, Marc; Zyskowski, Michael; Crönlein, Moritz; Pförringer, Dominik; Schmitt-Sody, Marcus; Sandmann, Gunther; Huber-Wagner, Stefan; Biberthaler, Peter; Kirchhoff, Chlodwig

2017-10-01

To detect concomitant intra-articular glenohumeral injuries, in acute displaced fractures of the lateral clavicle, initially missed due to unfeasible clinical evaluation of the acutely injured shoulder. All patients suffering from an acute displaced lateral clavicle fracture with indication to surgical treatment underwent diagnostic shoulder arthroscopy prior to open reduction and internal fixation. In case of therapy-relevant intra-articular glenohumeral injuries, subsequent surgical treatment was performed. Intra-articular injuries were found in 13 of 28 patients (46.4 %) with initially suspected isolated lateral clavicle fracture. Additional surgical treatment was performed in 8 of 28 cases (28.6 %). Superior labral anterior-posterior (SLAP) lesions were observed in 4 of 28 patients (14.3 %; SLAP II a: 1; II b: 1; III: 1; and IV: 1). Lesions of the pulley system were found in 3 of 28 patients (10.7 %; Habermeyer III°). One partial articular supraspinatus tendon avulsion lesion (3.6 %) and one lesion of the subscapularis tendon (3.6 %; Fox and Romeo II°) were observed. Traumatic concomitant glenohumeral injuries in lateral clavicle fractures seem to be more frequent than expected in general. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce complication rate. IV.

Vitamin D serum levels are associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture.

PubMed

Gumieiro, David Nicoletti; Murino Rafacho, Bruna Paola; Buzati Pereira, Bruna Letícia; Cavallari, Karelin Alvisi; Tanni, Suzana Erico; Azevedo, Paula Schmidt; Polegato, Bertha Furlan; Mamede Zornoff, Leonardo Antonio; Dinhane, Daniel Innocenti; Innocenti Dinhane, Kandir Genésio; Cação Pereira, Gilberto José; de Paiva, Sergio Alberto Rupp; Minicucci, Marcos Ferreira

2015-01-01

The aim of this study was to evaluate the association between serum levels of 25(OH) vitamin D3 with midupper arm muscle circumference (MUAMC), handgrip strength and length of hospital stay (LOS) after hip fracture. In total, 102 consecutive patients with hip fracture over the age of 65 were admitted to the orthopedic unit and prospectively evaluated. All of the patients were treated according to specific protocols depending on the type of fracture. Anthropometric measurements and handgrip strength were performed, and blood samples were taken for serum biochemistry and 25(OH) vitamin D3 analysis within the first 72 h of admission. All of the patients were followed during their hospital stay, and the length of stay was recorded. Of the patients, two were excluded because of pathologic fractures. In total, 100 patients with a mean age of 80 ± 7 y were included in the analysis. Among these patients, 73% were female, and 37% had vitamin D deficiency. The median LOS was 7 (5-11) d. Patients with vitamin D deficiency had lower handgrip strength in univariate analysis. In the multiple linear regression analysis with robust standard error, serum vitamin D levels adjusted by age and sex were associated with handgrip strength but not with MUAMC and LOS after hip fracture. In conclusion, vitamin D serum levels were associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture. Copyright © 2015 Elsevier Inc. All rights reserved.

Efficacy of magnetic resonance imaging for diagnosis of penile fracture: A controlled study

PubMed Central

Tarhan, Fatih; Hamarat, Mustafa B.; Can, Utku; Coskun, Alper; Camur, Emre; Sarica, Kemal

2017-01-01

Purpose To evaluate the diagnostic value of magnetic resonance imaging (MRI) in patients with suspected penile fracture. Materials and Methods A total of 122 patients admitted to our inpatient clinic with a suspicion of penile fracture following a recent history of penile trauma and who underwent surgical exploration were included this study. A thorough physical examination, a detailed medical history, description of the trauma, and preoperative International Index of Erectile Function (IIEF) scores were obtained for each patient prior to surgery. Thirty-eight of these patients were evaluated with MRI before the surgical exploration. Intraoperative findings were also recorded. Physical findings and IIEF scores were also recorded at postoperative 6 months. Results The mean age of our patient group was 36.5±12.3 years. Penile fracture was detected in 105 of 122 patients in whom surgical exploration was performed owing to a suspected diagnosis. The mean time interval from penile trauma to hospital admittance was 9.9±15.1 hours. No cavernosal defect was detected in 9 of 84 patients (10.7%) who were not evaluated with MRI prior to surgery. Compared with surgical exploration, MRI findings showed 100% (30 of 30) sensitivity and 87.5% (7 of 8) specificity in the diagnosis of penile fracture. MRI had a high negative predictive value of 100% (7 of 7) and a positive predictive value of 96.7% (30 of 31) with just 1 misdiagnosed patient. Conclusions MRI is a reliable diagnostic tool in the diagnosis of penile fractures. Compared to history and physical findings taken all together, the high sensitivity and specificity of this imaging technique can decrease the number of unnecessary surgical explorations. PMID:28681035

Efficacy of magnetic resonance imaging for diagnosis of penile fracture: A controlled study.

PubMed

Saglam, Erkin; Tarhan, Fatih; Hamarat, Mustafa B; Can, Utku; Coskun, Alper; Camur, Emre; Sarica, Kemal

2017-07-01

To evaluate the diagnostic value of magnetic resonance imaging (MRI) in patients with suspected penile fracture. A total of 122 patients admitted to our inpatient clinic with a suspicion of penile fracture following a recent history of penile trauma and who underwent surgical exploration were included this study. A thorough physical examination, a detailed medical history, description of the trauma, and preoperative International Index of Erectile Function (IIEF) scores were obtained for each patient prior to surgery. Thirty-eight of these patients were evaluated with MRI before the surgical exploration. Intraoperative findings were also recorded. Physical findings and IIEF scores were also recorded at postoperative 6 months. The mean age of our patient group was 36.5±12.3 years. Penile fracture was detected in 105 of 122 patients in whom surgical exploration was performed owing to a suspected diagnosis. The mean time interval from penile trauma to hospital admittance was 9.9±15.1 hours. No cavernosal defect was detected in 9 of 84 patients (10.7%) who were not evaluated with MRI prior to surgery. Compared with surgical exploration, MRI findings showed 100% (30 of 30) sensitivity and 87.5% (7 of 8) specificity in the diagnosis of penile fracture. MRI had a high negative predictive value of 100% (7 of 7) and a positive predictive value of 96.7% (30 of 31) with just 1 misdiagnosed patient. MRI is a reliable diagnostic tool in the diagnosis of penile fractures. Compared to history and physical findings taken all together, the high sensitivity and specificity of this imaging technique can decrease the number of unnecessary surgical explorations.

Minimally displaced clavicle fracture after high-energy injury: are they likely to displace?

PubMed

Riehl, John T; Athans, Bill J; Munro, Mark W; Langford, Joshua R; Kupiszewski, Stanley J; Haidukewych, George J; Koval, Kenneth J

2014-06-01

Nondisplaced or minimally displaced clavicle fractures are often considered to be benign injuries. These fractures in the trauma patient population, however, may deserve closer follow-up than their low-energy counterparts. We sought to determine the initial assessment performed on these patients and the rate of subsequent fracture displacement in patients sustaining high-energy trauma when a supine chest radiograph on initial trauma survey revealed a well-aligned clavicle fracture. We retrospectively reviewed the cases of trauma alert patients who sustained a midshaft clavicle fracture (AO/OTA type 15-B) with less than 100% displacement treated at a single level 1 trauma centre between 2005 and 2010. We compared fracture displacement on initial supine chest radiographs and follow-up radiographs. Orthopedic consultation and the type of imaging studies obtained were also recorded. Ninety-five patients with clavicle fractures met the inclusion criteria. On follow-up, 57 (60.0%) had displacement of 100% or more of the shaft width. Most patients (63.2%) in our study had an orthopedic consultation during their hospital admission, and 27.4% had clavicle radiographs taken on the day of admission. Clavicle fractures in patients with a high-energy mechanism of injury are prone to fracture displacement, even when initial supine chest radiographs show nondisplacement. We recommend clavicle films as part of the initial evaluation for all patients with clavicle fractures and early follow-up within the first 2 weeks of injury.

Minimally displaced clavicle fracture after high-energy injury: Are they likely to displace?

PubMed Central

Riehl, John T.; Athans, Bill J.; Munro, Mark W.; Langford, Joshua R.; Kupiszewski, Stanley J.; Haidukewych, George J.; Koval, Kenneth J.

2014-01-01

Background Nondisplaced or minimally displaced clavicle fractures are often considered to be benign injuries. These fractures in the trauma patient population, however, may deserve closer follow-up than their low-energy counterparts. We sought to determine the initial assessment performed on these patients and the rate of subsequent fracture displacement in patients sustaining high-energy trauma when a supine chest radiograph on initial trauma survey revealed a well-aligned clavicle fracture. Methods We retrospectively reviewed the cases of trauma alert patients who sustained a midshaft clavicle fracture (AO/OTA type 15-B) with less than 100% displacement treated at a single level 1 trauma centre between 2005 and 2010. We compared fracture displacement on initial supine chest radiographs and follow-up radiographs. Orthopedic consultation and the type of imaging studies obtained were also recorded. Results Ninety-five patients with clavicle fractures met the inclusion criteria. On follow-up, 57 (60.0%) had displacement of 100% or more of the shaft width. Most patients (63.2%) in our study had an orthopedic consultation during their hospital admission, and 27.4% had clavicle radiographs taken on the day of admission. Conclusion Clavicle fractures in patients with a high-energy mechanism of injury are prone to fracture displacement, even when initial supine chest radiographs show nondisplacement. We recommend clavicle films as part of the initial evaluation for all patients with clavicle fractures and early follow-up within the first 2 weeks of injury. PMID:24869608

Uncertainty Analysis of Simulated Hydraulic Fracturing

NASA Astrophysics Data System (ADS)

Chen, M.; Sun, Y.; Fu, P.; Carrigan, C. R.; Lu, Z.

2012-12-01

Artificial hydraulic fracturing is being used widely to stimulate production of oil, natural gas, and geothermal reservoirs with low natural permeability. Optimization of field design and operation is limited by the incomplete characterization of the reservoir, as well as the complexity of hydrological and geomechanical processes that control the fracturing. Thus, there are a variety of uncertainties associated with the pre-existing fracture distribution, rock mechanics, and hydraulic-fracture engineering that require evaluation of their impact on the optimized design. In this study, a multiple-stage scheme was employed to evaluate the uncertainty. We first define the ranges and distributions of 11 input parameters that characterize the natural fracture topology, in situ stress, geomechanical behavior of the rock matrix and joint interfaces, and pumping operation, to cover a wide spectrum of potential conditions expected for a natural reservoir. These parameters were then sampled 1,000 times in an 11-dimensional parameter space constrained by the specified ranges using the Latin-hypercube method. These 1,000 parameter sets were fed into the fracture simulators, and the outputs were used to construct three designed objective functions, i.e. fracture density, opened fracture length and area density. Using PSUADE, three response surfaces (11-dimensional) of the objective functions were developed and global sensitivity was analyzed to identify the most sensitive parameters for the objective functions representing fracture connectivity, which are critical for sweep efficiency of the recovery process. The second-stage high resolution response surfaces were constructed with dimension reduced to the number of the most sensitive parameters. An additional response surface with respect to the objective function of the fractal dimension for fracture distributions was constructed in this stage. Based on these response surfaces, comprehensive uncertainty analyses were conducted among input parameters and objective functions. In addition, reduced-order emulation models resulting from this analysis can be used for optimal control of hydraulic fracturing. This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

Optimization of Tube Current in Cone-beam Computed Tomography for the Detection of Vertical Root Fractures with Different Intracanal Materials.

PubMed

Gaêta-Araujo, Hugo; Silva de Souza, Gabriela Queiroz; Freitas, Deborah Queiroz; de Oliveira-Santos, Christiano

2017-10-01

There is no consensus about the accuracy of cone-beam computed tomography (CBCT) for detecting vertical root fractures (VRFs), nor is there certainty about the isolated effect of different tube current parameters on the diagnosis of VRF through CBCT scans. This study aimed to evaluate how tube current affects the detection of VRF on CBCT examinations in the absence of intracanal materials and in the presence of gutta-percha (GP) and metal (MP) or fiberglass (FP) intracanal posts. The sample consisted of 320 CBCT scans of tooth roots with and without VRF divided into 8 groups: no fracture/no intracanal material; no fracture + GP; no fracture + MP; no fracture + FP; fracture/no intracanal material; fracture + GP; fracture + MP; fracture + FP. The scans were acquired with an OP300 unit using 4 different milliamperes (4 mA, 8 mA, 10 mA, 13 mA). Five oral radiologists analyzed the images. The area under the receiver operating characteristic curve (Az), sensitivity, specificity, positive and negative predictive values, and interobserver agreement were calculated. Diagnostic performance for the different milliamperes tested was similar for teeth without root filling materials or with FP. Teeth with GP and MP showed the highest Az values for 8 mA and 10 mA, respectively. For teeth with MP, specificity was significantly higher when 10 mA was used. For teeth without root filling materials or with FP, the use of a reduced milliampere does not seem to influence the detection of VRF in a significant manner. For teeth with GP and MP, an increased milliampere may lead to increased diagnostic performance. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Facial trauma.

PubMed

Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Preoperative trajectory planning for closed reduction of long-bone diaphyseal fracture using a computer-assisted reduction system.

PubMed

Du, Hailong; Hu, Lei; Li, Changsheng; He, Chunqing; Zhang, Lihai; Tang, Peifu

2015-03-01

Balancing reduction accuracy with soft-tissue preservation is a challenge in orthopaedics. Computer-assisted orthopaedic surgery (CAOS) can improve accuracy and reduce radiation exposure. However, previous reports have not summarized the fracture patterns to which CAOS has been applied. We used a CAOS system and a stereolithography model to define a new fracture classification. Twenty reduction tests were performed to evaluate the effectiveness of preoperative trajectory planning. Twenty tests ran automatically and smoothly. Only three slight scratches occurred. Seventy-six path points represented displacement deviations of < 2 mm (average < 1 mm) and angulation deviation of < 1.5°. Because of the strength of muscles, mechanical sensors are used to prevent iatrogenic soft-tissue injury. Secondary fractures are prevented mainly through preoperative trajectory planning. Based on our data, a 1 mm gap between the edges of fractures spikes is sufficient to avoid emergency braking from spike interference. Copyright © 2014 John Wiley & Sons, Ltd.

Probabilistic Assessment of Fracture Progression in Composite Structures

NASA Technical Reports Server (NTRS)

Chamis, Christos C.; Minnetyan, Levon; Mauget, Bertrand; Huang, Dade; Addi, Frank

1999-01-01

This report describes methods and corresponding computer codes that are used to evaluate progressive damage and fracture and to perform probabilistic assessment in built-up composite structures. Structural response is assessed probabilistically, during progressive fracture. The effects of design variable uncertainties on structural fracture progression are quantified. The fast probability integrator (FPI) is used to assess the response scatter in the composite structure at damage initiation. The sensitivity of the damage response to design variables is computed. The methods are general purpose and are applicable to stitched and unstitched composites in all types of structures and fracture processes starting from damage initiation to unstable propagation and to global structure collapse. The methods are demonstrated for a polymer matrix composite stiffened panel subjected to pressure. The results indicated that composite constituent properties, fabrication parameters, and respective uncertainties have a significant effect on structural durability and reliability. Design implications with regard to damage progression, damage tolerance, and reliability of composite structures are examined.

Tarsal navicular stress fractures: radiographic evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pavlov, H.; Torg, J.S.; Freiberger, R.H.

1983-09-01

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.

Evaluation of selective vs. point-source perforating for hydraulic fracturing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Underwood, P.J.; Kerley, L.

1996-12-31

This paper is a case history comparing and evaluating the effects of fracturing the Reef Ridge Diatomite formation in the Midway-Sunset Field, Kern County, California, using {open_quotes}select-fire{close_quotes} and {open_quotes}point-source{close_quotes} perforating completions. A description of the reservoir, production history, and fracturing techniques used leading up to this study is presented. Fracturing treatment analysis and production history matching were used to evaluate the reservoir and fracturing parameters for both completion types. The work showed that single fractures were created with the point-source (PS) completions, and multiple fractures resulted from many of the select-fire (SF) completions. A good correlation was developed between productivitymore » and the product of formation permeability, net fracture height, bottomhole pressure, and propped fracture length. Results supported the continued development of 10 wells using the PS concept with a more efficient treatment design, resulting in substantial cost savings.« less

Water Pressure Effects on Strength and Deformability of Fractured Rocks Under Low Confining Pressures

NASA Astrophysics Data System (ADS)

Noorian Bidgoli, Majid; Jing, Lanru

2015-05-01

The effect of groundwater on strength and deformation behavior of fractured crystalline rocks is one of the important issues for design, performance and safety assessments of surface and subsurface rock engineering problems. However, practical difficulties make the direct in situ and laboratory measurements of these properties of fractured rocks impossible at present, since effects of complex fracture system hidden inside the rock masses cannot be accurately estimated. Therefore, numerical modeling needs to be applied. The overall objective of this paper is to deepen our understanding on the validity of the effective stress concept, and to evaluate the effects of water pressure on strength and deformation parameters. The approach adopted uses discrete element methods to simulate the coupled stress-deformation-flow processes in a fractured rock mass with model dimensions at a representative elementary volume (REV) size and realistic representation of fracture system geometry. The obtained numerical results demonstrate that water pressure has significant influence on the strength, but with minor effects on elastic deformation parameters, compared with significant influence by the lateral confining pressure. Also, the classical effective stress concept to fractured rock can be quite different with that applied in soil mechanics. Therefore, one should be cautious when applying the classical effective stress concept to fractured rock media.

Rate of displacement for Jakob Type 1 lateral condyle fractures treated with a cast.

PubMed

Zale, C; Winthrop, Z A; Hennrikus, W

2018-04-01

The aim of this retrospective study is to report the rate of displacement of Jakob Type 1 lateral condyle fractures that were initially treated in a cast. We performed a retrospective review of all patients that were treated for a non-displaced (Jakob Type 1 < 2 mm) lateral condyle fracture of the humerus at our institution between 2002 and 2015. A total of 59 patients were initially treated with casting. Five fractures displaced and were converted to a closed pinning treatment plan with a conversion rate of 8.5%. There was a mean of 13.2 days (4 to 21) between treatment by initial casting and closed pinning. This study demonstrates an 8.5% displacement and conversion rate from cast treatment to closed pinning for initially non-displaced Jakob Type 1 lateral condyle fractures of the humerus. The internal oblique radiograph is most accurate to determine displacement. We recommend obtaining an internal oblique view at initial evaluation and at follow-up in the cast for lateral condyle fractures. To minimize movement at the fracture site, we recommend treating Jakob Type 1 lateral condyle fractures with a long arm cast with the elbow at 90° and the forearm in the supine position with a sling-loop design. IV - retrospective therapeutic study.

Role of mastoid pneumatization in temporal bone fractures.

PubMed

Ilea, A; Butnaru, A; Sfrângeu, S A; Hedeşiu, M; Dudescu, C M; Berce, P; Chezan, H; Hurubeanu, L; Trombiţaş, V E; Câmpian, R S; Albu, S

2014-07-01

The mastoid portion of the temporal bone has multiple functional roles in the organism, including regulation of pressure in the middle ear and protection of the inner ear. We investigated whether mastoid pneumatization plays a role in the protection of vital structures in the temporal bone during direct lateral trauma. The study was performed on 20 human temporal bones isolated from cadavers. In the study group formed by 10 temporal bone samples, mastoid cells were removed and the resulting neocavities were filled. The mastoids were maintained intact in the control group. All samples were impacted at the same speed and kinetic energy. The resultant temporal bone fractures were evaluated by CT. Temporal squama fractures were 2.88 times more frequent, and mastoid fractures were 2.76 times more frequent in the study group. Facial nerve canal fractures were 6 times more frequent in the study group and involved all the segments of the facial nerve. Carotid canal fractures and jugular foramen fractures were 2.33 and 2.5 times, respectively, more frequent in the study group. The mastoid portion of the temporal bone plays a role in the absorption and dispersion of kinetic energy during direct lateral trauma to the temporal bone, reducing the incidence of fracture in the setting of direct trauma. © 2014 by American Journal of Neuroradiology.

Spontaneous rib fractures.

PubMed

Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber

2015-07-01

Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

Comparison of Clinical Efficacy of Lateral and Lateral and Medial Double-plating Fixation of Distal Femoral Fractures.

PubMed

Bai, Zhibiao; Gao, Shichang; Hu, Zhenming; Liang, Anlin

2018-03-20

The present study was performed to compare the clinical efficacy of lateral plate and lateral and medial double-plating fixation of distal femoral fractures and explore the indication of lateral and medial double-plating fixation of the distal femoral fractures. From March 2006 to April 2014, 48 and 12 cases of distal femoral fractures were treated with lateral plate (single plate) and lateral and medial plates (double plates), respectively. During the surgery, after setting the lateral plate for the distal femoral fractures, if the varus stress test of the knee was positive and the lateral collateral ligament rupture was excluded, lateral and medial double-plating fixation was used for the stability of the fragments. All the patients were followed up at an average period of 15.9 months. The average operation time, the intraoperative hemorrhage and the fracture union time of the two groups were compared. One year after operation, knee function was evaluated by the Kolmert's standard. There was no significant difference in the average operation time, intraoperative hemorrhage, fracture healing time and excellent and good rates of postoperative knee function between two groups. Positive Varus stress test during operation can be an indication for lateral and medial double-plating fixation of distal femoral fractures.

Fracturing alliance allows massive diatomite oil reserves to be economically produced at Lost Hills, California: A case study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klins, M.A.; Stewart, D.W.; Pferdehirt, D.J.

1995-12-31

As North American oilfield operations mature, there is a perceptible loosening of the autocratic ties between oil companies and contractors. They are being replaced by alliances or partnerships designed to minimize cost while improving profitability of the companies involved. Many papers have been written concerning alliance theory, but little documentation exists detailing actual performance. This paper evaluates a mature alliance, its implementation, structure and results. In Lost Hills, California, the diatomite formation requires hydraulic fracturing to allow oil recovery at profitable production rates. Because hydraulic fracturing is approximately two-thirds of the total well cost, it is imperative that fracturing investmentsmore » be optimized to allow field development to proceed at optimum levels. Therefore, in 1990, a fracturing alliance (the first of its kind) was initiated between Chevron and Schlumberger Dowell. Over 1 billion lbm of sand has been successfully placed during approximately 2,000 fracture stimulation jobs. Through this prototype fracturing alliance, many major accomplishments are being achieved. The most notable are the hydraulic fracturing costs that have been reduced by 40% while improving the profitability of both companies. This paper illustrates the benefits of an alliance and justifies the change in management style from a low-bid operating strategy to a win-win customer/supplier attitude.« less

Numerical simulation based on core analysis of a single fracture in an Enhanced Geothermal System

NASA Astrophysics Data System (ADS)

Jarrahi, Miad; Holländer, Hartmut

2017-04-01

The permeability of reservoirs is widely affected by the presence of fractures dispersed within them, as they form superior paths for fluid flow. Core analysis studies the fractures characteristics and explains the fluid-rock interactions to provide the information of permeability and saturation of a hydraulic fracturing reservoir or an enhanced geothermal system (EGS). This study conducted numerical simulations of a single fracture in a Granite core obtained from a depth of 1890 m in borehole EPS1 from Soultz-sous-Forêts, France. Blaisonneau et al. (2016) designed the apparatus to investigate the complex physical phenomena on this cylindrical sample. The method of the tests was to percolate a fluid through a natural fracture contained in a rock sample, under controlled thermo-hydro-mechanical conditions. A divergent radial flow within the fracture occurred due to the injection of fluid into the center of the fracture. The tests were performed within a containment cell with a normal stress of 2.6, 4.9, 7.2 and 9.4 MPa loading on the sample perpendicular to the fracture plane. This experiment was numerically performed to provide an efficient numerical method by modeling single phase flow in between the fracture walls. Detailed morphological features of the fracture such as tortuosity and roughness, were obtained by image processing. The results included injection pressure plots with respect to injection flow rate. Consequently, by utilizing Hagen-Poiseuille's cubic law, the equivalent hydraulic aperture size, of the fracture was derived. Then, as the sample is cylindrical, to modify the Hagen-Poiseuille's cubic law for circular parallel plates, the geometric relation was applied to obtain modified hydraulic aperture size. Finally, intrinsic permeability of the fracture under each mechanical normal stress was evaluated based on modified hydraulic aperture size. The results were presented in two different scenarios, before and after reactive percolation test, to demonstrate the effect of chemical reactive flow. The fracture after percolation test showed larger equivalent aperture size and higher permeability. Additionally, the higher the normal stress, the lower permeability was investigated. This confirmed the permeability evolution due to chemical percolation and mechanical loading. All results showed good agreements with corresponding experimental results provided by Blaisonneau et al. (2016). Keyword: Core analysis, Hydraulic fracturing, Enhanced geothermal system, Permeability, Fluid-rock interactions.

In vitro resistance to fracture of roots obturated with Resilon or gutta-percha.

PubMed

Monteiro, Jeanne; de Ataide, Ida de Noronha; Chalakkal, Paul; Chandra, Pavan Kumar

2011-06-01

There have been varied results from studies comparing postendodontic fracture resistance between teeth obturated with Resilon or gutta-percha. This study was performed to evaluate the fracture resistance of roots obturated by using Resilon (RealSeal system) or gutta-percha (with AH Plus sealer). Eighty extracted human mandibular single-rooted premolars stored in 10% formalin were used in the study. They were prepared by using a crown-down technique, debrided with NaOCl, ethylenediaminetetraacetic acid, and sterile water and divided into 4 groups. Obturation was performed by using the lateral condensation method. The negative control group consisted of unfilled specimens, and the positive control group consisted of those obturated with flowable, dual-cure composite resin. All root specimens were stored for 2 weeks in 100% humidity to allow complete setting of the sealer. Each specimen was mounted in acrylic in a polyvinyl ring and tested for fracture resistance with the Universal testing machine. The loading fixture of the machine was mounted with its spherical tip aligned with the center of the canal opening of each root. A vertical loading force was applied until it fractured the root. The force values were subjected to statistical analysis including analysis of variance and Fisher least significant difference testing. Teeth obturated with Resilon were more resistant to fracture than those obturated with gutta-percha. The difference was found to be highly significant (P=.00001). Resilon increased the resistance to fracture of single-rooted teeth in vitro. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Physical performance and radiographic and clinical vertebral fractures in older men.

PubMed

Cawthon, Peggy M; Blackwell, Terri L; Marshall, Lynn M; Fink, Howard A; Kado, Deborah M; Ensrud, Kristine E; Cauley, Jane A; Black, Dennis; Orwoll, Eric S; Cummings, Steven R; Schousboe, John T

2014-09-01

In men, the association between poor physical performance and likelihood of incident vertebral fractures is unknown. Using data from the MrOS study (N = 5958), we describe the association between baseline physical performance (walking speed, grip strength, leg power, repeat chair stands, narrow walk [dynamic balance]) and incidence of radiographic and clinical vertebral fractures. At baseline and follow-up an average of 4.6 years later, radiographic vertebral fractures were assessed using semiquantitative (SQ) scoring on lateral thoracic and lumbar radiographs. Logistic regression modeled the association between physical performance and incident radiographic vertebral fractures (change in SQ grade ≥1 from baseline to follow-up). Every 4 months after baseline, participants self-reported fractures; clinical vertebral fractures were confirmed by centralized radiologist review of the baseline study radiograph and community-acquired spine images. Proportional hazards regression modeled the association between physical performance with incident clinical vertebral fractures. Multivariate models were adjusted for age, bone mineral density (BMD, by dual-energy X-ray absorptiometry [DXA]), clinical center, race, smoking, height, weight, history of falls, activity level, and comorbid medical conditions; physical performance was analyzed as quartiles. Of 4332 men with baseline and repeat radiographs, 192 (4.4%) had an incident radiographic vertebral fracture. With the exception of walking speed, poorer performance on repeat chair stands, leg power, narrow walk, and grip strength were each associated in a graded manner with an increased risk of incident radiographic vertebral fracture (p for trend across quartiles <0.001). In addition, men with performance in the worst quartile on three or more exams had an increased risk of radiographic fracture (odds ratio [OR] = 1.81, 95% confidence interval [CI] 1.33-2.45) compared with men with better performance on all exams. Clinical vertebral fracture (n =149 of 5813, 2.6%) was not consistently associated with physical performance. We conclude that poorer physical performance is associated with an increased risk of incident radiographic (but not clinical) vertebral fracture in older men. © 2014 American Society for Bone and Mineral Research.

Modeling Single Well Injection-Withdrawal (SWIW) Tests for Characterization of Complex Fracture-Matrix Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cotte, F.P.; Doughty, C.; Birkholzer, J.

2010-11-01

The ability to reliably predict flow and transport in fractured porous rock is an essential condition for performance evaluation of geologic (underground) nuclear waste repositories. In this report, a suite of programs (TRIPOLY code) for calculating and analyzing flow and transport in two-dimensional fracture-matrix systems is used to model single-well injection-withdrawal (SWIW) tracer tests. The SWIW test, a tracer test using one well, is proposed as a useful means of collecting data for site characterization, as well as estimating parameters relevant to tracer diffusion and sorption. After some specific code adaptations, we numerically generated a complex fracture-matrix system for computationmore » of steady-state flow and tracer advection and dispersion in the fracture network, along with solute exchange processes between the fractures and the porous matrix. We then conducted simulations for a hypothetical but workable SWIW test design and completed parameter sensitivity studies on three physical parameters of the rock matrix - namely porosity, diffusion coefficient, and retardation coefficient - in order to investigate their impact on the fracture-matrix solute exchange process. Hydraulic fracturing, or hydrofracking, is also modeled in this study, in two different ways: (1) by increasing the hydraulic aperture for flow in existing fractures and (2) by adding a new set of fractures to the field. The results of all these different tests are analyzed by studying the population of matrix blocks, the tracer spatial distribution, and the breakthrough curves (BTCs) obtained, while performing mass-balance checks and being careful to avoid some numerical mistakes that could occur. This study clearly demonstrates the importance of matrix effects in the solute transport process, with the sensitivity studies illustrating the increased importance of the matrix in providing a retardation mechanism for radionuclides as matrix porosity, diffusion coefficient, or retardation coefficient increase. Interestingly, model results before and after hydrofracking are insensitive to adding more fractures, while slightly more sensitive to aperture increase, making SWIW tests a possible means of discriminating between these two potential hydrofracking effects. Finally, we investigate the possibility of inferring relevant information regarding the fracture-matrix system physical parameters from the BTCs obtained during SWIW testing.« less

SHOULDER ARTHROPLASTY RECORDS

PubMed Central

Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

2015-01-01

The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

Proximal fractures of the humerus in patients older than 75 years of age: should we consider operative treatment?

PubMed

de Kruijf, Marjolein; Vroemen, J P A M; de Leur, K; van der Voort, E A M; Vos, D I; Van der Laan, L

2014-06-01

Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly. In this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations. Sixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results were obtained with the modern locked plate osteosynthesis (mean DASH 34.4). Prosthetic treatment, mostly used in highly comminuted fractures, often resulted in poor function (mean DASH 72.9). Persistent pain and ADL limitations were more present in more comminuted fractures (64 and 50 % in patients with 4-part fractures vs. 14 % in 2-part fractures). There were no postoperative deaths within 3 months of surgery, and fracture-related and non-fracture-related complication rates were low (non-union 3 %; 1 myocardial infarction). This study shows that it is safe and justifiable to consider surgical treatment of a severely dislocated proximal humerus fracture in selected patients aged 75 and older. According to OCEBM Working Group,Level IV.

[Evaluation of visual functions in elderly patients with femoral neck fracture].

PubMed

Oner, Mithat; Oner, Ayşe; Güney, Ahmet; Halici, Mehmet; Arda, Hatice; Bilal, Okkeş

2009-01-01

We aimed at assessing the visual functions in elderly patients with femoral neck fracture and to compare the results with age-matched controls in this three-year prospective study. Seventy-one patients with a history of fall related hip fracture (39 females, 32 males; mean age 76.3+/-9.7 years; range 64 to 90 years) and who were diagnosed with femoral neck fracture after direct graphy were treated by means of bipolar partial prosthesis and they were contacted postoperatively or prior to discharge to participate in the study. Visual acuity, depth perception, the presence of cataract in the red reflex were evaluated. A dilated fundus and slit-lamp examination were performed if possible. On completion of the examination, the ophthalmologist documented the causes of any visual impairment found. Control group was comprised of age-matched 40 subjects (22 females, 18 males; mean age 73.2+/-7.6 years; range 62 to 90 years) who applied to ophtalmology clinic for routine examination. The visual acuity was significantly decreased in the patient group as was stereopsis (p<0.05). We found no difference between the study group and the controls when we evaluate the distribution of self reported eye disease and eye disease found on ocular examination. The rate of cases who reported not usually wearing glasses was 35% while it was 5% in the control group. When we evaluate the time since last examination, 38% of cases had not had an eye examination for over four years, as compared with 22.5% of controls. This study shows that elderly people should have their eyes tested at least once every two years, refractive errors should be corrected and eye diseases should be treated to decrease the risk of fall-related femoral neck fractures.

Novel approach to the diagnosis of fractures in an austere environment using a stethoscope and a cellular phone.

PubMed

Matzek, Brett A; Fivecoat, Phillip T; Ritz, Reis B

2014-03-01

Fracture diagnosis in the austere environment where radiographic tests are not available can be a challenge. In the past, a diagnostic technique has been described using a tuning fork and stethoscope to assess decreased sound conduction in the fractured extremity. In this study, we evaluate the use of a cellular phone's vibrate function and a stethoscope to limit equipment carried by expeditionary practitioners. The purpose of this study was to evaluate the accuracy of fracture diagnosis using a cellular phone and stethoscope. This is a pilot study to assess the usefulness of the above technique before clinical implementation. In 3 cadavers, we created fractures of the humerus and femur. Twenty-seven emergency medicine residents and an attending physician performed the diagnostic technique. Overall, the use of the cellular phone and stethoscope resulted in a sensitivity of 73% (95% confidence interval [CI]: 0.64 to 0.81) and a specificity of 83% (95% CI: 0.77 to 0.88), with a positive predicted value of 68% (95% CI: 0.59 to 0.77) and a negative predicted value of 86% (95% CI: 0.81 to 0.90). Positive likelihood ratio was 4.3, and negative likelihood ratio was 0.32. The use of a cellular phone and stethoscope may be a useful tool for the diagnosis of fractures in the austere environment. However, further study is needed to validate these findings in the clinical environment. Published by Wilderness Medical Society on behalf of Wilderness Medical Society.

Fracture resistance of 3 types of primary esthetic stainless steel crowns.

PubMed

Beattie, Sean; Taskonak, Burak; Jones, James; Chin, Judith; Sanders, Brian; Tomlin, Angela; Weddell, James

2011-01-01

Demand is increasing for esthetic restorations in pediatric dentistry. When full coverage is indicated, one option is to use esthetic stainless steel crowns (SSCs). However, this type of crown is prone to fracture. The purpose of this study was to evaluate the fracture resistance of 3 types of esthetic SSCs. Esthetic SSCs for first primary mandibular molars were cemented to idealized epoxy dies with glass ionomer cement. The die-crown units were fractured on a universal testing machine. The force was delivered by a stainless steel ball fixture, set in a uniaxial lever to replicate a cusp contact, with a crosshead speed of 1 mm/min. The differences among the 3 types of crown, in terms of force required to fracture, were compared statistically by 1-way analysis of variance. Pairwise comparisons were performed with Fisher's protected least significant difference test, at an overall significance level of 5%. The force required to fracture, expressed as average ± standard error, did not differ significantly among the 3 brands of esthetic SSCs: 1730 N ± 50 N, 1826 N ± 62 N and 1671 N ± 68 N, respectively (p = 0.19), well below the maximum bite force of pediatric patients determined in a previous study. Esthetic SSCs should be able to resist occlusal forces over short clinical periods. However, long-term occlusal loading and fatigue failures should be taken into account when evaluating the success of this type of crown.

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

PubMed Central

Neubauer, Jakob; Benndorf, Matthias; Reidelbach, Carolin; Krauß, Tobias; Lampert, Florian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Fiebich, Martin; Goerke, Sebastian M.

2016-01-01

Purpose To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures. Methods As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT. Results Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004). No significant differences were detected concerning the modalities’ specificities (with values between P = .98). Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001). Conclusion The diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run. PMID:27788215

Quality indicators for hip fracture care, a systematic review.

PubMed

Voeten, S C; Krijnen, P; Voeten, D M; Hegeman, J H; Wouters, M W J M; Schipper, I B

2018-05-17

Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.

Influence of the preparation design and artificial aging on the fracture resistance of monolithic zirconia crowns.

PubMed

Mitov, Gergo; Anastassova-Yoshida, Yana; Nothdurft, Frank Phillip; von See, Constantin; Pospiech, Peter

2016-02-01

The aim of this study was to evaluate the fracture resistance and fracture behavior of monolithic zirconia crowns in accordance with the preparation design and aging simulation method. An upper first molar was prepared sequentially with three different preparation designs: shoulderless preparation, 0.4 mm chamfer and 0.8 mm chamfer preparation. For each preparation design, 30 monolithic zirconia crowns were fabricated. After cementation on Cr-Co alloy dies, the following artificial aging procedures were performed: (1) thermal cycling and mechanical loading (TCML): 5000 cycles of thermal cycling 5℃-55℃ and chewing simulation (1,200,000 cycles, 50 N); (2) Low Temperature Degradation simulation (LTD): autoclave treatment at 137℃, 2 bar for 3 hours and chewing simulation; and (3) no pre-treatment (control group). After artificial aging, the crowns were loaded until fracture. The mean values of fracture resistance varied between 3414 N (LTD; 0.8 mm chamfer preparation) and 5712 N (control group; shoulderless preparation). Two-way ANOVA analysis showed a significantly higher fracture loads for the shoulderless preparation, whereas no difference was found between the chamfer preparations. In contrast to TCML, after LTD simulation the fracture strength of monolithic zirconia crowns decreased significantly. The monolithic crowns tested in this study showed generally high fracture load values. Preparation design and LTD simulation had a significant influence on the fracture strength of monolithic zirconia crowns.

Morphological Expressions of Crater Infill Collapse: Model Simulations of Chaotic Terrains on Mars

NASA Astrophysics Data System (ADS)

Roda, Manuel; Marketos, George; Westerweel, Jan; Govers, Rob

2017-10-01

Martian chaotic terrains are characterized by deeply depressed intensively fractured areas that contain a large number of low-strain tilted blocks. Stronger deformation (e.g., higher number of fractures) is generally observed in the rims when compared to the middle regions of the terrains. The distribution and number of fractures and tilted blocks are correlated with the size of the chaotic terrains. Smaller chaotic terrains are characterized by few fractures between undeformed blocks. Larger terrains show an elevated number of fractures uniformly distributed with single blocks. We investigate whether this surface morphology may be a consequence of the collapse of the infill of a crater. We perform numerical simulations with the Discrete Element Method and we evaluate the distribution of fractures within the crater and the influence of the crater size, infill thickness, and collapsing depth on the final morphology. The comparison between model predictions and the morphology of the Martian chaotic terrains shows strong statistical similarities in terms of both number of fractures and correlation between fractures and crater diameters. No or very weak correlation is observed between fractures and the infill thickness or collapsing depth. The strong correspondence between model results and observations suggests that the collapse of an infill layer within a crater is a viable mechanism for the peculiar morphology of the Martian chaotic terrains.

TIBIAL SHAFT FRACTURES.

PubMed

Kojima, Kodi Edson; Ferreira, Ramon Venzon

2011-01-01

The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

Evaluation of Shear Strength of RC Beams with Multiple Interfaces Formed before Initial Setting Using 3D Printing Technology

PubMed Central

Kim, Kyeongjin; Park, Sangmin; Jeong, Yoseok; Lee, Jaeha

2017-01-01

With the recent development of 3D printing technology, concrete materials are sometimes used in 3D printing. Concrete structures based on 3D printing have been characterized to have the form of multiple layer build-up. Unlike general concrete structures, therefore, the 3D-printed concrete can be regarded as an orthotropic material. The material property of the 3D-printed concrete’s interface between layers is expected to be far different from that of general concrete bodies since there are no aggregate interlocks and weak chemical bonding. Such a difference finally affects the structural performance of concrete structures even though the interfaces are formed before initial setting of the concrete. The current study mainly reviewed the changes in fracture energy (toughness) with respect to various environmental conditions of such interface. Changes in fracture energies of interfaces between concrete layers were measured using low-speed Crack Mouth Opening Displacement (CMOD) closed loop concrete fracture test. The experimental results indicated reduction in fracture energy as well as tensile strengths. To improve the tensile strength of interfaces, the use of bridging materials is suggested. Since it was assumed that reduction in fracture energy could be a cause of shear strength, to evaluate the reduced structural performance of concrete structure constructed with multiple interfaces by 3D printing technology, the shear strength of RC beam by 3D printing technology was predicted and compared with that of plain RC beam. Based on the fracture energy measured in this study, Modified Compression Field Theory (MCFT) theory-applied Vector 2 program was employed to predict the degree of reduction in shear strength without considering stirrups. Reduction factors were presented based on the obtained results to predict the reduction in shear strength due to interfaces before initial setting of the concrete.

Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report.

PubMed

Zeng, Canjun; Xiao, Jidong; Wu, Zhanglin; Huang, Wenhua

2015-01-01

The aim of this study is to evaluate the efficacy and feasibility of three-dimensional printing (3D printing) assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach. A total of 38 patients with unstable pelvic fractures were analyzed retrospectively from August 2012 to February 2014. All cases were treated operatively with internal fixation assisted by three-dimensional printing from minimal invasive para-rectus abdominis approach. Both preoperative CT and three-dimensional reconstruction were performed. Pelvic model was created by 3D printing. Data including the best entry points, plate position and direction and length of screw were obtained from simulated operation based on 3D printing pelvic model. The diaplasis and internal fixation were performed by minimal invasive para-rectus abdominis approach according to the optimized dada in real surgical procedure. Matta and Majeed score were used to evaluate currative effects after operation. According to the Matta standard, the outcome of the diaplasis achieved 97.37% with excellent and good. Majeed assessment showed 94.4% with excellent and good. The imageological examination showed consistency of internal fixation and simulated operation. The mean operation time was 110 minutes, mean intraoperative blood loss 320 ml, and mean incision length 6.5 cm. All patients have achieved clinical healing, with mean healing time of 8 weeks. Three-dimensional printing assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach is feasible and effective. This method has the advantages of trauma minimally, bleeding less, healing rapidly and satisfactory reduction, and worthwhile for spreading in clinical practice.

Geothermal reservoir engineering research

NASA Technical Reports Server (NTRS)

Ramey, H. J., Jr.; Kruger, P.; Brigham, W. E.; London, A. L.

1974-01-01

The Stanford University research program on the study of stimulation and reservoir engineering of geothermal resources commenced as an interdisciplinary program in September, 1972. The broad objectives of this program have been: (1) the development of experimental and computational data to evaluate the optimum performance of fracture-stimulated geothermal reservoirs; (2) the development of a geothermal reservoir model to evaluate important thermophysical, hydrodynamic, and chemical parameters based on fluid-energy-volume balances as part of standard reservoir engineering practice; and (3) the construction of a laboratory model of an explosion-produced chimney to obtain experimental data on the processes of in-place boiling, moving flash fronts, and two-phase flow in porous and fractured hydrothermal reservoirs.

The Role of Ultrasound Imaging of Callus Formation in the Treatment of Long Bone Fractures in Children.

PubMed

Wawrzyk, Magdalena; Sokal, Jan; Andrzejewska, Ewa; Przewratil, Przemysław

2015-01-01

In the process of diagnosis and treatment of fractures, an X-ray study is typically performed. In modern medicine very important is the development of new diagnostic methods without adverse effects on the body. One of such techniques is ultrasound imaging. It has a high value in imaging most areas of the body, including the musculoskeletal system. Reports on the use of ultrasound in the evaluation of the callus are rare and this could be a method equivalent to or even better than standard radiographs. The aim of the study was to analyze the correlation of ultrasound with radiographs in imaging of callus formation after fractures of long bones in children and to analyze the correlation of vascular resistance index (RI) and the degree of vascularization of the callus with a subjective radiological assessment of the bone union quality. The prospective study was planned to qualify 50 children treated for long bones fractures of the arm, forearm, thigh and lower leg. Ultrasound diagnosis was carried out using a Philips iU22 camera equipped with a linear probe with 17-5-MHz resolution and MSK Superficial program. During ultrasound examination measurements of the callus were performed. Using the Power Doppler callus vascularity was visualized and vascular resistance index (RI) was measured. The same measurements were made within the corresponding area of the healthy limb. The results obtained by ultrasound were compared with radiograph measurements and with the subjective assessment of the callus quality. Preliminary results were developed on a group of 24 patients, where 28 fractured bones and 28 corresponding healthy bones were examined. Fifteen boys and 9 girls participated in the study. The average age at injury was, respectively, 11 and 9 years. In both groups fractures without displacement were the most frequent. A similar frequency was observed in fractures requiring reposition and subperiosteal fractures. In contrast, fractures with a slight displacement of the fragments, were 3 times more common in girls. Statistical analysis of the measurements of length and width of the callus demonstrated that the differences between results obtained in the ultrasound in comparison with X-rays were not statistically significant. Moreover, preliminary results showed a significantly higher degree of vascularization of the callus than of the healthy periosteum. Preliminary results indicate the high efficacy of ultrasound in the evaluation of callus formation after fractures of long bones in children and the possibility of its alternative use to X-ray examinations.

Application of Fractal Geometry in Evaluation of Effective Stimulated Reservoir Volume in Shale Gas Reservoirs

NASA Astrophysics Data System (ADS)

Sheng, Guanglong; Su, Yuliang; Wang, Wendong; Javadpour, Farzam; Tang, Meirong

According to hydraulic-fracturing practices conducted in shale reservoirs, effective stimulated reservoir volume (ESRV) significantly affects the production of hydraulic fractured well. Therefore, estimating ESRV is an important prerequisite for confirming the success of hydraulic fracturing and predicting the production of hydraulic fracturing wells in shale reservoirs. However, ESRV calculation remains a longstanding challenge in hydraulic-fracturing operation. In considering fractal characteristics of the fracture network in stimulated reservoir volume (SRV), this paper introduces a fractal random-fracture-network algorithm for converting the microseismic data into fractal geometry. Five key parameters, including bifurcation direction, generating length (d), deviation angle (α), iteration times (N) and generating rules, are proposed to quantitatively characterize fracture geometry. Furthermore, we introduce an orthogonal-fractures coupled dual-porosity-media representation elementary volume (REV) flow model to predict the volumetric flux of gas in shale reservoirs. On the basis of the migration of adsorbed gas in porous kerogen of REV with different fracture spaces, an ESRV criterion for shale reservoirs with SRV is proposed. Eventually, combining the ESRV criterion and fractal characteristic of a fracture network, we propose a new approach for evaluating ESRV in shale reservoirs. The approach has been used in the Eagle Ford shale gas reservoir, and results show that the fracture space has a measurable influence on migration of adsorbed gas. The fracture network can contribute to enhancement of the absorbed gas recovery ratio when the fracture space is less than 0.2 m. ESRV is evaluated in this paper, and results indicate that the ESRV accounts for 27.87% of the total SRV in shale gas reservoirs. This work is important and timely for evaluating fracturing effect and predicting production of hydraulic fracturing wells in shale reservoirs.

Accuracy of specimen-specific nonlinear finite element analysis for evaluation of distal radius strength in cadaver material.

PubMed

Matsuura, Yusuke; Kuniyoshi, Kazuki; Suzuki, Takane; Ogawa, Yasufumi; Sukegawa, Koji; Rokkaku, Tomoyuki; Takahashi, Kazuhisa

2014-11-01

Distal radius fracture, which often occurs in the setting of osteoporosis, can lead to permanent deformity and disability. Great effort has been directed toward developing noninvasive methods for evaluating the distal radius strength, with the goal of assessing fracture risk. The aim of this study was to evaluate distal radius strength using a finite element model and to gauge the accuracy of finite element model measurement using cadaver material. Ten wrists were obtained from cadavers with a mean age of 89.5 years at death. CT images of each wrist in an extended position were obtained. CT-based finite element models were prepared with Mechanical Finder software. Fracture on the models was simulated by applying a mechanical load to the palm in a direction parallel to the forearm axis, after which the fracture load and the site at which the fracture began were identified. For comparison, the wrists were fractured using a universal testing machine and the fracture load and the site of fracture were identified. The fracture load was 970.9 N in the finite element model group and 990.0 N in the actual measurement group. The site of the initial fracture was extra-articular to the distal radius in both groups. The finite element model was predictive for distal radius fracture when compared to the actual measurement. In this study, a finite element model for evaluation of distal radius strength was validated and can be used to predict fracture risk. We conclude that a finite element model is useful for the evaluation of distal radius strength. Knowing distal radius strength might avoid distal radius fracture because appropriate antiosteoporotic treatment can be initiated.

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT.

PubMed

Cho, S H; Sung, Y M; Kim, M S

2012-10-01

The objective of this study was to review the prevalence and radiological features of rib fractures missed on initial chest CT evaluation, and to examine the diagnostic value of additional coronal images in a large series of trauma patients. 130 patients who presented to an emergency room for blunt chest trauma underwent multidetector row CT of the thorax within the first hour during their stay, and had follow-up CT or bone scans as diagnostic gold standards. Images were evaluated on two separate occasions: once with axial images and once with both axial and coronal images. The detection rates of missed rib fractures were compared between readings using a non-parametric method of clustered data. In the cases of missed rib fractures, the shapes, locations and associated fractures were evaluated. 58 rib fractures were missed with axial images only and 52 were missed with both axial and coronal images (p=0.088). The most common shape of missed rib fractures was buckled (56.9%), and the anterior arc (55.2%) was most commonly involved. 21 (36.2%) missed rib fractures had combined fractures on the same ribs, and 38 (65.5%) were accompanied by fracture on neighbouring ribs. Missed rib fractures are not uncommon, and radiologists should be familiar with buckle fractures, which are frequently missed. Additional coronal imagescan be helpful in the diagnosis of rib fractures that are not seen on axial images.

Biomechanical investigation of an alternative concept to angular stable plating using conventional fixation hardware.

PubMed

Windolf, Markus; Klos, Kajetan; Wähnert, Dirk; van der Pol, Bas; Radtke, Roman; Schwieger, Karsten; Jakob, Roland P

2010-05-21

Angle-stable locking plates have improved the surgical management of fractures. However, locking implants are costly and removal can be difficult. The aim of this in vitro study was to evaluate the biomechanical performance of a newly proposed crossed-screw concept ("Fence") utilizing conventional (non-locked) implants in comparison to conventional LC-DCP (limited contact dynamic compression plate) and LCP (locking compression plate) stabilization, in a human cadaveric diaphyseal gap model. In eight pairs of human cadaveric femora, one femur per pair was randomly assigned to receive a Fence construct with either elevated or non-elevated plate, while the contralateral femur received either an LCP or LC-DCP instrumentation. Fracture gap motion and fatigue performance under cyclic loading was evaluated successively in axial compression and in torsion. Results were statistically compared in a pairwise setting. The elevated Fence constructs allowed significantly higher gap motion compared to the LCP instrumentations (axial compression: p

Diagnosis and management of hook of hamate fractures.

PubMed

Kadar, Assaf; Bishop, Allen T; Suchyta, Marissa A; Moran, Steven L

2018-06-01

The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Patients were sent a quickDASH questionnaire regarding the outcomes of their treatment. Hook of hamate fractures were diagnosed with advanced imaging at a median of 27 days. Clinical findings of hook of hamate tenderness had better sensitivity than carpal tunnel-view radiographs. Nonunion occurred in 24% of patients with non-operative treatment and did not occur in the operative group. Both treatment groups achieved good clinical results, with a grip strength of 80% compared with the non-injured hand and a median quickDASH score of 2. Advanced imaging improved the time to diagnosis and treatment compared to historical case series. Nonunion is common in patients treated non-operatively. IV.

Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study.

PubMed

Barrett-Connor, Elizabeth; Nielson, Carrie M; Orwoll, Eric; Bauer, Douglas C; Cauley, Jane A

2010-03-15

To study the causes and consequences of radiologically confirmed rib fractures (seldom considered in the context of osteoporosis) in community dwelling older men. Prospective cohort study (Osteoporotic Fractures in Men (MrOS) Study). 5995 men aged 65 or over recruited in 2000-2 from six US sites; 99% answered mailed questionnaires about falls and fractures every four months for a mean 6.2 (SD 1.3) year follow-up. New fractures validated by radiology reports; multivariate Cox proportional hazard ratios were used to evaluate factors independently associated with time to incident rib fracture; associations between baseline rib fracture and incident hip and wrist fracture were also evaluated. The incidence of rib fracture was 3.5/1000 person years, and 24% (126/522) of all incident non-spine fractures were rib fractures. Nearly half of new rib fractures (48%; n=61) followed falling from standing height or lower. Independent risk factors for an incident rib fracture were age 80 or above, low bone density, difficulty with instrumental activities of daily living, and a baseline history of rib/chest fracture. Men with a history of rib/chest fracture had at least a twofold increased risk of an incident rib fracture (adjusted hazard ratio 2.71, 95% confidence interval 1.86 to 3.95), hip fracture (2.05, 1.33 to 3.15), and wrist fracture (2.06, 1.14 to 3.70). Only 14/82 of men reported being treated with bone specific drugs after their incident rib fracture. Rib fracture, the most common incident clinical fracture in men, was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture. A history of rib fracture predicted a more than twofold increased risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture.

Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete's Prospective NFL Career.

PubMed

Vopat, Bryan; Beaulieu-Jones, Brendin R; Waryasz, Gregory; McHale, Kevin J; Sanchez, George; Logan, Catherine A; Whalen, James M; DiGiovanni, Christopher W; Provencher, Matthew T

2017-08-01

Navicular injuries can result in persistent pain, posttraumatic osteoarthritis, and diminished performance and function. To determine the epidemiology of navicular fracture in players participating in the National Football League (NFL) Scouting Combine and evaluate the impact of a navicular injury on the NFL draft position and NFL game play compared with matched controls. Cohort study; Level of evidence, 3. Data were collected on players who previously sustained a navicular injury and participated in the NFL Combine between 2009 and 2015. The epidemiology of navicular injury was determined through an evaluation of the number of injuries, surgeries, and collegiate games missed as well as the position played, a physical examination, the surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared with a set of matched controls. NFL performance outcomes included the draft position, career length ≥2 years, and number of games played and started within the first 2 years. Between 2009 and 2015, 14 of 2285 (0.6%) players were identified as having sustained a navicular injury. A total of 11 of 14 (79%) athletes had sustained an overt navicular fracture, while 3 of 14 (21%) were diagnosed with stress reactions on magnetic resonance imaging. Eight patients who sustained a navicular fracture underwent surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (odds ratio, 1.3; P = .04). Fifty-seven percent of players with navicular injury (72.7% of fractures) were undrafted versus 30.9% in the control group ( P = .001). Overall, 28.6% of players with navicular fracture played ≥2 years in the NFL compared with 69.6% in the control group ( P = .02). A previous navicular fracture results in a greater risk of developing posttraumatic osteoarthritis. Although only a low prevalence of navicular injury in prospective NFL players was noted, players with these injuries had a greater probability of not being drafted and not competing in at least 2 NFL seasons when compared with matched controls without an injury history to the NFL Combine.

Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete’s Prospective NFL Career

PubMed Central

Vopat, Bryan; Beaulieu-Jones, Brendin R.; Waryasz, Gregory; McHale, Kevin J.; Sanchez, George; Logan, Catherine A.; Whalen, James M.; DiGiovanni, Christopher W.; Provencher, Matthew T.

2017-01-01

Background: Navicular injuries can result in persistent pain, posttraumatic osteoarthritis, and diminished performance and function. Purpose: To determine the epidemiology of navicular fracture in players participating in the National Football League (NFL) Scouting Combine and evaluate the impact of a navicular injury on the NFL draft position and NFL game play compared with matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on players who previously sustained a navicular injury and participated in the NFL Combine between 2009 and 2015. The epidemiology of navicular injury was determined through an evaluation of the number of injuries, surgeries, and collegiate games missed as well as the position played, a physical examination, the surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared with a set of matched controls. NFL performance outcomes included the draft position, career length ≥2 years, and number of games played and started within the first 2 years. Results: Between 2009 and 2015, 14 of 2285 (0.6%) players were identified as having sustained a navicular injury. A total of 11 of 14 (79%) athletes had sustained an overt navicular fracture, while 3 of 14 (21%) were diagnosed with stress reactions on magnetic resonance imaging. Eight patients who sustained a navicular fracture underwent surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (odds ratio, 1.3; P = .04). Fifty-seven percent of players with navicular injury (72.7% of fractures) were undrafted versus 30.9% in the control group (P = .001). Overall, 28.6% of players with navicular fracture played ≥2 years in the NFL compared with 69.6% in the control group (P = .02). Conclusion: A previous navicular fracture results in a greater risk of developing posttraumatic osteoarthritis. Although only a low prevalence of navicular injury in prospective NFL players was noted, players with these injuries had a greater probability of not being drafted and not competing in at least 2 NFL seasons when compared with matched controls without an injury history to the NFL Combine. PMID:28840151

A Discrete Fracture Network Model with Stress-Driven Nucleation and Growth

NASA Astrophysics Data System (ADS)

Lavoine, E.; Darcel, C.; Munier, R.; Davy, P.

2017-12-01

The realism of Discrete Fracture Network (DFN) models, beyond the bulk statistical properties, relies on the spatial organization of fractures, which is not issued by purely stochastic DFN models. The realism can be improved by injecting prior information in DFN from a better knowledge of the geological fracturing processes. We first develop a model using simple kinematic rules for mimicking the growth of fractures from nucleation to arrest, in order to evaluate the consequences of the DFN structure on the network connectivity and flow properties. The model generates fracture networks with power-law scaling distributions and a percentage of T-intersections that are consistent with field observations. Nevertheless, a larger complexity relying on the spatial variability of natural fractures positions cannot be explained by the random nucleation process. We propose to introduce a stress-driven nucleation in the timewise process of this kinematic model to study the correlations between nucleation, growth and existing fracture patterns. The method uses the stress field generated by existing fractures and remote stress as an input for a Monte-Carlo sampling of nuclei centers at each time step. Networks so generated are found to have correlations over a large range of scales, with a correlation dimension that varies with time and with the function that relates the nucleation probability to stress. A sensibility analysis of input parameters has been performed in 3D to quantify the influence of fractures and remote stress field orientations.

Mixing implants of differing metallic composition in the treatment of upper-extremity fractures.

PubMed

Acevedo, Daniel; Loy, Bo Nasmyth; Loy, Bo Nasymuth; Lee, Brian; Omid, Reza; Itamura, John

2013-09-01

Mixing implants with differing metallic compositions has been avoided for fear of galvanic corrosion and subsequent failure of the implants and of bone healing. The purpose of this study was to evaluate upper-extremity fractures treated with open reduction and internal fixation with metallic implants that differed in metallic composition placed on the same bone. The authors studied the effects of using both stainless steel and titanium implants on fracture healing, implant failure, and other complications associated with this method of fixation. Their hypothesis was that combining these metals on the same bone would not cause clinically significant nonunions or undo clinical effects from galvanic corrosion. A retrospective review was performed of 17 patients with upper-extremity fractures fixed with metal implants of differing metallic compositions. The primary endpoint was fracture union. Eight clavicles, 2 proximal humeri, 3 distal humeri, 3 olecranons, and 1 glenoid fracture with an average follow-up 10 months were reviewed. All fractures healed. One patient experienced screw backout, which did not affect healing. This study implies that mixing implants with differing metallic compositions on the same bone for the treatment of fractures does not adversely affect bone healing. No evidence existed of corrosion or an increase in complications with this method of treatment. Contrary to prior belief, small modular hand stainless steel plates can be used to assist in reduction of smaller fracture fragments in combination with anatomic titanium plates to obtain anatomic reduction of the fracture without adversely affecting healing. Copyright 2013, SLACK Incorporated.

Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.

PubMed

Hulme, Paul A; Krebs, Jörg; Ferguson, Stephen J; Berlemann, Ulrich

2006-08-01

Systematic literature review. To evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient pain relief, restoration of mobility and vertebral body height, complication rate, and incidence of new adjacent vertebral fractures. Vertebroplasty and kyphoplasty have been gaining popularity for treating vertebral fractures. Current reviews provide an overview of the procedures but are not comprehensive and tend to rely heavily on personal experience. This article aimed to compile all available data and evaluate the clinical outcome of the 2 procedures. This is a systematic review of all the available data presented in peer-reviewed published clinical trials. The methodological quality of included studies was evaluated, and data were collected targeting specific standard measurements. Where possible, a quantitative aggregation of the data was performed. A large proportion of subjects had some pain relief, including 87% with vertebroplasty and 92% with kyphoplasty. Vertebral height restoration was possible using kyphoplasty (average 6.6 degrees ) and for a subset of patients using vertebroplasty (average 6.6 degrees ). Cement leaks occurred for 41% and 9% of treated vertebrae for vertebroplasty and kyphoplasty, respectively. New fractures of adjacent vertebrae occurred for both procedures at rates that are higher than the general osteoporotic population but approximately equivalent to the general osteoporotic population that had a previous vertebral fracture. The problem with stating definitely that vertebroplasty and kyphoplasty are safe and effective procedures is the lack of comparative, blinded, randomized clinical trials. Standardized evaluative methods should be adopted.

Etude hydromecanique d'une fracture en cisaillement sous contrainte normale constante

NASA Astrophysics Data System (ADS)

Lamontagne, Eric

This research study deals with the effects of shear direction and injection flow rate on the flow directional anisotropy for a given normal stress. It presents experimental works on hydromechanical shear behaviour of a fracture under constant normal stress conditions that permits the characterisation of the intrinsic hydraulic transmissivity in relation with the directional anisotropy of the roughness morphology on the fracture surfaces. Tests were performed on mortar replicas of a natural fracture so that the fracture roughness and void space geometry were kept the same for each test. The experimental work program was performed through direct shear tests on the fracture replicas in four shear directions under four constant normal stress levels. The application of the normal stress was followed by several injections of fluid under constant flow rate. Then, for each defined shear displacement, several injections of fluid were done at different flow rate but under constant flow rate. The test results show that: (1) for the whole shear tests, the global intrinsic transmissivity is included within an enveloping zone of about one order of size. The transmissivity curves within the enveloping zone has a particularity to increase about two orders of size in the first millimetre of shear displacement and subsequently stabilised rapidly; (2) the highest dilatancy do not correspond necessarily with the highest intrinsic transmissivity so that, the behaviour of the global intrinsic transmissivity is not directly proportional to the fracture dilatancy during shear; (3) after the peak shear stress, the divergence is more marked between the global intrinsic transmissivity curves at various flow rate; (4) after peak shear strength and the beginning of asperity degradation, the gradual passage to residual friction shear behaviour causes a directional flow anisotropy and a reorientation of the flow chenalisation direction sub perpendicularly to the shear direction; (5) the anisotropy is not to develop equally between the two sense in the perpendicular direction to shear direction. In order to characterise the dynamics of the flow pattern in the fracture, a statistical analysis of the surfaces morphology of the fracture and the casting of void space geometry were performed before and after shear. A statistical analysis of asperity heights, on the global scale of the fracture surfaces, permits to characterise the fracture morphology and put in evidence a large morphological structure on which are superposed smaller asperities of variable dimensions. This large dimension structure generate a higher level landing occupying more than half of the fracture area. The study of the surfaces morphology of the fracture, performed with the geostatistical mean asperity heights variogram by direction before shearing, show the presence of two entangled morphologic structure families (28 and 15 mm). This same study done after shearing shows that the asperity degradation seems associated with the reduction of the global intrinsic transmissivity of the fracture. Finally, the void spaces morphology evaluated by casting techniques, during the shear tests, has permitted to verify the contacts evolution with the increasing shear displacement and visualised flow chenalisation during fracture shearing.

Bone scan as a screening test for missed fractures in severely injured patients.

PubMed

Lee, K-J; Jung, K; Kim, J; Kwon, J

2014-12-01

In many cases, patients with severe blunt trauma have multiple fractures throughout the body. These fractures are not often detectable by history or physical examination, and their diagnosis can be delayed or even missed. Thus, screening test fractures of the whole body is required after initial management. We performed this study to evaluate the reliability of bone scans for detecting missed fractures in patients with multiple severe traumas and we analyzed the causes of missed fractures by using bone scan. A bone scan is useful as a screening test for fractures of the entire body of severe trauma patients who are passed the acute phase. We reviewed the electronic medical records of severe trauma patients who underwent a bone scan from September 2009 to December 2010. Demographic and medical data were compared and statistically analyzed to determine whether missed fractures were detected after bone scan in the two groups. A total of 382 patients who had an injury severity score [ISS] greater than 16 points with multiple traumas visited the emergency room. One hundred and thirty-one patients underwent bone scan and 81 patients were identified with missed fractures by bone scan. The most frequent location for missed fractures was the rib area (55 cases, 41.98%), followed by the extremities (42 cases, 32.06%). The missed fractures that required surgery or splint were most common in extremities (11 cases). In univariate analysis, higher ISS scores and mechanism of injury were related with the probability that missed fractures would be found with a bone scan. The ISS score was statistically significant in multivariate analysis. Bone scan is an effective method of detecting missed fractures among patients with multiple severe traumas. Level IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Outcomes and secondary prevention strategies for male hip fractures.

PubMed

Riley, Rebecca L; Carnes, Molly L; Gudmundsson, Adalsteinn; Elliott, Mary E

2002-01-01

To assess clinical outcomes and determine whether osteoporosis assessment and secondary prevention strategies were performed for male veterans hospitalized for hip fractures. Retrospective chart review for male veterans hospitalized for hip fracture from January 1993 through July 1999. The Veterans Affairs Medical Center, Madison, WI. Medical charts were available for 46 of 53 male patients admitted for hip fracture during the study period. Three subjects were excluded because hip fracture was associated with high-impact trauma. Mean age of the 43 study patients was 72 years (range 43-91 y), and mean length of hospitalization was 16 days (median 11 d, range 3-108 d). Thirty-two (82%) of 39 veterans whose disposition was documented were discharged to a nursing home. Eleven (26%) of 43 men died within 12 months after fracture. Twelve (28%) had fractured previously. Four (10%) subsequently had another fracture. Three of 9 patients with documented ambulation status were ambulatory at 1 year. Three patients received a bone mass measurement within a prespecified time interval of 6 months subsequent to fracture. No patient's records included a diagnosis of osteoporosis either before or within 6 months after fracture. One-third of the patients had documentation of calcium or multivitamin supplementation at discharge. One patient was receiving calcitonin at the time of fracture and continued to receive it afterward. No other patient was prescribed antiresorptive therapy by the time of hospital discharge. Male veterans with hip fractures received inadequate evaluation and treatment for osteoporosis, although a substantial portion had documentation of recurrent fractures. Education of clinicians and creation of algorithms for management of established osteoporosis may improve outcomes for these individuals.

Evaluation of new binders using newly developed fracture energy test : [summary].

DOT National Transportation Integrated Search

2013-07-01

The flexibility and cohesion that give asphalt concrete its performance characteristics largely derive from the properties of binders. The durability of binders affects the function and lifetime of paving, and considering how extensive Floridas ro...

Laboratory evaluation of asphalt binder rutting, fracture, and adhesion tests.

DOT National Transportation Integrated Search

2014-04-01

The current performance grading (PG) specification for asphalt binders was developed based on the Strategic Highway : Research Program (SHRP) and is based primarily on the study of unmodified asphalt binders. Over the years, experience has : proven t...

Posttraumatic Intracranial Tuberculous Subdural Empyema in a Patient with Skull Fracture

PubMed Central

Kim, Jiha; Kim, Choonghyo; Ryu, Young-Joon

2016-01-01

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M. tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema. PMID:27226867

Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model.

PubMed

Ni, W; Jiang, Y

2017-02-01

This study used a simulation model to determine the cost-effective threshold of fracture risk to treat osteoporosis among elderly Chinese women. Osteoporosis treatment is cost-effective among average-risk women who are at least 75 years old and above-average-risk women who are younger than 75 years old. Aging of the Chinese population is imposing increasing economic burden of osteoporosis. This study evaluated the cost-effectiveness of osteoporosis treatment among the senior Chinese women population. A discrete event simulation model using age-specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture; costs (2015 US dollars); and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness to pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute 10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. In baseline analysis, simulated ICERs were higher than the WTP threshold among Chinese women younger than 75, but much lower than the WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher WTP threshold or a lower annual treatment cost. A 30 % increase in WTP or a 30 % reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. The current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.

On the importance of aging to the crack growth resistance of human enamel.

PubMed

Yahyazadehfar, Mobin; Zhang, Dongsheng; Arola, Dwayne

2016-03-01

With improvements in oral health and an overall increase in quality of life, the percentage of fully or largely dentate seniors is increasing. Understanding the effects of aging on the mechanical properties of teeth is essential to the maintenance of lifelong oral health. In this investigation the effects of aging on the fracture toughness of human enamel were evaluated from incremental crack growth experiments performed on tissue of donor teeth representing "young" (17 ⩽ age ⩽ 25) and "old" (age ⩾ 55) age groups. Results showed that the old enamel exhibited significantly lower resistance to fracture than that of the young tissue in two orthogonal directions of crack growth. For crack growth transverse to the enamel rods, the fracture toughness of the old enamel (0.37 ± 0.15 MPa m(0.5)) was nearly 70% lower than that of tissue from the young teeth (1.23 ± 0.20 MPa m(0.5)). Based on results from a mechanistic analysis of crack growth, the reduction in fracture resistance is attributed to a decrease in the degree of extrinsic toughening. The practice of restorative dentistry should account for these changes in tooth tissues in the treatment of senior patients. The mechanical behavior of enamel has been studied for over 3 decades. Due to the limited volume of tissue available for evaluation, past work has been largely based on indentation methods. In this investigation we have evaluated the resistance to fracture of human enamel using a conventional fracture mechanics approach and incremental crack growth. We compared the fracture resistance of cuspal enamel obtained from the teeth of representative "young" and "old" donor groups. Our results show that there is a substantial reduction in the resistance to fracture with age, that it is anisotropic, and that the degradation is more severe than that which occurs to dentin. As such, we feel this work is a significant contribution to the field. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Imaging Fracture Networks Using Angled Crosshole Seismic Logging and Change Detection Techniques

NASA Astrophysics Data System (ADS)

Knox, H. A.; Grubelich, M. C.; Preston, L. A.; Knox, J. M.; King, D. K.

2015-12-01

We present results from a SubTER funded series of cross borehole geophysical imaging efforts designed to characterize fracture zones generated with an alternative stimulation method, which is being developed for Enhanced Geothermal Systems (EGS). One important characteristic of this stimulation method is that each detonation will produce multiple fractures without damaging the wellbore. To date, we have collected six full data sets with ~30k source-receiver pairs each for the purposes of high-resolution cross borehole seismic tomographic imaging. The first set of data serves as the baseline measurement (i.e. un-stimulated), three sets evaluate material changes after fracture emplacement and/or enhancement, and two sets are used for evaluation of pick error and seismic velocity changes attributable to changing environmental factors (i.e. saturation due to rain/snowfall in the shallow subsurface). Each of the six datasets has been evaluated for data quality and first arrivals have been picked on nearly 200k waveforms in the target area. Each set of data is then inverted using a Vidale-Hole finite-difference 3-D eikonal solver in two ways: 1) allowing for iterative ray tracing and 2) with fixed ray paths determined from the test performed before the fracture stimulation of interest. Utilizing these two methods allows us to compare and contrast the results from two commonly used change detection techniques. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.

Transverse and Oblique Long Bone Fracture Evaluation by Low Order Ultrasonic Guided Waves: A Simulation Study

PubMed Central

Li, Ying; Liu, Dan; Xu, Kailiang; Le, Lawrence H.; Wang, Weiqi

2017-01-01

Ultrasonic guided waves have recently been used in fracture evaluation and fracture healing monitoring. An axial transmission technique has been used to quantify the impact of the gap breakage width and fracture angle on the amplitudes of low order guided wave modes S0 and A0 under a 100 kHz narrowband excitation. In our two dimensional finite-difference time-domain (2D-FDTD) simulation, the long bones are modeled as three layers with a soft tissue overlay and marrow underlay. The simulations of the transversely and obliquely fractured long bones show that the amplitudes of both S0 and A0 decrease as the gap breakage widens. Fixing the crack width, the increase of the fracture angle relative to the cross section perpendicular to the long axis enhances the amplitude of A0, while the amplitude of S0 shows a nonmonotonic trend with the decrease of the fracture angle. The amplitude ratio between the S0 and A0 modes is used to quantitatively evaluate the fracture width and angles. The study suggests that the low order guided wave modes S0 and A0 have potentials for transverse and oblique bone fracture evaluation and fracture healing monitoring. PMID:28182135

Transverse and Oblique Long Bone Fracture Evaluation by Low Order Ultrasonic Guided Waves: A Simulation Study.

PubMed

Li, Ying; Liu, Dan; Xu, Kailiang; Ta, Dean; Le, Lawrence H; Wang, Weiqi

2017-01-01

Ultrasonic guided waves have recently been used in fracture evaluation and fracture healing monitoring. An axial transmission technique has been used to quantify the impact of the gap breakage width and fracture angle on the amplitudes of low order guided wave modes S 0 and A 0 under a 100 kHz narrowband excitation. In our two dimensional finite-difference time-domain (2D-FDTD) simulation, the long bones are modeled as three layers with a soft tissue overlay and marrow underlay. The simulations of the transversely and obliquely fractured long bones show that the amplitudes of both S 0 and A 0 decrease as the gap breakage widens. Fixing the crack width, the increase of the fracture angle relative to the cross section perpendicular to the long axis enhances the amplitude of A 0, while the amplitude of S 0 shows a nonmonotonic trend with the decrease of the fracture angle. The amplitude ratio between the S 0 and A 0 modes is used to quantitatively evaluate the fracture width and angles. The study suggests that the low order guided wave modes S 0 and A 0 have potentials for transverse and oblique bone fracture evaluation and fracture healing monitoring.

Aluminum Lithium Alloy 2195 Fusion Welding Improvements with New Filler Wire

NASA Technical Reports Server (NTRS)

Russell, C.

2001-01-01

The objective of this research was to assess the B218 weld filler wire for Super Lightweight External Tank production, which could improve current production welding and repair productivity. We took the following approaches: (1) Perform a repair weld quick look evaluation between 4043/B218 and B218/B218 weld filler wire combinations and evaluation tensile properties for planished and unplanished conditions; and (2) Perform repair weld evaluation on structural simulation panel using 4043-B218 and B218/B218 weld filler wire combinations and evaluation tensile and simulated service fracture properties for planished and unplanished conditions.

Impact Behavior of Composite Fan Blade Leading Edge Subcomponent with Thermoplastic Polyurethane Interleave

NASA Technical Reports Server (NTRS)

Miller, Sandi G.; Roberts, Gary D.; Kohlman, Lee W.; Heimann, Paula J.; Pereira, J. Michael; Ruggeri, Charles R.; Martin, Richard E.; McCorkle, Linda S.

2015-01-01

Impact damage tolerance and damage resistance is a critical metric for application of polymer matrix composites where failure caused by impact damage could compromise structural performance and safety. As a result, several materials and/or design approaches to improve impact damage tolerance have been investigated over the past several decades. Many composite toughening methodologies impart a trade-off between increased fracture toughness and compromised in-plane strength and modulus. In large part, mechanical tests to evaluate composite damage tolerance include static methods such as Mode I, Mode II, and mixed mode failures. However, ballistic impact damage resistance does not always correlate with static properties. The intent of this paper is to evaluate the influence of a thermoplastic polyurethane veil interleave on the static and dynamic performance of composite test articles. Static coupon tests included tension, compression, double cantilever beam, and end notch flexure. Measurement of the resistance to ballistic impact damage were made to evaluate the composites response to high speed impact. The interlayer material showed a decrease of in-plane performance with only a moderate improvement to Mode I and Mode II fracture toughness. However, significant benefit to impact damage tolerance was observed through ballistic tests.

Outlet strut fracture of Björk-Shiley convexo-concave valves: can valve-manufacturing characteristics explain the risk?

PubMed

Omar, R Z; Morton, L S; Beirne, M; Blot, W J; Lawford, P V; Hose, R; Taylor, K M

2001-06-01

Björk-Shiley 60 degrees convexo-concave prosthetic heart valves (Shiley, Inc, Irvine, Calif, a subsidiary of Pfizer, Inc) continue to be a concern for approximately 35,000 nonexplanted patients worldwide, with approximately 600 events reported to the manufacturer to date. Fractures of the outlet struts of the valves began to appear in the early 1980s and have continued to the present, but their causes are only partially understood. A matched case-control study was conducted evaluating manufacturing records for 52 valves with outlet strut fractures and 248 control subjects matched for age at implantation, valve size, and valve position. In addition to the risk factors recognized as determinants of outlet strut fracture, the United Kingdom case-control study has observed 7- to 9-fold increased risk with performance of multiple hook deflection tests. This test was performed more than once, usually after rework on the valve. Six valves in this study underwent multiple hook deflection tests, of which 4 experienced an outlet strut fracture. Cracks and further rework were noted for these valves. Significant associations were also observed between outlet strut fracture and disc-to-strut gap measurements taken before the attachment of the sewing ring. It is our view that a combination of factors related to valve design, manufacturing process, and patient characteristics are responsible for outlet strut fractures of Björk-Shiley convexo-concave valves. Multiple hook deflection tests have emerged as a potential new risk factor for outlet strut fracture in both The Netherlands and the United Kingdom. This factor appears to be correlated with the presence of other abnormalities. A further study is needed to investigate the factors correlated with multiple hook deflection tests. On confirmation of risk, the presence of multiple hook deflection tests may be added to equations, quantifying the risk of outlet strut fracture for comparison against risk of mortality and serious morbidity from explant operations.

Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

PubMed

Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

2010-02-01

: A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for most analyses, the success of prophylactic fixation was highly sensitive to the effectiveness and the relative morbidity and mortality of the additional procedure. : Prophylactic fixation with a cephalomedullary nail was not found to be cost-effective for the average older woman who sustained a hip fracture. However, it may be appropriate for select patient populations. The study supports the need for basic science and clinical trials investigating the effectiveness of prophylactic fixation for patient populations at higher lifetime risk for contralateral hip fracture.

[Clinical observation on the different treatments targeted at different types of radial head fracture and radial neck fracture].

PubMed

Zhang, Ying-Ze; Guo, Ming-Ke; Zheng, Zhan-le; Zhang, Qi; Chen, Wei

2009-06-15

To assess the effect of the different treatments targeted at different types of radial head fracture and radial neck fracture. A retrospective study was performed in 87 patients from February 2006 to March 2007. Fifty-four patients with radial head fractures included 36 males and 18 females, aged from 18 to 65 years (the average age was 33); Forty of them resulted from crashing, 8 from traffic injury and 6 from falling injury. According to Mason classification system, there were 15 type I, 23 type II and 16 type III. Thirty-three patients with radial neck fractures included 21 males and 12 females, aged from 9 to 17 years (the average age was 13), 29 of them resulted from crashing, 1 from traffic injury and 3 from falling injury. According to O'Brien classification system, there were 8 type I, 14 type II and 11 type III. Type I of radial head fractures and radial neck fractures were immobilization with cast, the patients with type II of radial head fractures were treated with open reduction and micro-screw or T-trapezoid and bridge-shaped plate fixation and type III had operations to fix with bridge-shaped locked plate and repair the broken annular ligament, or replace heads with prosthesis. All patients with type II and type III of radial neck fractures were treated with closed reduction by leverage and percutaneous intra-medullary nailing. The patients were followed up for 4-12 months (mean 7.2 months). The functional recovery degrees were evaluated with Wheeler's evaluation system. In group of radial head fractures, the results were excellent in 26 patients, good in 20, fair in 6 and poor in 2, the excellent and good rate was 85.2%. In group of radial neck fractures, the results were excellent in 20 patients, good in 9, fair in 4 and poor in no patient, and the excellent and good rate was 87.9%. Different types of fractures should choose different surgical methods according to their characters. The excellent functional recovery depend on anatomical reduction, retaining the head of radius, early repairing and protecting the broken annular ligament of radius, and early functional training.

Bioprosthetic Valve Fracture to Facilitate Transcatheter Valve-in-Valve Implantation.

PubMed

Allen, Keith B; Chhatriwalla, Adnan K; Cohen, David J; Saxon, John T; Aggarwal, Sanjeev; Hart, Anthony; Baron, Suzanne; Davis, J Russell; Pak, Alex F; Dvir, Danny; Borkon, A Michael

2017-11-01

Valve-in-valve transcatheter aortic valve replacement is less effective in small surgical bioprostheses. We evaluated the feasibility of bioprosthetic valve fracture with a high-pressure balloon to facilitate valve-in-valve transcatheter aortic valve replacement. In vitro bench testing on aortic tissue valves was performed on 19-mm and 21-mm Mitroflow (Sorin, Milan, Italy), Magna and Magna Ease (Edwards Lifesciences, Irvine, CA), Trifecta and Biocor Epic (St. Jude Medical, Minneapolis, MN), and Hancock II and Mosaic (Medtronic, Minneapolis, MN). High-pressure balloons Tru Dilation, Atlas Gold, and Dorado (C.R. Bard, Murray Hill, NJ) were used to determine which valves could be fractured and at what pressure fracture occurred. Mitroflow, Magna, Magna Ease, Mosaic, and Biocor Epic surgical valves were successfully fractured using high-pressures balloon 1 mm larger than the labeled valve size whereas Trifecta and Hancock II surgical valves could not be fractured. Only the internal valve frame was fractured, and the sewing cuff was never disrupted. Manufacturer's rated burst pressures for balloons were exceeded, with fracture pressures ranging from 8 to 24 atmospheres depending on the surgical valve. Testing further demonstrated that fracture facilitated the expansion of previously constrained, underexpanded transcatheter valves (both balloon and self-expanding) to the manufacturer's recommended size. Bench testing demonstrates that the frame of most, but not all, bioprosthetic surgical aortic valves can be fractured using high-pressure balloons. The safety of bioprosthetic valve fracture to optimize valve-in-valve transcatheter aortic valve replacement in small surgical valves requires further clinical investigation. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A method to evaluate hydraulic fracture using proppant detection.

PubMed

Liu, Juntao; Zhang, Feng; Gardner, Robin P; Hou, Guojing; Zhang, Quanying; Li, Hu

2015-11-01

Accurate determination of the proppant placement and propped fracture height are important for evaluating and optimizing stimulation strategies. A technology using non-radioactive proppant and a pulsed neutron gamma energy spectra logging tool to determine the placement and height of propped fractures is proposed. Gd2O3 was incorporated into ceramic proppant and a Monte Carlo method was utilized to build the logging tools and formation models. Characteristic responses of the recorded information of different logging tools to fracture widths, proppant concentrations and influencing factors were studied. The results show that Gd capture gamma rays can be used to evaluate propped fractures and it has higher sensitivity to the change of fracture width and traceable proppant content compared with the exiting non-radioactive proppant evaluation techniques and only an after-fracture measurement is needed for the new method; The changes in gas saturation and borehole size have a great impact on determining propped fractures when compensated neutron and pulsed neutron capture tool are used. A field example is presented to validate the application of the new technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Ender nailing in fractures of the proximal femur. II. Analysis of our cohort].

PubMed

Bartonícek, J

1989-12-01

The work presents the analysis of the group of 172 patients with the fracture of the proximal femur treated by the technique of Ender nailing between June 1985 and December 1988. The group comprised 45 male (26 per cent) and 127 female (74 per cent) patients. Their average age was 76 years (ranging from 20 to 97 years of age) out of which 75 per cent of patients were older than 70 years and 40 per cent older than 80 years. Indication of Ender nailing in patients under 60 years of age we consider exceptional. In our group we operated on in total 14 patients under 60 years of age (ranging from 20 to 57 years of age) and namely in case of the comminuted type of fracture increased risk of infection or serious total condition. The whole group was operated on by 21 variously experienced surgeons. 147 operations were performed in the general anesthesia and 25 in the epidural one. The fractures of the proximal femur were divided into basicervical--10 (6 per cent), stable pertrochanteric 96 (56 per cent), unstable pertrochanteric--38 (22 per cent), per-subtrochanteric--19 (11 per cent) and subtrochanteric--9 (5 per cent). For the objective evaluation we compared our classification of the fracture of the trochanteric part with these of Evens, Kyle and Jensen. For stable fractures we considered the types I and II according to Kyle, for unstable the type III of Kyle classification. Per-subtrochanteric fractures (Kyle IV) we singled out for their seriousness as a separate group of unstable pertrochanteric fractures. Almost the same spectrum of fractures was in the group of 108 patients in which we evaluated longterm results. The minimum observence period was 3 months the mean period 6.3 months. Almost all patients from this group were followed up until complete healing. The mean duration of operation was 52 minutes, the mean duration of anesthesia was 81 minutes and the duration of X-ray exposure was 2.6 minutes. These data were calculated also for individual types of fractures. In this case the time intervals differed according to the seriousness of the fracture. The comparison of our time data with other authors reliably evaluating the results of Ender nailing has proved that it is necessary to free this intervention from the myth of a quick and easy operation. The average number of nails inserted in one patient was 3.6.(ABSTRACT TRUNCATED AT 400 WORDS)

Radiographic Evaluation of Ankle Joint Stability After Calcaneofibular Ligament Elevation During Open Reduction and Internal Fixation of Calcaneus Fracture.

PubMed

Wang, Chien-Shun; Tzeng, Yun-Hsuan; Lin, Chun-Cheng; Huang, Ching-Kuei; Chang, Ming-Chau; Chiang, Chao-Ching

2016-09-01

The aim of this prospective study was to evaluate the influence of sectioning the calcaneofibular ligament (CFL) during an extensile lateral approach during open reduction and internal fixation (ORIF) of calcaneal fractures on ankle joint stability. Forty-two patients with calcaneal fractures that received ORIF were included. Talar tilt stress and anterior drawer radiographs were performed on the operative and contralateral ankles 6 months postoperatively. The average degree of talar tilt on stress radiographs was 3.4 degrees (range, 0-12 degrees) on the operative side and 3.2 degrees (range, 0-14 degrees) on the contralateral side. The mean anterior drawer on stress radiographs of the CFL incised ankle was 6.1 mm (range, 2.4-11.8 mm) and on the contralateral ankle was 5.7 mm (range, 2.6-8.6 mm). There was no statistically significant difference of talar tilt and anterior drawer between the CFL incised side and the contralateral side (P = .658 and .302, respectively). The results suggest that sectioning of the CFL without any repair during ORIF of a calcaneal fracture does not have a negative effect on stability of the ankle. Repair of the CFL is, thus, probably not necessary following extended lateral approach for ORIF of calcaneal fractures. Level II, comparative study. © The Author(s) 2016.

The QUALYOR (QUalité Osseuse LYon Orléans) study: a new cohort for non invasive evaluation of bone quality in postmenopausal osteoporosis. Rationale and study design.

PubMed

Chapurlat, Roland; Pialat, Jean-Baptiste; Merle, Blandine; Confavreux, Elisabeth; Duvert, Florence; Fontanges, Elisabeth; Khacef, Farida; Peres, Sylvie Loiseau; Schott, Anne-Marie; Lespessailles, Eric

2017-12-27

The diagnostic performance of densitometry is inadequate. New techniques of non-invasive evaluation of bone quality may improve fracture risk prediction. Testing the value of these techniques is the goal of the QUALYOR cohort. The bone mineral density (BMD) of postmenopausal women who sustain osteoporotic fracture is generally above the World Health Organization definition for osteoporosis. Therefore, new approaches to improve the detection of women at high risk for fracture are warranted. We have designed and recruited a new cohort to assess the predictive value of several techniques to assess bone quality, including high-resolution peripheral quantitative computerized tomography (HRpQCT), hip QCT, calcaneus texture analysis, and biochemical markers. We have enrolled 1575 postmenopausal women, aged at least 50, with an areal BMD femoral neck or lumbar spine T-score between - 1.0 and - 3.0. Clinical risk factors for fracture have been collected along with serum and blood samples. We describe the design of the QUALYOR study. Among these 1575 women, 80% were aged at least 60. The mean femoral neck T-score was - 1.6 and the mean lumbar spine T-score was -1.2. This cohort is currently being followed up. QUALYOR will provide important information on the relationship between bone quality variables and fracture risk in women with moderately decreased BMD.

In situ AFM investigation of slow crack propagation mechanisms in a glassy polymer

NASA Astrophysics Data System (ADS)

George, M.; Nziakou, Y.; Goerke, S.; Genix, A.-C.; Bresson, B.; Roux, S.; Delacroix, H.; Halary, J.-L.; Ciccotti, M.

2018-03-01

A novel experimental technique based on in situ AFM monitoring of the mechanisms of damage and the strain fields associated to the slow steady-state propagation of a fracture in glassy polymers is presented. This micron-scale investigation is complemented by optical measurements of the sample deformation up to the millimetric macroscopic scale of the sample in order to assess the proper crack driving conditions. These multi-scale observations provide important insights towards the modeling of the fracture toughness of glassy polymers and its relationship with the macromolecular structure and non-linear rheological properties. This novel technique is first tested on a standard PMMA thermoplastic in order to both evaluate its performance and the richness of this new kind of observations. Although the fracture propagation in PMMA is well known to proceed through crazing in the bulk of the samples, our observations provide a clear description and quantitative evaluation of a change of fracture mechanism towards shear yielding fracture accompanied by local necking close to the free surface of the sample, which can be explained by the local change of stress triaxiality. Moreover, this primary surface necking mechanism is shown to be accompanied by a network of secondary grooves that can be related to surface crazes propagating towards the interior of the sample. This overall scenario is validated by post-mortem fractographic investigations by scanning electron microscopy.

Clinical characteristics and surgical experience of Type III Wagstaffe fractures: Pay attention to concomitant chondral injury of the talus.

PubMed

Zhang, Ming; Chen, Yun-Feng; Wang, Lei; Li, Fan; Wei, Hai-Feng; Shi, Zhong-Min

2017-04-27

The purpose of this study was to investigate clinical characteristics and surgical management of Type III Wagstaffe fracture. From August 2012 to July 2015, 13 patients with Type III Wagstaffe fractures were surgically treated. During operation, the cartilage of joint surface was explored. Wagstaffe fragment was fixed with cannulated screw or suture, Chaput fragment was fixed with cannulated screw or plate, and Cotton test was performed to evaluate the stability of syndesmosis during the operation. All the patients were followed up for 14.3 months in average. Clinical outcome was assessed with Olerud-Molander score and American Orthopedic Foot and Ankle Society (AOFAS) score. The traumatic arthritis was evaluated with osteoarthritis-score (OA-score). During the operation, chondral injury was found on the lateral top of the talus in 8 cases, as "kissing lesion" of Chaput fragment. The fractures healed uneventfully and all the patients recovered satisfactorily except two had moderate restriction in ankle movement. The average Olerud-Molander score and AOFAS score were 82.3 and 86.1, respectively. Type III Wagstaffe is a rare and often missed fracture. 61% are associated with a chondral lesion on the lateral top of the talus. Anatomical reduction and rigid fixation of both fragments are mandatory to obtain ankle stability and good results. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Separate Vertical Wirings for the Extra-articular Fractures of the Distal Pole of the Patella.

PubMed

Kim, Young Mo; Yang, Jun Young; Kim, Kyung Cheon; Kang, Chan; Joo, Yong Bum; Lee, Woo Yong; Hwang, Jung Mo

2011-12-01

To evaluate the usefulness of separate vertical wirings for extra-articular fracture of distal pole of patella. We have analyzed the clinical results of 18 cases that underwent separate vertical wirings for extra-articular fracture of distal pole of the patella from March 2005 to March 2010, by using the range of motion and Bostman score. Occurrence of complication was also evaluated. Additionally, by taking simple radiographs, the correlation between the postoperative degree of anterior transposition of bone fragment and the time of bone fusion, preoperative length of bone fragment, and occurrence of comminuted fracture were investigated. It took an average of 13.8 weeks for radiological bone union after separate vertical wiring fixation. Flexion contracture was an average of 0.8 degrees and further flexion was an average of 127.6°, and Bostman score was an average of 27.5 points (excellent in 12 cases, and good in 6 cases). On the first postoperative year, average flexion contracture was 0.6 degrees and further flexion was an average of 136.3°, which exhibited increased joint motion and recovery to normal range of motion, and Bostman score was an average of 28.7 points (excellent in 16 cases, and good in 2 cases). There was no statistically significant difference between the preoperative bone fragment length and presence of comminution, and degree of anterior transposition of bone fragment after fracture union on simple radiograph (p=0.175, p=0.146). We were able to obtain satisfactory clinical results, while preserving the bone fragment by separate vertical wiring fixation for extra-articular fracture of distal pole of patella. Moreover, the method is easy to perform, which is also considered as a useful surgical method for extra-articular fracture of distal pole of patella.

A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value.

PubMed

Timashpolsky, Alisa; Dagum, Alexander B; Sayeed, Syed M; Romeiser, Jamie L; Rosenfeld, Elisheva A; Conkling, Nicole

2016-01-01

There are >150,000 patient visits per year to emergency rooms for facial trauma. The reliability of a computed tomography (CT) scan has made it the primary modality for diagnosing facial skeletal injury, with the physical examination playing more a cursory role. Knowing the predictive value of physical findings in facial skeletal injuries may enable more appropriate use of imaging and health care resources. A blinded prospective study was undertaken to assess the predictive value of physical examination findings in detecting maxillofacial fracture in trauma patients, and in determining whether a patient will require surgical intervention. Over a four-month period, the authors' team examined patients admitted with facial trauma to the emergency department of their hospital. The evaluating physician completed a standardized physical examination evaluation form indicating the physical findings. Corresponding CT scans and surgical records were then reviewed, and the results recorded by a plastic surgeon who was blinded to the results of the physical examination. A total of 57 patients met the inclusion criteria; there were 44 male and 13 female patients. The sensitivity, specificity, positive predictive value and negative predictive value of grouped physical examination findings were determined in major areas. In further analysis, specific examination findings with n≥9 (15%) were also reported. The data demonstrated a high negative predictive value of at least 90% for orbital floor, zygomatic, mandibular and nasal bone fractures compared with CT scan. Furthermore, none of the patients who did not have a physical examination finding for a particular facial fracture required surgery for that fracture. Thus, the instrument performed well at ruling out fractures in these areas when there were none. Ultimately, these results may help reduce unnecessary radiation and costly imaging in patients with facial trauma without facial fractures.

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

PubMed Central

Cho, S H; Sung, Y M; Kim, M S

2012-01-01

Objective The objective of this study was to review the prevalence and radiological features of rib fractures missed on initial chest CT evaluation, and to examine the diagnostic value of additional coronal images in a large series of trauma patients. Methods 130 patients who presented to an emergency room for blunt chest trauma underwent multidetector row CT of the thorax within the first hour during their stay, and had follow-up CT or bone scans as diagnostic gold standards. Images were evaluated on two separate occasions: once with axial images and once with both axial and coronal images. The detection rates of missed rib fractures were compared between readings using a non-parametric method of clustered data. In the cases of missed rib fractures, the shapes, locations and associated fractures were evaluated. Results 58 rib fractures were missed with axial images only and 52 were missed with both axial and coronal images (p=0.088). The most common shape of missed rib fractures was buckled (56.9%), and the anterior arc (55.2%) was most commonly involved. 21 (36.2%) missed rib fractures had combined fractures on the same ribs, and 38 (65.5%) were accompanied by fracture on neighbouring ribs. Conclusion Missed rib fractures are not uncommon, and radiologists should be familiar with buckle fractures, which are frequently missed. Additional coronal imagescan be helpful in the diagnosis of rib fractures that are not seen on axial images. PMID:22514102

Hydraulic Fracturing and Production Optimization in Eagle Ford Shale Using Coupled Geomechanics and Fluid Flow Model

NASA Astrophysics Data System (ADS)

Suppachoknirun, Theerapat; Tutuncu, Azra N.

2017-12-01

With increasing production from shale gas and tight oil reservoirs, horizontal drilling and multistage hydraulic fracturing processes have become a routine procedure in unconventional field development efforts. Natural fractures play a critical role in hydraulic fracture growth, subsequently affecting stimulated reservoir volume and the production efficiency. Moreover, the existing fractures can also contribute to the pressure-dependent fluid leak-off during the operations. Hence, a reliable identification of the discrete fracture network covering the zone of interest prior to the hydraulic fracturing design needs to be incorporated into the hydraulic fracturing and reservoir simulations for realistic representation of the in situ reservoir conditions. In this research study, an integrated 3-D fracture and fluid flow model have been developed using a new approach to simulate the fluid flow and deliver reliable production forecasting in naturally fractured and hydraulically stimulated tight reservoirs. The model was created with three key modules. A complex 3-D discrete fracture network model introduces realistic natural fracture geometry with the associated fractured reservoir characteristics. A hydraulic fracturing model is created utilizing the discrete fracture network for simulation of the hydraulic fracture and flow in the complex discrete fracture network. Finally, a reservoir model with the production grid system is used allowing the user to efficiently perform the fluid flow simulation in tight formations with complex fracture networks. The complex discrete natural fracture model, the integrated discrete fracture model for the hydraulic fracturing, the fluid flow model, and the input dataset have been validated against microseismic fracture mapping and commingled production data obtained from a well pad with three horizontal production wells located in the Eagle Ford oil window in south Texas. Two other fracturing geometries were also evaluated to optimize the cumulative production and for the three wells individually. Significant reduction in the production rate in early production times is anticipated in tight reservoirs regardless of the fracturing techniques implemented. The simulations conducted using the alternating fracturing technique led to more oil production than when zipper fracturing was used for a 20-year production period. Yet, due to the decline experienced, the differences in cumulative production get smaller, and the alternating fracturing is not practically implementable while field application of zipper fracturing technique is more practical and widely used.

Distal Fibula Fractures in National Football League Athletes.

PubMed

Werner, Brian C; Mack, Christina; Franke, Kristina; Barnes, Ronnie P; Warren, Russell F; Rodeo, Scott A

2017-09-01

Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes' season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition. To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture rates in NFL athletes by position, type of play, and contact type; (3) determine the rates of distal fibula fracture surgery in NFL athletes; and (4) report the days missed due to distal fibula fractures in NFL athletes. Descriptive epidemiology study. A retrospective review of distal fibula fractures reported to the NFL from 2000 to 2014 was performed using the NFL Injury Surveillance System. All distal fibula fractures were included, along with isolated and combined fracture patterns. Stress fractures and proximal fibula fractures were excluded. Epidemiological data and rates of surgery were determined. Return to sport was calculated and stratified by injury pattern and management. Overall, 237 distal fibula fractures in NFL athletes from 2000 to 2014 were included; 197 (83%) were isolated distal fibula fractures. A mean of 16 distal fibula fractures occurred each year (median, 16 per year). Fractures occurred most frequently on running (38%) and passing (24%) plays, but the frequency was next highest on kickoffs (16%), despite the relative infrequency of kickoffs during the average game compared with other play types. Surgery was reported for more than half of all distal fibula fractures (n = 128, 54%). Overall, patients who underwent surgery missed significantly more days (mean, 123.8 days) than players who did not undergo surgery (mean, 75.3 days) ( P < .001). Players with isolated distal fibula fractures had significantly fewer days missed (mean, 93.6 days) compared with those with combined patterns (mean, 132.3 days) ( P = .0004). Fibula fractures affect a number of NFL athletes and result in significant time missed from competition. Further research is required to determine the optimal management of fibula fractures in NFL athletes. In this study, time to return to play depended on both the fracture pattern and whether surgery was required and ranged from 72 to 145 days.

Treatment with rhBMP-2 of extreme radial bone atrophy secondary to fracture management in an Italian Greyhound.

PubMed

Bernard, F; Furneaux, R; Adrega Da Silva, C; Bardet, J-F

2008-01-01

rhBMP-2 solution on a collagen sponge was placed along the diaphysis of an atrophicradius, which had a history of recurring fractures. Two months after rhBMP-2 treatment, new mineralized bone was present, which significantly increased the diameter of the radius and allowed the removal of the external skeletal fixator (ESF). Due to carpo-metacarpal joint compromise, a pancarpal arthrodesis was performed seven months later. At follow-up evaluation two years later the dog was only very mildly lame.

When are CT angiograms indicated for patients with lower extremity fractures? A review of 275 extremities.

PubMed

Monazzam, Shafagh; Goodell, Parker B; Salcedo, Edgardo S; Nelson, Sandahl H; Wolinsky, Philip R

2017-01-01

Computed tomography angiogram (CTA) is frequently utilized to detect vascular injuries even without examination findings indicating a vascular injury. We had the following hypotheses: (1) a CTA for lower extremity fractures with no clinical signs of a vascular injury is not indicated, and (2) fracture location and pattern would correlate with the risk of a vascular injury. A retrospective review was conducted on patients who had an acute lower extremity fracture(s) and a CTA. Their charts were reviewed for multiple factors including the presence or absence of hard or soft signs of a vascular injury, soft tissue status, and fracture location/pattern. Every CTA radiology report was reviewed and any vascular intervention or amputation resulting from a vascular injury was recorded. Statistical analysis was performed. Of the 275 CTAs of fractured extremities reviewed, 80 (29%) had a positive CTA finding and 16 (6%) required treatment. A total of 109 (40%) of the extremities had no hard or soft signs; all had normal CTAs. Having at least one hard or soft sign was a significant risk factor for having a positive CTA. An open fracture, isolated proximal third fibula fracture, distal and shaft tibia fractures, and the presence of multiple fractures in one extremity were also associated with an increased risk for having a positive CTA. We found no evidence to support the routine use of CTAs to evaluate lower extremity fractures unless at least one hard or soft sign is present. The presence of an open fracture, distal tibia or tibial shaft fractures, multiple fractures in one extremity, and/or an isolated proximal third fibula fracture increases the risk of having a finding consistent with a vascular injury on a CTA. Only 6% of the cases required treatment, and all of them had diminished or absent distal pulses on presentation. Diagnostic test, level III.

Measurement of Function Post Hip Fracture: Testing a Comprehensive Measurement Model of Physical Function

PubMed Central

Gruber-Baldini, Ann L.; Hicks, Gregory; Ostir, Glen; Klinedinst, N. Jennifer; Orwig, Denise; Magaziner, Jay

2015-01-01

Background Measurement of physical function post hip fracture has been conceptualized using multiple different measures. Purpose This study tested a comprehensive measurement model of physical function. Design This was a descriptive secondary data analysis including 168 men and 171 women post hip fracture. Methods Using structural equation modeling, a measurement model of physical function which included grip strength, activities of daily living, instrumental activities of daily living and performance was tested for fit at 2 and 12 months post hip fracture and among male and female participants and validity of the measurement model of physical function was evaluated based on how well the model explained physical activity, exercise and social activities post hip fracture. Findings The measurement model of physical function fit the data. The amount of variance the model or individual factors of the model explained varied depending on the activity. Conclusion Decisions about the ideal way in which to measure physical function should be based on outcomes considered and participant Clinical Implications The measurement model of physical function is a reliable and valid method to comprehensively measure physical function across the hip fracture recovery trajectory. Practical but useful assessment of function should be considered and monitored over the recovery trajectory post hip fracture. PMID:26492866

Stress Rupture Fracture Model and Microstructure Evolution for Waspaloy

NASA Astrophysics Data System (ADS)

Yao, Zhihao; Zhang, Maicang; Dong, Jianxin

2013-07-01

Stress rupture behavior and microstructure evolution of nickel-based superalloy Waspaloy specimens from tenon teeth of an as-received 60,000-hour service-exposed gas turbine disk were studied between 923 K and 1088 K (650 °C and 815 °C) under initial applied stresses varying from 150 to 840 MPa. Good microstructure stability and performance were verified for this turbine disk prior to stress rupture testing. Microstructure instability, such as the coarsening and dissolution of γ' precipitates at the varying test conditions, was observed to be increased with temperature and reduced stress. Little microstructure variation was observed at 923 K (650 °C). Only secondary γ' instability occurred at 973 K (700 °C). Four fracture mechanisms were obtained. Transgranular creep fracture was exhibited up to 923 K (650 °C) and at high stress. A mixed mode of transgranular and intergranular creep fracture occurred with reduced stress as a transition to intergranular creep fracture (ICF) at low stress. ICF was dominated by grain boundary sliding at low temperature and by the nucleation and growth of grain boundary cavities due to microstructure instability at high temperature. The fracture mechanism map and microstructure-related fracture model were constructed. Residual lifetime was also evaluated by the Larson-Miller parameter method.

Fracture Toughness Properties of Gd123 Superconducting Bulks

NASA Astrophysics Data System (ADS)

Fujimoto, H.; Murakami, A.

Fracture toughness properties of melt growth GdBa2Cu3Ox (Gd123) large single domain superconducting bulks with Ag2O of 10 wt% and Pt of 0.5 wt%; 45 mm in diameter and 25 mm in thickness with low void density were evaluated at 77 K through flexural tests of specimens cut from the bulks, and compared to those of a conventional Gd123 with voids. The densified Gd123 bulks were prepared with a seeding and temperature gradient method; first melt processed in oxygen, then crystal growth in air; two-step regulated atmosphere heat treatment. The plane strain fracture toughness, KIC was obtained by the three point flexure test of the specimens with through precrack, referring to the single edge pre-cracked beam (SEPB) method, according to the JIS-R-1607, Testing Methods for Fracture Toughness of High Performance Ceramics. The results show that the fracture toughness of the densified Gd123 bulk with low void density was higher than that of the standard Gd123 bulk with voids, as well as the flexural strength previously reported. We also compared the fracture toughness of as-grown bulks with that of annealed bulks. The relation between the microstructure and the fracture toughness of the Gd123 bulk was clearly shown.

Impact of Recycled Asphalt Shingles (RAS) on Asphalt Binder Performance

DOT National Transportation Integrated Search

2018-01-01

This study evaluated the effect of reclaimed asphalt pavement (RAP) and recycled asphalt shingles (RAS) on virgin binder true grade and fracture energy density (FED). A mortar approach, which avoids the need for binder extraction, was adopted to quan...

Electromyography assessment in zygomaticomaxillary complex fractures.

PubMed

Waheed El-Anwar, Mohammad; Elsheikh, Ezzeddin; Sweed, Ahmed Hassan; Ezzeldin, Nillie

2015-12-01

The aim of this study was to assess the activity of the masseter and temporalis muscles using surface electromyography (EMG) in patients with zygomaticomaxillary complex (ZMC) fractures. This prospective study was carried out on 25 patients who had ZMC fractures. Fifteen patients were managed by open reduction and rigid fixation (ORIF) using titanium miniplates. This study, using surface electromyography, analyzed the activity of the masseter and temporalis muscles of 25 patients with ZMC fractures; 15 of them were surgically treated under general anesthesia (GA). Evaluations were made before surgery and 6 weeks after surgery by recording the mean of muscle contraction of 20 motor unit action potential (MUAP) against resistance, and statistical analyses were performed. A significant EMG difference between the normal and ZMC fracture sides was found (P < 0.0001) for both masseter and temporalis muscles and was significantly improved after ORIF. However, postoperative EMV values of the repaired side was significantly less than measured postoperatively in the normal side (P < 0.0001) for both muscles. ZMC fractures significantly diminish muscular activity of the masseter and temporalis and even though significant recovery of muscle activity was revealed after 6 weeks, it is still less than normal activity, highlighting the importance of postoperative rehabilitation.

Stabilization of multiple rib fractures in a canine model.

PubMed

Huang, Ke-Nan; Xu, Zhi-Fei; Sun, Ju-Xian; Ding, Xin-Yu; Wu, Bin; Li, Wei; Qin, Xiong; Tang, Hua

2014-12-01

Operative stabilization is frequently used in the clinical treatment of multiple rib fractures (MRF); however, no ideal material exists for use in this fixation. This study investigates a newly developed biodegradable plate system for the stabilization of MRF. Silk fiber-reinforced polycaprolactone (SF/PCL) plates were developed for rib fracture stabilization and studied using a canine flail chest model. Adult mongrel dogs were divided into three groups: one group received the SF/PCL plates, one group received standard clinical steel plates, and the final group did not undergo operative fracture stabilization (n = 6 for each group). Radiographic, mechanical, and histologic examination was performed to evaluate the effectiveness of the biodegradable material for the stabilization of the rib fractures. No nonunion and no infections were found when using SF-PCL plates. The fracture sites collapsed in the untreated control group, leading to obvious chest wall deformity not encountered in the two groups that underwent operative stabilization. Our experimental study shows that the SF/PCL plate has the biocompatibility and mechanical strength suitable for fixation of MRF and is potentially ideal for the treatment of these injuries. Copyright © 2014 Elsevier Inc. All rights reserved.

Thermal Drawdown-Induced Flow Channeling in Fractured Geothermal Reservoirs

DOE PAGES

Fu, Pengcheng; Hao, Yue; Walsh, Stuart D. C.; ...

2015-06-30

In this paper, we investigate the flow-channeling phenomenon caused by thermal drawdown in fractured geothermal reservoirs. A discrete fracture network-based, fully coupled thermal–hydrological–mechanical simulator is used to study the interactions between fluid flow, temperature change, and the associated rock deformation. The responses of a number of randomly generated 2D fracture networks that represent a variety of reservoir characteristics are simulated with various injection-production well distances. We find that flow channeling, namely flow concentration in cooled zones, is the inevitable fate of all the scenarios evaluated. We also identify a secondary geomechanical mechanism caused by the anisotropy in thermal stress thatmore » counteracts the primary mechanism of flow channeling. This new mechanism tends, to some extent, to result in a more diffuse flow distribution, although it is generally not strong enough to completely reverse flow channeling. We find that fracture intensity substantially affects the overall hydraulic impedance of the reservoir but increasing fracture intensity generally does not improve heat production performance. Finally, increasing the injection-production well separation appears to be an effective means to prolong the production life of a reservoir.« less

Numerical Modelling of Extended Leak-Off Test with a Pre-Existing Fracture

NASA Astrophysics Data System (ADS)

Lavrov, A.; Larsen, I.; Bauer, A.

2016-04-01

Extended leak-off test (XLOT) is one of the few techniques available for stress measurements in oil and gas wells. Interpretation of the test is often difficult since the results depend on a multitude of factors, including the presence of natural or drilling-induced fractures in the near-well area. Coupled numerical modelling of XLOT has been performed to investigate the pressure behaviour during the flowback phase as well as the effect of a pre-existing fracture on the test results in a low-permeability formation. Essential features of XLOT known from field measurements are captured by the model, including the saw-tooth shape of the pressure vs injected volume curve, and the change of slope in the pressure vs time curve during flowback used by operators as an indicator of the bottomhole pressure reaching the minimum in situ stress. Simulations with a pre-existing fracture running from the borehole wall in the radial direction have revealed that the results of XLOT are quite sensitive to the orientation of the pre-existing fracture. In particular, the fracture initiation pressure and the formation breakdown pressure increase steadily with decreasing angle between the fracture and the minimum in situ stress. Our findings seem to invalidate the use of the fracture initiation pressure and the formation breakdown pressure for stress measurements or rock strength evaluation purposes.

High energy injury is a risk factor for preoperative venous thromboembolism in the patients with hip fractures: A prospective observational study.

PubMed

Park, Jin Sup; Jang, Jae Hoon; Park, Ki Young; Moon, Nam Hoon

2018-06-01

The purpose of this study was to identify the incidence of preoperative venous thromboembolism (VTE), and determine if high energy hip fracture affects preoperative VTE occurrence. Three-hundred nine patients (244 low and 61 high energy injuries) treated between March 2015 and March 2017 were included in this study. Indirect multidetector computed tomographic venography for the detection of preoperative VTE was performed at admission. The incidence of preoperative VTE was compared between high and low energy injury hip fractures. Logistic regression analysis was used to identify independent risk factors for preoperative VTE. The overall incidence of preoperative VTE was 18.4% (56 of 305 patients). Preoperative VTE was identified in 17 (27.9%) and 39 (16.0%) patients in the high and low energy injury groups, respectively (p = 0.034). Multivariate logistic regression analysis showed that high energy injury, history of VTE, and myeloproliferative disease were significant predictive factors of preoperative VTE (OR = 2.451; 95% CI = 1.227-4.896, OR = 11.174; 95% CI = 3.500-35.673, OR = 6.936; 95% CI = 1.641-29.321, respectively) CONCLUSION: Because high energy hip fracture is significantly associated with preoperative VTE occurrence, preoperative evaluation and proper thromboprophylaxis should be performed for patients with a high-energy hip fracture. Copyright © 2018 Elsevier Ltd. All rights reserved.

Loading capacity of zirconia implant supported hybrid ceramic crowns.

PubMed

Rohr, Nadja; Coldea, Andrea; Zitzmann, Nicola U; Fischer, Jens

2015-12-01

Recently a polymer infiltrated hybrid ceramic was developed, which is characterized by a low elastic modulus and therefore may be considered as potential material for implant supported single crowns. The purpose of the study was to evaluate the loading capacity of hybrid ceramic single crowns on one-piece zirconia implants with respect to the cement type. Fracture load tests were performed on standardized molar crowns milled from hybrid ceramic or feldspar ceramic, cemented to zirconia implants with either machined or etched intaglio surface using four different resin composite cements. Flexure strength, elastic modulus, indirect tensile strength and compressive strength of the cements were measured. Statistical analysis was performed using two-way ANOVA (p=0.05). The hybrid ceramic exhibited statistically significant higher fracture load values than the feldspar ceramic. Fracture load values and compressive strength values of the respective cements were correlated. Highest fracture load values were achieved with an adhesive cement (1253±148N). Etching of the intaglio surface did not improve the fracture load. Loading capacity of hybrid ceramic single crowns on one-piece zirconia implants is superior to that of feldspar ceramic. To achieve maximal loading capacity for permanent cementation of full-ceramic restorations on zirconia implants, self-adhesive or adhesive cements with a high compressive strength should be used. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Treatment cost of patients with maxillofacial fractures at the University Hospital in Mostar 2002-2006.

PubMed

Jurić, Mario; Novakovic, Josip; Carapina, Mirela; Kneiević, Ervin

2010-03-01

The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.

Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review.

PubMed

Rubin, Katrine Hass; Friis-Holmberg, Teresa; Hermann, Anne Pernille; Abrahamsen, Bo; Brixen, Kim

2013-08-01

A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence, and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance of each tool was sufficient for practical use, and last, to examine whether the complexity of the tools influenced their discriminative power. We searched PubMed, Embase, and Cochrane databases for papers and evaluated these with respect to methodological quality using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist. A total of 48 tools were identified; 20 had been externally validated, however, only six tools had been tested more than once in a population-based setting with acceptable methodological quality. None of the tools performed consistently better than the others and simple tools (i.e., the Osteoporosis Self-assessment Tool [OST], Osteoporosis Risk Assessment Instrument [ORAI], and Garvan Fracture Risk Calculator [Garvan]) often did as well or better than more complex tools (i.e., Simple Calculated Risk Estimation Score [SCORE], WHO Fracture Risk Assessment Tool [FRAX], and Qfracture). No studies determined the effectiveness of tools in selecting patients for therapy and thus improving fracture outcomes. High-quality studies in randomized design with population-based cohorts with different case mixes are needed. Copyright © 2013 American Society for Bone and Mineral Research.

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.

PubMed

Dedeoğlu, Süleyman Semih; İmren, Yunus; Çabuk, Haluk; Çakar, Murat; Arslan, Samet Murat; Esenyel, Cem Zeki

2017-01-01

We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

[Arthroscopically Assisted Minimally Invasive Fixation of a Type D2c Scapular Fracture].

PubMed

Kornherr, Patrick; Konerding, Christiane; Kovacevic, Mark; Wenda, Klaus

2018-06-12

Fractures of the scapula are rare and have an incidence of 1% of all fractures. Publications highlight glenoid rim fractures. Classification by Ideberg and Euler and Rüdi are accepted. Euler and Rüdi describe three extra-articular and two intra-articular fracture patterns. The indications for surgery are displaced glenoid fractures, scapula tilt of more than 40° and injuries to the superior shoulder suspensory complex. We describe a case of a 22 year old man, who while cycling collided with a moving car due to wet roads. After his admission to hospital as a polytraumatised patient, the trauma CT-Scan showed haemothorax with several associated rip fractures, displaced humeral shaft fracture and fractures of the acromion and glenoid, classified as type D2c according to Euler and Rüdi. Following damage control principles, drainage of the haemothorax was already performed in the ER and surgical treatment of the displaced humeral shaft fracture was performed on the day of admission. No peripheral neurological deficits were evident. After pulmonary stabilisation, surgery was performed 6 days later on the glenoid and acromion fracture, which in conjunction may be regarded as an injury to the superior shoulder suspensory complex. We performed an arthroscopically-assisted screw fixation of the glenoid fracture (type D2c according to Euler and Rüdi) and an ORIF procedure at the acromion. Postoperative rehabilitation was performed with passive abduction and elevation up to 90° for the first two weeks and active abduction an elevation up to 90° for weeks 3 to 6. Full ROM was allowed at week 7. Articular fractures of the glenoid are rare and mainly seen as rim fractures. The indications for surgery are displaced articular fractures and injury to the superior shoulder suspensory complex. As demonstrated by this article, type D2c fractures according to Euler and Rüdi can be treated effectively as an arthroscopically-assisted screw fixation procedure. Georg Thieme Verlag KG Stuttgart · New York.

Internal Fixation of Complicated Acetabular Fractures Directed by Preoperative Surgery with 3D Printing Models.

PubMed

Liu, Zhao-Jie; Jia, Jian; Zhang, Yin-Guang; Tian, Wei; Jin, Xin; Hu, Yong-Cheng

2017-05-01

The purpose of this article is to evaluate the efficacy and feasibility of preoperative surgery with 3D printing-assisted internal fixation of complicated acetabular fractures. A retrospective case review was performed for the above surgical procedure. A 23-year-old man was confirmed by radiological examination to have fractures of multiple ribs, with hemopneumothorax and communicated fractures of the left acetabulum. According to the Letounel and Judet classification, T-shaped fracture involving posterior wall was diagnosed. A 3D printing pelvic model was established using CT digital imaging and communications in medicine (DICOM) data preoperatively, with which surgical procedures were simulated in preoperative surgery to confirm the sequence of the reduction and fixation as well as the position and length of the implants. Open reduction with internal fixation (ORIF) of the acetabular fracture using modified ilioinguinal and Kocher-Langenbeck approaches was performed 25 days after injury. Plates that had been pre-bent in the preoperative surgery were positioned and screws were tightened in the directions determined in the preoperative planning following satisfactory reduction. The duration of the operation was 170 min and blood loss was 900 mL. Postoperative X-rays showed that anatomical reduction of the acetabulum was achieved and the hip joint was congruous. The position and length of the implants were not different when compared with those in preoperative surgery on 3D printing models. We believe that preoperative surgery using 3D printing models is beneficial for confirming the reduction and fixation sequence, determining the reduction quality, shortening the operative time, minimizing preoperative difficulties, and predicting the prognosis for complicated fractures of acetabulam. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

On the Processing of Spalling Experiments. Part II: Identification of Concrete Fracture Energy in Dynamic Tension

NASA Astrophysics Data System (ADS)

Lukić, Bratislav B.; Saletti, Dominique; Forquin, Pascal

2017-12-01

This paper presents a second part of the study aimed at investigating the fracture behavior of concrete under high strain rate tensile loading. The experimental method together with the identified stress-strain response of three tests conducted on ordinary concrete have been presented in the paper entitled Part I (Forquin and Lukić in Journal of Dynamic Behavior of Materials, 2017. https://doi.org/10.1007/s40870-017-0135-1). In the present paper, Part II, the investigation is extended towards directly determining the specific fracture energy of each observed fracture zone by visualizing the dynamic cracking process with a temporal resolution of 1 µs. Having access to temporal displacement fields of the sample surface, it is possible to identify the fracture opening displacement (FOD) and the fracture opening velocity of any principle (open) and secondary (closed) fracture at each measurement instance, that may or may not lead to complete physical failure of the sample. Finally, the local Stress-FOD curves were obtained for each observed fracture zone, opposed to previous works where indirect measurements were used. The obtained results indicated a much lower specific fracture energy compared to the results often found in the literature. Furthermore, numerical simulations were performed with a damage law to evaluate the validity of the proposed experimental data processing and compare it to the most often used one in the previous works. The results showed that the present method can reliably predict the specific fracture energy needed to open one macro-fracture and suggested that indirect measurement techniques can lead to an overestimate of specific fracture energy due to the stringent assumption of linear elasticity up-to the peak and the inability of having access to the real post-peak change of axial stress.

Fracture and distant migration of the Bard Recovery filter: a retrospective review of 363 implantations for potentially life-threatening complications.

PubMed

Tam, Matthew D; Spain, James; Lieber, Michael; Geisinger, Michael; Sands, Mark J; Wang, Weiping

2012-02-01

To report the occurrence of fracture of the Recovery filter and incidence of potentially life-threatening complications associated with fractured fragment migration. A retrospective study of images obtained after placement of Recovery inferior vena cava (IVC) filters from 2003 to 2006 was conducted at a single tertiary-care center. Images were reevaluated for fracture and migration; complications related to filter fracture were investigated. Kaplan-Meier survival analysis was performed to investigate the relationship between time in situ and fracture. A total of 363 Recovery filters were placed; 97 were retrieved, leaving 266 filters in situ (135 patients subsequently died of other causes). The following images were evaluated: 130 chest computed tomography (CT) scans, 153 abdominal CT scans, 254 chest radiographs, 148 radiographs of the abdomen/pelvis, and 106 cavagrams. Mean imaging follow-up interval was 18.4 months (maximum, 81.3 mo). No en bloc migration occurred outside the IVC. Twenty-six limb fractures (all short limbs) were identified in 20 patients; the earliest occurred at 4.1 months. Eight fragment migrations occurred into pulmonary arteries, seven into iliac/femoral veins, one into the right ventricle, and one into the renal vein. Seven fragments were intracaval near the filter, one was extracaval, and one could not be located. Kaplan-Meier survival estimates predicted a fracture rate of 40% at 5.5 years. Of the 20 patients with filter fractures, three died of unrelated causes and 17 remain asymptomatic. Recovery filter fractures occurred at the short limb only, with a suggested 5.5-year fracture risk of 40%. No life-threatening events occurred in patients with filter fracture. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation.

PubMed

Mardanpour, Keykhosro; Rahbar, Mahtab

2013-07-01

This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients' age was 37 years (range 20 to 67). Twenty six patients were men (4 patients with type B and 22 patients with type C fracture) and 12 women (7 patients with type B and 5 patients with type C fracture). The commonest cause was a road traffic accident (N=37, about 97%). Internal fixation was done by plaque with ilioinguinal and Kocher-Langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. There were 11 type-C and 27 type-B pelvic fractures according to Tile's classification. Thirty six patients sustained additional injuries. The commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months).The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005). Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks.

Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density.

PubMed

Pang, M Y C; Eng, J J

2008-07-01

Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients. Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients. Thirty-nine chronic stroke survivors with low hip BMD (T-score <-1.0) were studied. Each subject was evaluated for the following: balance, mobility, leg muscle strength, spasticity, and fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls. Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R2 = 0.494, P < 0.001). Logistic regression showed that fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04). Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility fractures among chronic stroke survivors with low hip BMD.

Influence of the preparation design and artificial aging on the fracture resistance of monolithic zirconia crowns

PubMed Central

Anastassova-Yoshida, Yana; Nothdurft, Frank Phillip; von See, Constantin; Pospiech, Peter

2016-01-01

PURPOSE The aim of this study was to evaluate the fracture resistance and fracture behavior of monolithic zirconia crowns in accordance with the preparation design and aging simulation method. MATERIALS AND METHODS An upper first molar was prepared sequentially with three different preparation designs: shoulderless preparation, 0.4 mm chamfer and 0.8 mm chamfer preparation. For each preparation design, 30 monolithic zirconia crowns were fabricated. After cementation on Cr-Co alloy dies, the following artificial aging procedures were performed: (1) thermal cycling and mechanical loading (TCML): 5000 cycles of thermal cycling 5℃–55℃ and chewing simulation (1,200,000 cycles, 50 N); (2) Low Temperature Degradation simulation (LTD): autoclave treatment at 137℃, 2 bar for 3 hours and chewing simulation; and (3) no pre-treatment (control group). After artificial aging, the crowns were loaded until fracture. RESULTS The mean values of fracture resistance varied between 3414 N (LTD; 0.8 mm chamfer preparation) and 5712 N (control group; shoulderless preparation). Two-way ANOVA analysis showed a significantly higher fracture loads for the shoulderless preparation, whereas no difference was found between the chamfer preparations. In contrast to TCML, after LTD simulation the fracture strength of monolithic zirconia crowns decreased significantly. CONCLUSION The monolithic crowns tested in this study showed generally high fracture load values. Preparation design and LTD simulation had a significant influence on the fracture strength of monolithic zirconia crowns. PMID:26949485

Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study

PubMed Central

Ibrahim, Nurul Izzah; Ahmad, Mohd Sharkawi; Zulfarina, Mohamed S; Zaris, Sharifah Nurul Aqilah Sayed Mohd; Mohamed, Isa Naina; Mohamed, Norazlina; Mokhtar, Sabarul Afian; Shuid, Ahmad Nazrun

2018-01-01

Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient’s ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that ‘age’ and ‘ability to walk before fracture’ were the determinant factors of dependent for ‘bathing’, ‘dressing’ and ‘toileting’. The ‘ability to walk before fracture’ was the determinant factor of dependent for ‘transferring’. ‘Age’ and ‘gender’ were the determinant factors of dependent for ‘continence’, while ‘age’ was the determinant factor of dependent for ‘feeding’. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study. PMID:29772744

A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study.

PubMed

Yuenyongviwat, Varah; Tuntarattanapong, Pakjai; Tangtrakulwanich, Boonsin

2016-01-11

Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. The authors developed a new adjustable drill guide for cannulated screw guide wire insertion for multiple screw fixation. Eight orthopaedic surgeons performed the experimental study to evaluate the efficacy of this device. Each surgeon performed guide wire insertion for multiple screw fixation in six synthetic femurs: three times with the new device and three times with the conventional technique. The fluoroscopic time, operative time and surgeon satisfaction were evaluated. In the operations with the new adjustable drill guide, the fluoroscopic and operative times were significantly lower than the operations with the conventional technique (p < 0.05). The mean score for the level of satisfaction of this device was also statistically significantly better (p = 0.02) than the conventional technique. The fluoroscopic and operative times with the new adjustable drill guide were reduced for multiple screw fixation of femoral neck fracture and the satisfaction of the surgeons was good.

Vitamin D profile in National Football League players.

PubMed

Maroon, Joseph C; Mathyssek, Christina M; Bost, Jeffrey W; Amos, Austin; Winkelman, Robert; Yates, Anthony P; Duca, Mark A; Norwig, John A

2015-05-01

By maintaining phosphate and calcium homeostasis, vitamin D is critical for bone health and possibly physical performance. Hence, vitamin D is important to athletes. Few studies have investigated vitamin D levels in relation to fractures and performance in athletes, and no published study has included a multiracial sample of professional American football players. To assess vitamin D levels, including the prevalence of vitamin D deficiency/insufficiency, in professional American football players and to evaluate the association of vitamin D levels with race, fracture history, and the ability to obtain a contract position, which may be a marker for athletic performance. Cohort study; Level of evidence, 3. Serum vitamin D levels of 80 professional football players from a single team in the National Football League were obtained during the 2011 off-season (mean age, 26.5±3.7 years; black, n=67 [84%]). These levels were used to compare injury reports from the 2011-2012 and 2012-2013 seasons. Statistical analyses were performed to test if vitamin D levels were related to race, fracture history, and the ability to obtain a contract position. Mean vitamin D level was 27.4±11.7 ng/mL, with significantly lower levels for black players (25.6±11.3 ng/mL) versus white players (37.4±8.6 ng/mL; F 1,78=13.00, P=.001). All athletes who were vitamin D deficient were black. When controlling for number of professional years played, vitamin D levels were significantly lower in players with at least 1 bone fracture when compared with no fractures. Players who were released during the preseason because of either injury or poor performance had significantly lower vitamin D levels than did players who played in the regular season. Black professional football players have a higher rate of vitamin D deficiency than do white players. Furthermore, professional football players with higher vitamin D levels were more likely to obtain a contract position in the National Football League. Professional football players deficient in vitamin D levels may be at greater risk of bone fractures. © 2015 The Author(s).

Characteristics of bone fractures and usefulness of micro-computed tomography for fracture detection in rabbits: 210 cases (2007-2013).

PubMed

Sasai, Hiroshi; Fujita, Daisuke; Tagami, Yukari; Seto, Eiko; Denda, Yuki; Hamakita, Hideaki; Ichihashi, Tomonori; Okamura, Kensaku; Furuya, Masaru; Tani, Hiroyuki; Sasai, Kazumi; Yamate, Jyoji

2015-06-15

To characterize bone fractures and the usefulness of micro-CT for imaging fractures in pet rabbits. Retrospective case series. 210 client-owned rabbits with bone fractures. Medical records of rabbits evaluated for bone fractures from 2007 through 2013 were examined. Information was collected on signalment and nature of fractures, and radiographic and micro-CT images of fractures were reviewed. Almost half (n = 95 [47.7%]) of fractures were in rabbits < 3 years old. Accidental fall was the most common cause. Vertebral fracture was the most common type of fracture with a nonneoplastic cause (n = 46 [23.2%]) and was most common in the L4-L7 region. The tibia was the most common site for limb fracture among all fractures with a nonneoplastic cause (45 [22.7%]). Twelve (5.7%) fractures had a neoplastic cause, and 7 of these were associated with metastatic uterine adenocarcinoma. Females were significantly more likely to have a fracture caused by neoplasia than were males. Compared with radiography, micro-CT provided more detailed fracture information, particularly for complicated fractures or structures (eg, skull, pelvic, vertebral, and comminuted limb fractures). Findings were useful for understanding the nature of fractures in pet rabbits and supported the use of micro-CT versus radiography for fracture detection and evaluation.

Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults.

PubMed

El-Sayed, Mohamed; Atef, Ashraf

2012-10-01

Although intramedullary fixation of closed simple (type A or B) diaphyseal tibial fractures in adults is well tolerated by patients, providing lower morbidity rates and better mobility, it is associated with some complications. This study evaluated the results of managing these fractures using percutaneous minimal internal fixation using one or more lag screws, and Ilizarov external fixation. This method was tested to evaluate its efficacy in immediate weight bearing, fracture healing and prevention of any post-immobilisation stiffness of the ankle and knee joints. This randomised blinded study was performed at a referral, academically supervised, level III trauma centre. Three hundred and twenty-four of the initial 351 patients completed this study and were followed up for a minimum of 12 (12-88) months. Patient ages ranged from 20 to 51 years, with a mean of 39 years. Ankle and knee movements and full weight bearing were encouraged immediately postoperatively. Solid union was assessed clinically and radiographically. Active and passive ankle and knee ranges of motion were measured and compared with the normal side using the Wilcoxon signed rank test for matched pairs. Subjective Olerud and Molander Ankle Score was used to detect any ankle joint symptoms at the final follow-up. No patient showed delayed or nonunion. All fractures healed within 95-129 days. Based on final clinical and radiographic outcomes, this technique proves to be adequate for managing simple diaphyseal tibial fractures. On the other hand, it is relatively expensive, technically demanding, necessitates exposure to radiation and patients are expected to be frame friendly.

Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems

PubMed Central

Punjabi, Mansi; Dewan, Ruchika Gupta; Kochhar, Rohit

2017-01-01

Aim and Objectives: The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. Materials and Methods: One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups (n = 25) and two control groups (n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Results: Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. Conclusion: GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth. PMID:29430099

Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems.

PubMed

Punjabi, Mansi; Dewan, Ruchika Gupta; Kochhar, Rohit

2017-01-01

The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups ( n = 25) and two control groups ( n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth.

Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study.

PubMed

Rubin, K H; Rothmann, M J; Holmberg, T; Høiberg, M; Möller, S; Barkmann, R; Glüer, C C; Hermann, A P; Bech, M; Gram, J; Brixen, K

2018-03-01

The Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study investigated the effectiveness of a two-step screening program for osteoporosis in women. We found no overall reduction in fractures from systematic screening compared to the current case-finding strategy. The group of moderate- to high-risk women, who accepted the invitation to DXA, seemed to benefit from the program. The purpose of the ROSE study was to investigate the effectiveness of a two-step population-based osteoporosis screening program using the Fracture Risk Assessment Tool (FRAX) derived from a self-administered questionnaire to select women for DXA scan. After the scanning, standard osteoporosis management according to Danish national guidelines was followed. Participants were randomized to either screening or control group, and randomization was stratified according to age and area of residence. Inclusion took place from February 2010 to November 2011. Participants received a self-administered questionnaire, and women in the screening group with a FRAX score ≥ 15% (major osteoporotic fractures) were invited to a DXA scan. Primary outcome was incident clinical fractures. Intention-to-treat analysis and two per-protocol analyses were performed. A total of 3416 fractures were observed during a median follow-up of 5 years. No significant differences were found in the intention-to-treat analyses with 34,229 women included aged 65-80 years. The per-protocol analyses showed a risk reduction in the group that underwent DXA scanning compared to women in the control group with a FRAX ≥ 15%, in regard to major osteoporotic fractures, hip fractures, and all fractures. The risk reduction was most pronounced for hip fractures (adjusted SHR 0.741, p = 0.007). Compared to an office-based case-finding strategy, the two-step systematic screening strategy had no overall effect on fracture incidence. The two-step strategy seemed, however, to be beneficial in the group of women who were identified by FRAX as moderate- or high-risk patients and complied with DXA.

Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors.

PubMed

Nambu, Atsushi; Onishi, Hiroshi; Aoki, Shinichi; Tominaga, Licht; Kuriyama, Kengo; Araya, Masayuki; Saito, Ryoh; Maehata, Yoshiyasu; Komiyama, Takafumi; Marino, Kan; Koshiishi, Tsuyota; Sawada, Eiichi; Araki, Tsutomu

2013-02-07

As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1-10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.

Hydraulic anisotropy characterization of pneumatic-fractured sediments using azimuthal self potential gradient

USGS Publications Warehouse

Wishart, D.N.; Slater, L.D.; Schnell, D.L.; Herman, G.C.

2009-01-01

The pneumatic fracturing technique is used to enhance the permeability and porosity of tight unconsolidated soils (e.g. clays), thereby improving the effectiveness of remediation treatments. Azimuthal self potential gradient (ASPG) surveys were performed on a compacted, unconsolidated clay block in order to evaluate their potential to delineate contaminant migration pathways in a mechanically-induced fracture network. Azimuthal resistivity (ARS) measurements were also made for comparative purposes. Following similar procedures to those used in the field, compressed kaolinite sediments were pneumatically fractured and the resulting fracture geometry characterized from strike analysis of visible fractures combined with strike data from optical borehole televiewer (BHTV) imaging. We subsequently injected a simulated treatment (electrolyte/dye) into the fractures. Both ASPG and ARS data exhibit anisotropic geoelectric signatures resulting from the fracturing. Self potentials observed during injection of electrolyte are consistent with electrokinetic theory and previous laboratory results on a fracture block model. Visual (polar plot) analysis and linear regression of cross plots show ASPG lobes are correlated with azimuths of high fracture strike density, evidence that the ASPG anisotropy is a proxy measure of hydraulic anisotropy created by the pneumatic fracturing. However, ARS data are uncorrelated with fracture strike maxima and resistivity anisotropy is probably dominated by enhanced surface conduction along azimuths of weak 'starter paths' formed from pulverization of the clay and increases in interfacial surface area. We find the magnitude of electrokinetic SP scales with the applied N2 gas pressure gradient (??PN2) for any particular hydraulically-active fracture set and that the positive lobe of the ASPG anomaly indicates the flow direction within the fracture network. These findings demonstrate the use of ASPG in characterizing the effectiveness of (1) pneumatic fracturing and (2) defining likely flow directions of remedial treatments in unconsolidated sediments and rock. ?? 2008 Elsevier B.V. All rights reserved.

Intra- and interobserver agreement in the classification and treatment of distal third clavicle fractures.

PubMed

Bishop, Julie Y; Jones, Grant L; Lewis, Brian; Pedroza, Angela

2015-04-01

In treatment of distal third clavicle fractures, the Neer classification system, based on the location of the fracture in relation to the coracoclavicular ligaments, has traditionally been used to determine fracture pattern stability. To determine the intra- and interobserver reliability in the classification of distal third clavicle fractures via standard plain radiographs and the intra- and interobserver agreement in the preferred treatment of these fractures. Cohort study (Diagnosis); Level of evidence, 3. Thirty radiographs of distal clavicle fractures were randomly selected from patients treated for distal clavicle fractures between 2006 and 2011. The radiographs were distributed to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons. Fourteen surgeons responded and took part in the study. The evaluators were asked to measure the size of the distal fragment, classify the fracture pattern as stable or unstable, assign the Neer classification, and recommend operative versus nonoperative treatment. The radiographs were reordered and redistributed 3 months later. Inter- and intrarater agreement was determined for the distal fragment size, stability of the fracture, Neer classification, and decision to operate. Single variable logistic regression was performed to determine what factors could most accurately predict the decision for surgery. Interrater agreement was fair for distal fragment size, moderate for stability, fair for Neer classification, slight for type IIB and III fractures, and moderate for treatment approach. Intrarater agreement was moderate for distal fragment size categories (κ = 0.50, P < .001) and Neer classification (κ = 0.42, P < .001) and substantial for stable fracture (κ = 0.65, P < .001) and decision to operate (κ = 0.65, P < .001). Fracture stability was the best predictor of treatment, with 89% accuracy (P < .001). Fracture stability determination and the decision to operate had the highest interobserver agreement. Fracture stability was the key determinant of treatment, rather than the Neer classification system or the size of the distal fragment. © 2015 The Author(s).

Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database.

PubMed

Sammy, Ian Ayenga; Chatha, Hridesh; Lecky, Fiona; Bouamra, Omar; Fragoso-Iñiguez, Marisol; Sattout, Abdo; Hickey, Michael; Edwards, John E

2017-04-01

First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) [year]. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors

PubMed Central

2013-01-01

Background As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Methods Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Results Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Conclusions Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients. PMID:23391264

Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study.

PubMed

Strotmeyer, Elsa S; Cauley, Jane A; Schwartz, Ann V; Nevitt, Michael C; Resnick, Helaine E; Bauer, Douglas C; Tylavsky, Frances A; de Rekeneire, Nathalie; Harris, Tamara B; Newman, Anne B

2005-07-25

Diabetes mellitus (DM) and related complications may increase clinical fracture risk in older adults. Our objectives were to determine if type 2 diabetes mellitus or impaired fasting glucose was associated with higher fracture rates in older adults and to evaluate how diabetic individuals with fractures differed from those without fractures. The Health, Aging, and Body Composition Study participants were well-functioning, community-dwelling men and women aged 70 to 79 years (N = 2979; 42% black), of whom 19% had DM and 6% had impaired fasting glucose at baseline. Incident nontraumatic clinical fractures were verified by radiology reports for a mean +/- SD of 4.5 +/- 1.1 years. Cox proportional hazards regression models determined how DM and impaired fasting glucose affected subsequent risk of fracture. Diabetes mellitus was associated with elevated fracture risk (relative risk, 1.64; 95% confidence interval, 1.07-2.51) after adjustment for a hip bone mineral density (BMD) and fracture risk factors. Impaired fasting glucose was not significantly associated with fractures (relative risk, 1.34; 95% confidence interval, 0.67-2.67). Diabetic participants with fractures had lower hip BMD (0.818 g/cm(2) vs 0.967 g/cm(2); P<.001) and lean mass (44.3 kg vs 51.7 kg) and were more likely to have reduced peripheral sensation (35% vs 14%), transient ischemic attack/stroke (20% vs 8%), a lower physical performance battery score (5.0 vs 7.0), and falls (37% vs 21%) compared with diabetic participants without fractures (P<.05). These results indicate that older white and black adults with DM are at higher fracture risk compared with nondiabetic adults with a similar BMD since a higher risk of nontraumatic fractures was found after adjustment for hip BMD. Fracture prevention needs to target specific risk factors found in older adults with DM.

The effects of extracorporeal shockwave on acute high-energy long bone fractures of the lower extremity.

PubMed

Wang, Ching-Jen; Liu, Hao-Chen; Fu, Te-Hu

2007-02-01

High-energy long bone fractures of the lower extremity are at risk of poor fracture healing and high rate of non-union. Extracorporeal shockwave was shown effective to heal non-union of long bone fracture. However, the effect of shockwave on acute fractures is unknown. The purpose of this study was to investigate the effects of shockwave on acute high-energy fractures of the lower extremity. Between January and October 2004, 56 patients with 59 acute high-energy fractures were enrolled in this study. Patients were randomly divided into two groups with 28 patients with 28 fractures in the study group and 28 patients with 31 fractures in the control group. Both groups showed similar age, gender, type of fracture and follow-up time. Patients in the study group received open reduction and internal fixation and shockwave treatment immediately after surgery on odd-numbered days of the week, whereas, patients in the control group received open reduction and internal fixation without shockwave treatment on even-numbered days of the week. Postoperative managements were similarly performed in both groups including crutch walking with non-weight bearing on the affected limb until fracture healing shown on radiographs. The evaluation parameters included clinical assessments of pain score and weight bearing status of the affected leg and serial radiographs at 3, 6 and 12 months. The primary end-point is the rate of non-union at 12 months, and the secondary end point is the rate of fracture healing at 3, 6 and 12 months. At 12 months, the rate of non-union was 11% for the study group versus 20% for the control group (P < 0.001). Significantly, better rate of fracture healing was noted in the study group than the control group at 3, 6 and 12 months (P < 0.001). Extracorporeal shockwave is effective on promoting fracture healing and decreasing the rate of non-union in acute high-energy fractures of the lower extremity.

Pattern of Cortical Fracture following Corticotomy for Distraction Osteogenesis.

PubMed

Luvan, M; Kanthan, S R; Roshan, G; Saw, A

2015-11-01

Corticotomy is an essential procedure for deformity correction and there are many techniques described. However there is no proper classification of the fracture pattern resulting from corticotomies to enable any studies to be conducted. We performed a retrospective study of corticotomy fracture patterns in 44 patients (34 tibias and 10 femurs) performed for various indications. We identified four distinct fracture patterns, Type I through IV classification based on the fracture propagation following percutaneous corticotomy. Type I transverse fracture, Type II transverse fracture with a winglet, Type III presence of butterfly fragment and Type IV fracture propagation to a fixation point. No significant correlation was noted between the fracture pattern and the underlying pathology or region of corticotomy.

[Calcaneal fractures treated by open reduction and internal fixation with a locking compression plate (LCP). A prospective study. part I: basic analysis of the group].

PubMed

Svatoš, F; Bartoška, R; Skála-Rosenbaum, J; Douša, P; Pacovský, V; Krbec, M

2011-01-01

In a prospective study of patients with calcaneal fractures treated by open reduction from an extensile lateral approach and LCP osteosynthesis, the authors evaluated the basic epidemiological data, mechanism of injury, type of fracture, essential data on surgery, days of hospital stay and the number of complications. In the period from September 1, 2006 to July 31, 2010, a total of 230 patients with 243 calcaneal fractures were treated. The fractures were classified as either open or closed and according to the Essex-Lopresti system. Of the total number of patients, 135 (55.6 % of all fractures) were indicated for conservative treatment and 108 (44.4% of all fractures) for surgical intervention. Indications for surgery based on the generally accepted criteria enabled us to select 77 patients with 82 fractures (33.7 % of all fractures) for treatment by the method of open reduction and LCP osteosynthesis. These patients constituted the group evaluated here. The other patients were treated using other techniques (21 fractures, i.e., 8.6 % of all fractures, by the Stehlík-Štulík transfixation method and further five [2.1 %] by screw osteosynthesis). Six surgeons were involved in the treatment of this group. For the diagnosis of fractures, plain radiographs in lateral and axial projection and axial and coronal CT images were used. All fractures were treated after subsidence of oedema by the method of open reduction and LCP fixation from an extensile lateral approach, with the use of a tourniquet. The follow-up period for the evaluation of functional outcome and bone union was 3 to 48 months. Fifty patients were followed up for over one year. The group evaluated comprised 58 men (75.3 %) with 63 fractures (76.8 %) and 19 women (24.7 %) with 19 fractures (23.2 %). The average age of the group was 42 years, with 41 years (range, 22-61 years) in men and 47 years (range, 30-70 years) in women. The most frequent cause of injury was a fall from a height below 1 metre and this was recorded in 38 patients (49.4 %); 18 patients (24.3 %) had a fall from a height below 3 metres. Eight fractures were caused by a fall from the window, seven calcaneal fractures, as part of .polytrauma, were sustained in road accidents (9.1 %) and six calcaneal bones were injured due to ankle sprain in walking on a flat surface (7.8 %). Bilateral fractures occurred in five (6.5 %) patients, the right and left heel bones were injured in 31 (40.3 %) and 41 (53.2 %) fracture cases, respectively. An open fracture was recorded on three occasions (3.7 %). Of the 82 evaluated fractures, 23 were type IIa fractures (28 %) and 59 were type IIb fractures (72 %) according to the Essex-Lopresti classification system. The average injury-surgery interval was 10 days (range, 1 - 23 days). The average operative time was 77 minutes (range, 45-175 min) and the average duration of tourniquet application was 61 minutes (range, 20-130 min). The average length of hospital stay was 18 days (range, 7-61 days). In 15 patients (18.3 % of osteosynthesis cases) wound healing was delayed. Deep wound infection developed in three cases (3.7 %); these required revision surgery which involved implant removal before bone union in two cases and healing of the wound after revision without implant removal in one case. A necrotic lesion in one case (1.2 %) was treated by muscle flap transfer. Complications which varied in type and severity were recorded in 22 % of the patients. The Rowe score was used to evaluate functional outcomes, which were excellent in 44 %, good in 46 %, satisfactory in 4 % and poor in 6 % of the surgically treated patients.. Only about one-third of the patients with calcaneal fractures were indicated for open LCP osteosynthesis. This is in agreement with the strict indication criteria established by the foreign authors with Professors Zwipp and Sanders at the head. It appears that this fracture chiefly occurs in the population of young active men (Kočiš reported only men and no woman with this fracture in his study). The authors focus on exact radiographic diagnosis including CT examination, as recommended by Stehlík and Štulík in their book. They recommend to use the Essex-Lopresti system for primary classification and, because of the frequency of LCP osteosynthesis procedures performed, also recommend to carry out this treatment in specialised institutions. The rate of serious complications in this study was relatively low and in accordance with the findings of Zwipp, Zeman and others. The analysis of basic data on the group of patients with calcaneal fractures treated by open reduction and LCP fixation showed the following: chiefly young active men sustained this fracture; calcaneal fracture was usually due to a fall or jump from a level not too high; X-ray examination (lateral and axial projection) was sufficient to make a diagnosis; for a decision to operate it was useful to complete the diagnosis by CT examination; the prerequisite for minimising post-operative complications was strict adherence to the established indication criteria, surgery only after oedema had subsided and use of the correct surgical technique. The number of complications and their nature did not differ from the data reported by other authors.

Simulation of a multistage fractured horizontal well in a water-bearing tight fractured gas reservoir under non-Darcy flow

NASA Astrophysics Data System (ADS)

Zhang, Rui-Han; Zhang, Lie-Hui; Wang, Rui-He; Zhao, Yu-Long; Huang, Rui

2018-06-01

Reservoir development for unconventional resources such as tight gas reservoirs is in increasing demand due to the rapid decline of production in conventional reserves. Compared with conventional reservoirs, fluid flow in water-bearing tight gas reservoirs is subject to more nonlinear multiphase flow and gas slippage in nano/micro matrix pores because of the strong collisions between rock and gas molecules. Economic gas production from tight gas reservoirs depends on extensive application of water-based hydraulic fracturing of horizontal wells, associated with non-Darcy flow at a high flow rate, geomechanical stress sensitivity of un-propped natural fractures, complex flow geometry and multiscale heterogeneity. How to efficiently and accurately predict the production performance of a multistage fractured horizontal well (MFHW) is challenging. In this paper, a novel multicontinuum, multimechanism, two-phase simulator is established based on unstructured meshes and the control volume finite element method to analyze the production performance of MFHWs. The multiple interacting continua model and discrete fracture model are coupled to integrate the unstimulated fractured reservoir, induced fracture networks (stimulated reservoir volumes, SRVs) and irregular discrete hydraulic fractures. Several simulations and sensitivity analyses are performed with the developed simulator for determining the key factors affecting the production performance of MFHWs. Two widely applied fracturing models, classic hydraulic fracturing which generates long double-wing fractures and the volumetric fracturing aimed at creating large SRVs, are compared to identify which of them can make better use of tight gas reserves.

Rostral mandibular fracture repair in a pet bearded dragon (Pogona vitticeps).

PubMed

Nau, Melissa R; Eshar, David

2018-04-15

CASE DESCRIPTION A 2-year-old male bearded dragon (Pogona vitticeps) was evaluated because of a traumatic mandibular fracture. CLINICAL FINDINGS An open comminuted fracture of the rostral aspect of the right mandible was evident, with a fragment of bone exposed and dorsally displaced. Whole-body radiography revealed no evidence of additional injury. Other findings were unremarkable, except for moderate anemia (PCV, 19%). TREATMENT AND OUTCOME The fracture fragments were stabilized with 2 crossed 36-gauge interfragmentary wire loops. An external fixator device was fashioned from four 25-gauge needles inserted at alternating angles through the fracture fragments; plastic IV fluid line tubing filled with dental acrylic was used as a connecting bar. One day after surgery, the lizard had regained its typical activity level and appetite. Body weight was measured and the external fixator was inspected 1 week after surgery and monthly thereafter. Three months after initial injury, the fracture was stable, radiography revealed bony callus formation at the fracture site, and the external fixator was removed. Recheck radiography performed 5.5 months after initial injury revealed complete osseous union of the fracture fragments, and the interfragmentary wires were removed. CLINICAL RELEVANCE Surgical management of the traumatic comminuted mandibular fracture in this bearded dragon by means of a combination of internal and external fixation resulted in complete healing of the mandible and restoration of function. Management of this complicated fracture was achieved with the aid of readily available and inexpensive supplies in a clinical setting, which may be useful to other clinicians in the management of similar cases.

Ipsilateral intact fibula as a predictor of tibial plafond fracture pattern and severity.

PubMed

Luk, Pamela C; Charlton, Timothy P; Lee, Jackson; Thordarson, David B

2013-10-01

The objective of this study was to determine whether there is a difference in fracture pattern and severity of comminution between tibial plafond fractures with and without associated fibular fractures using computed tomography (CT). We hypothesized that the presence of an intact fibula was predictive of increased tibial plafond fracture severity. This was a case control, radiographic review performed at a single level I university trauma center. Between November 2007 and July 2011, 104 patients with 107 operatively treated tibial pilon fractures and preoperative CT scans were identified: 70 patients with 71 tibial plafond fractures had associated fibular fractures, and 34 patients with 36 tibial plafond fractures had intact fibulas. Four criteria were compared between the 2 groups: AO/OTA classification of distal tibia fractures, Topliss coronal and sagittal fracture pattern classification, plafond region of greatest comminution, and degree of proximal extension of fracture line. The intact fibula group had greater percentages of AO/OTA classification B2 type (5.5 vs 0, P = .046) and B3 type (52.8 vs 28.2, P = .013). Conversely, the percentage of AO/OTA classification C3 type was greater in the fractured fibula group (53.5 vs 30.6, P = .025). Evaluation using the Topliss sagittal and coronal classifications revealed no difference between the 2 groups (P = .226). Central and lateral regions of the plafond were the most common areas of comminution in fractured fibula pilons (32% and 31%, respectively). The lateral region of the plafond was the most common area of comminution in intact fibula pilon fractures (42%). There was no statistically significant difference (P = .71) in degree of proximal extension of fracture line between the 2 groups. Tibial plafond fractures with intact fibulas were more commonly associated with AO/OTA classification B-type patterns, whereas those with fractured fibulas were more commonly associated with C-type patterns. An intact fibula may be predictive of less comminution of the plafond. The lateral and central regions of the plafond were the most common areas of comminution in tibial plafond fractures, regardless of fibular status. Level III, case control study.

Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children.

PubMed

Gourineni, Prasad; Gupta, Asheesh

2011-10-01

Tillaux and Triplane fractures occur in children predominantly from external rotation mechanism. We hypothesized that in displaced fractures, the talus would shift laterally along with the distal fibula and the distal tibial epiphyseal fragment increasing the medial joint space. Consecutive cases evaluated retrospectively. Level I and Level II centers. Twenty-two skeletally immature patients with 14 displaced Triplane fractures and eight displaced Tillaux fractures were evaluated for medial joint space widening. Measurement of fracture displacement and medial joint space widening before and after intervention. Thirteen Triplane and six Tillaux fractures (86%) showed medial space widening of 1 to 9 mm and equal to the amount of fracture displacement. Reduction of the fracture reduced the medial space to normal. There were no known complications. Medial space widening of the ankle may be a sign of ankle fracture displacement. Anatomic reduction of the fracture reduces the medial space and may improve the results in Tillaux and Triplane fractures.

Fracture control methods for space vehicles. Volume 1: Fracture control design methods. [for space shuttle configuration planning

NASA Technical Reports Server (NTRS)

Liu, A. F.

1974-01-01

A systematic approach for applying methods for fracture control in the structural components of space vehicles consists of four major steps. The first step is to define the primary load-carrying structural elements and the type of load, environment, and design stress levels acting upon them. The second step is to identify the potential fracture-critical parts by means of a selection logic flow diagram. The third step is to evaluate the safe-life and fail-safe capabilities of the specified part. The last step in the sequence is to apply the control procedures that will prevent damage to the fracture-critical parts. The fracture control methods discussed include fatigue design and analysis methods, methods for preventing crack-like defects, fracture mechanics analysis methods, and nondestructive evaluation methods. An example problem is presented for evaluation of the safe-crack-growth capability of the space shuttle crew compartment skin structure.

Lewis Structures Technology, 1988. Volume 3: Structural Integrity Fatigue and Fracture Wind Turbines HOST

NASA Technical Reports Server (NTRS)

1988-01-01

The charter of the Structures Division is to perform and disseminate results of research conducted in support of aerospace engine structures. These results have a wide range of applicability to practioners of structural engineering mechanics beyond the aerospace arena. The specific purpose of the symposium was to familiarize the engineering structures community with the depth and range of research performed by the division and its academic and industrial partners. Sessions covered vibration control, fracture mechanics, ceramic component reliability, parallel computing, nondestructive evaluation, constitutive models and experimental capabilities, dynamic systems, fatigue and damage, wind turbines, hot section technology (HOST), aeroelasticity, structural mechanics codes, computational methods for dynamics, structural optimization, and applications of structural dynamics, and structural mechanics computer codes.

[Case-control study on bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle joint].

PubMed

Qi, Yue-Feng; Chen, Fa-Lin; Bao, Shu-Ren; Li, Cheng-Huan; Zhao, Xing-Wei; Liu, Shi-Ming; Chen, Wen-Xue; Li, Ye; Wang, Peng

2012-08-01

To explore therapeutic effects of bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle,and analyze manipulative reduction mechanism. From 2005 to 2008, 95 patients with over degree II supination-eversion fractures of ankle were treated respectively by manipulation and operation. There were 43 cases [11 males and 32 females with an average age of (44.95 +/- 12.65) years] in manipulation group, and 2 cases were degree II, 11 cases were degree III, and 30 cases were degree IV. There were 52 cases [21 males and 31 females with an average age of (39.96 +/- 13.28) years] in operative group,and 6 cases were degree II, 18 cases were degree III, and 28 cases were degree IV. Bone setting manipulation and hard splint external fixation were applied to manipulative group. Operative reduction internal fixation was performed in operative group. X-ray was used to evaluate reduction of fracture before and after treatment, 2 months after treatment. Ankle joint function was evaluated according to Olerud-Molander scoring system after 6 months treatment. All patients were followed up with good reduction. Three cases occurred wound complication in operative group, but not in manipulative group. In manipulation group, 19 cases got excellent results, 20 cases good and 4 cases fair; while in operative group, 30 cases got excellent results, 20 cases good and 2 cases poor. There were no significant differences in fracture reduction and ankle joint function recovery between two groups (P > 0.05). Efficacy of operative treatment was better than that of manipulative treatment at degree IV fracture (P < 0.05). Bone setting manipulation is a good method for treating supination-eversion ankle joint fractures, which has advantages of simple and safe operation, reliable efficacy. For ankle join fracture at degree IV, manipulative reduction should be adopted earlier, and operative treatment also necessary

Comparative Evaluation of Marginal Adaptation and Fracture Strength of Different Ceramic Inlays Produced by CEREC Omnicam and Heat-Pressed Technique.

PubMed

Oz, F D; Bolay, S

2018-01-01

The aim of this in vitro study was to evaluate marginal adaptation and fracture strength of inlays produced by CEREC Omnicam using different types of blocs and heat-pressed technique. Methods: Seventy-five extracted human mandibular molars were divided randomly into 5 groups ( n =15). 60 molars in four groups received MOD inlay preparations. Experimental groups were CO: Intact teeth, EC: IPS e.max CAD and CEREC, LU: Lava Ultimate and CEREC, EL: IPS Empress CAD and CEREC, EP: IPS Empress Esthetic ingots and heat-pressed technique. Marginal gap measurements were taken with a stereomicroscope. Restorations were cemented with Variolink N and stored in distilled water at 37°C for 24 hours. All samples were subjected to thermocycling. The fracture strength of specimens was determined at a 0.5 mm/min crosshead speed until fracture. Fracture modes were determined. Statistical analyses were performed using one-way analysis of variance for fracture strength data and Kruskal-Wallis for marginal gap data ( p =0.05). The mean marginal gap size of EC, LU, EL, and EP were 33.54  µ m, 33.77  µ m, 34.23  µ m, and 85.34  µ m, respectively. EP had statistically higher values than other groups. The fracture strength values were significantly higher in the intact teeth group (3959,00 ± 1279,79 N) than those of restored groups EC (2408,00 ± 607,97 N), LU (2206,73 ± 675,16), EL (2573.27 ± 644,73) ve EP (2879,53 ± 897,30). Inlays fabricated using CEREC Omnicam demonstrated better marginal adaptation than inlays produced with heat-pressed technique, whereas fracture strength values of inlays fabricated with different type of blocks using CEREC Omnicam exhibited similarity to those fabricated with heat-pressed technique.

Comparative Evaluation of Marginal Adaptation and Fracture Strength of Different Ceramic Inlays Produced by CEREC Omnicam and Heat-Pressed Technique

PubMed Central

Bolay, S.

2018-01-01

Objective The aim of this in vitro study was to evaluate marginal adaptation and fracture strength of inlays produced by CEREC Omnicam using different types of blocs and heat-pressed technique. Methods: Seventy-five extracted human mandibular molars were divided randomly into 5 groups (n=15). 60 molars in four groups received MOD inlay preparations. Experimental groups were CO: Intact teeth, EC: IPS e.max CAD and CEREC, LU: Lava Ultimate and CEREC, EL: IPS Empress CAD and CEREC, EP: IPS Empress Esthetic ingots and heat-pressed technique. Marginal gap measurements were taken with a stereomicroscope. Restorations were cemented with Variolink N and stored in distilled water at 37°C for 24 hours. All samples were subjected to thermocycling. The fracture strength of specimens was determined at a 0.5 mm/min crosshead speed until fracture. Fracture modes were determined. Statistical analyses were performed using one-way analysis of variance for fracture strength data and Kruskal–Wallis for marginal gap data (p=0.05). Results The mean marginal gap size of EC, LU, EL, and EP were 33.54 µm, 33.77 µm, 34.23 µm, and 85.34 µm, respectively. EP had statistically higher values than other groups. The fracture strength values were significantly higher in the intact teeth group (3959,00 ± 1279,79 N) than those of restored groups EC (2408,00 ± 607,97 N), LU (2206,73 ± 675,16), EL (2573.27 ± 644,73) ve EP (2879,53 ± 897,30). Conclusion Inlays fabricated using CEREC Omnicam demonstrated better marginal adaptation than inlays produced with heat-pressed technique, whereas fracture strength values of inlays fabricated with different type of blocks using CEREC Omnicam exhibited similarity to those fabricated with heat-pressed technique. PMID:29853894

Comparison between open plating versus minimally invasive plate osteosynthesis for acute displaced clavicular shaft fractures.

PubMed

Sohn, Hoon-Sang; Kim, Won Ju; Shon, Min Soo

2015-08-01

Current literatures describe good clinical outcomes of acute displaced fracture of clavicle treated with minimally invasive plate osteosynthesis (MIPO). But, there are little comparative data of the outcomes between open plating and MIPO techniques. We compared the outcomes of open plating and MIPO for treatment of acute displaced clavicular shaft fractures. The author performed a retrospective review on a consecutive series of patients with clavicular shaft fracture who underwent open plating or MIPO. Fourteen patients were treated with open plating with interfragmentary screw fixation, and 19 were treated with the MIPO technique without exposing a fracture site itself. A superior plating method was applied to both groups. Patient demographics, clinical outcomes using Constant score and University of California Los Angeles (UCLA) shoulder score, operation time, union rate, complications, and radiographic evaluation were evaluated. There were no statistically significant differences in the demographic data, including patient's variables (age, gender, involved side, smoking, alcohol, and diabetic status) and fracture characteristics (trauma mechanism, distribution of fracture type, presence of polytrauma, and time from trauma to surgery) between the two groups. Mean operation time was 87.5 min in open plating and 77.2 min in MIPO (p=0.129). The mean time to union was 15.7 weeks in patients who underwent open plating and 16.8 weeks in patients who underwent MIPO (p=0.427). Although there was no significant difference, nonunion developed 1 case in MIPO while none was in open plating. Four patients in open plating had skin numbness (none in MIPO, p=0.024). There was no significant difference in the Constant score and UCLA score of the two surgical methods. This study showed that both open plating with interfragmentary screw fixation (Open plating) and minimally invasive plate osteosynthesis (MIPO) are equally effective and safe treatment methods for acute displaced clavicle shaft fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparison of Computed Tomography and Chest Radiography in the Detection of Rib Fractures in Abused Infants

ERIC Educational Resources Information Center

Wootton-Gorges, Sandra L.; Stein-Wexler, Rebecca; Walton, John W.; Rosas, Angela J.; Coulter, Kevin P.; Rogers, Kristen K.

2008-01-01

Purpose: Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants. Methods: This retrospective study included all 12 abused infants…

Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients.

PubMed

Banal, Frédéric; Gandjbakhch, Frédérique; Foltz, Violaine; Goldcher, Alain; Etchepare, Fabien; Rozenberg, Sylvie; Koeger, Anne-Claude; Bourgeois, Pierre; Fautrel, Bruno

2009-08-01

To date, early diagnosis of stress fractures depends on magnetic resonance imaging (MRI) or bone scan scintigraphy, as radiographs are usually normal at onset of symptoms. These examinations are expensive or invasive, time-consuming, and poorly accessible. A recent report has shown the ability of ultrasonography (US) to detect early stress fractures. Our objective was to evaluate sensitivity and specificity of US versus dedicated MRI (0.2 Tesla), taken as the gold standard, in early diagnosis of metatarsal bone stress fractures. A case-control study from November 2006 to December 2007 was performed. All consecutive patients with mechanical pain and swelling of the metatarsal region for less than 3 months and with normal radiographs were included. US and dedicated MRI examinations of the metatarsal bones were performed the same day by experienced rheumatologists with expertise in US and MRI. Reading was undertaken blind to the clinical assessment and MRI/US results. Forty-one feet were analyzed on US and dedicated MRI from 37 patients (28 women, 9 men, mean age 52.7 +/- 14.1 yrs). MRI detected 13 fractures in 12 patients. Sensitivity of US was 83%, specificity 76%, positive predictive value 59%, and negative predictive value 92%. Positive likehood ratio was 3.45, negative likehood ratio 0.22. In cases of normal radiographs, US is indicated in the diagnosis of metatarsal bone stress fractures, as it is a low cost, noninvasive, rapid, and easy technique with good sensitivity and specificity. From these data, we propose a new imaging algorithm including US.

Multiwell fracturing experiments. [Nitrogen foam fracture treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warpinski, N.

The objective of the Multiwell fracturing experiments is to test and develop the technology for the efficient stimulation of tight, lenticular gas sands. This requires basic understanding of: (1) fracture behavior and geometry in this complex lithologic environment, and (2) subsequent production into the created fracture. The intricate interplay of the hydraulic fracture with the lens geometry, the internal reservoir characteristics (fractures, reservoir breaks, etc.), the in situ stresses, and the mechanical defects (fracture, bedding, etc.) need to be defined in order to develop a successful stimulation program. The stimulation phase of the Multiwell Experiment is concerned with: (1) determiningmore » important rock/reservoir properties that influence or control fracture geometry and behavior, (2) designing fracture treatments to achieve a desired size and objectives, and (3) conducting post-treatment analyses to evaluate the effectiveness of the treatment. Background statement, project description, results and evaluation of future plans are presented. 5 refs., 2 figs., 2 tabs.« less

"Buckle" rib fracture: an artifact following cardio-pulmonary resuscitation detected on postmortem CT.

PubMed

Yang, Kyung-Moo; Lynch, Matthew; O'Donnell, Chris

2011-09-01

Buckle rib fractures are incomplete fractures involving the inner cortex alone, and are rarely detected on routine chest X-ray or at autopsy. The characteristics of these fractures have not been well evaluated in situ although they are commonly observed on postmortem CT images especially following CPR. The postmortem CT findings in 42 cases showing buckle rib fractures caused by CPR were reviewed. The cause of death in all cases was non-traumatic. The shape, number, location, and distribution of these buckle rib fractures and their relationship to other types of rib fractures were evaluated using a novel oblique axial multiplanar reconstruction technique. Almost all incomplete rib fractures associated with CPR are buckle rib fractures (90.5%). All rib fractures were distributed from the second to ninth ribs with over 95% being within the second to seventh ribs. Buckle rib fractures are dominant in the seventh to ninth ribs and the proportion of buckle rib fractures located in the vicinity of the costochondral junctions increases with the lower ribs. Over 97% of all CPR associated rib fractures are located in the anterior one third of the ribs based on a new measurement method utilizing oblique axial multiplanar reconstruction of the CT data. When recognition of incomplete or buckle rib fractures on postmortem CT is taken into account, detection of symmetry and continuity of rib fractures typically associated with CPR is improved compared with the detection of complete fractures alone. Recognition of buckle rib fractures and their characteristics on postmortem CT is of benefit to the forensic pathologist in evaluating the possibility of CPR and the differentiation of resuscitative artifact from forensically significant visceral injury observed at autopsy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Investigation of high temperature fracture of T-111 and ASTAR-811C

NASA Technical Reports Server (NTRS)

Gold, R. E.

1971-01-01

The high temperature deformation and fracture behavior of T-111 and ASTAR-811C were studied over the temperature range 982 to 2205 C (1800 to 4000 F). As-cast and wrought-recrystallized material as well as GTA welds in sheet and plate were evaluated using conventional tensile and creep tests. Post test examinations were performed using optical metallography, scanning electron microscopy and transmission electron microscopy. A high temperature region of reduced ductility, in terms of tensile elongation, was identified for both alloys. The reduction in tensile elongation became more severe with increase in grain size, being near catastrophic for the as-cast specimens. Optical and electron metallography indicated that even for failures at very low total strain, considerable deformation of a very localized nature had occurred prior to fracture.

Mandible Fractures

PubMed Central

Pickrell, Brent B.; Serebrakian, Arman T.; Maricevich, Renata S.

2017-01-01

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles. PMID:28496390

Mandible Fractures.

PubMed

Pickrell, Brent B; Serebrakian, Arman T; Maricevich, Renata S

2017-05-01

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

Brainstem auditory-evoked potentials as an objective tool for evaluating hearing dysfunction in traumatic brain injury.

PubMed

Lew, Henry L; Lee, Eun Ha; Miyoshi, Yasushi; Chang, Douglas G; Date, Elaine S; Jerger, James F

2004-03-01

Because of the violent nature of traumatic brain injury, traumatic brain injury patients are susceptible to various types of trauma involving the auditory system. We report a case of a 55-yr-old man who presented with communication problems after traumatic brain injury. Initial results from behavioral audiometry and Weber/Rinne tests were not reliable because of poor cooperation. He was transferred to our service for inpatient rehabilitation, where review of the initial head computed tomographic scan showed only left temporal bone fracture. Brainstem auditory-evoked potential was then performed to evaluate his hearing function. The results showed bilateral absence of auditory-evoked responses, which strongly suggested bilateral deafness. This finding led to a follow-up computed tomographic scan, with focus on bilateral temporal bones. A subtle transverse fracture of the right temporal bone was then detected, in addition to the left temporal bone fracture previously identified. Like children with hearing impairment, traumatic brain injury patients may not be able to verbalize their auditory deficits in a timely manner. If hearing loss is suspected in a patient who is unable to participate in traditional behavioral audiometric testing, brainstem auditory-evoked potential may be an option for evaluating hearing dysfunction.

The effects of low-intensity pulsed ultrasound and pulsed electromagnetic fields bone growth stimulation in acute fractures: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Hannemann, P F W; Mommers, E H H; Schots, J P M; Brink, P R G; Poeze, M

2014-08-01

The aim of this systematic review and meta-analysis was to evaluate the best currently available evidence from randomized controlled trials comparing pulsed electromagnetic fields (PEMF) or low-intensity pulsed ultrasound (LIPUS) bone growth stimulation with placebo for acute fractures. We performed a systematic literature search of the medical literature from 1980 to 2013 for randomized clinical trials concerning acute fractures in adults treated with PEMF or LIPUS. Two reviewers independently determined the strength of the included studies by assessing the risk of bias according to the criteria in the Cochrane Handbook for Systematic Reviews of Interventions. Seven hundred and thirty-seven patients from 13 trials were included. Pooled results from 13 trials reporting proportion of nonunion showed no significant difference between PEMF or LIPUS and control. With regard to time to radiological union, we found heterogeneous results that significantly favoured PEMF or LIPUS bone growth stimulation only in non-operatively treated fractures or fractures of the upper limb. Furthermore, we found significant results that suggest that the use of PEMF or LIPUS in acute diaphyseal fractures may accelerate the time to clinical union. Current evidence from randomized trials is insufficient to conclude a benefit of PEMF or LIPUS bone growth stimulation in reducing the incidence of nonunions when used for treatment in acute fractures. However, our systematic review and meta-analysis suggest that PEMF or LIPUS can be beneficial in the treatment of acute fractures regarding time to radiological and clinical union. PEMF and LIPUS significantly shorten time to radiological union for acute fractures undergoing non-operative treatment and acute fractures of the upper limb. Furthermore, PEMF or LIPUS bone growth stimulation accelerates the time to clinical union for acute diaphyseal fractures.

Proton pump inhibitors increase the incidence of bone fractures in hepatitis C patients.

PubMed

Mello, Michael; Weideman, Rick A; Little, Bertis B; Weideman, Mark W; Cryer, Byron; Brown, Geri R

2012-09-01

While proton pump inhibitors (PPI) may increase the risk of bone fractures, the incidence of new bone fractures in a chronic hepatitis C virus (HCV) infected cohort, with or without PPI exposure, has not been explored. A retrospective cohort study of the incidence of bone fractures over 10 years in 9,437 HCV antibody positive patients in the Dallas VA Hepatitis C Registry was performed. The study endpoint was the incidence of verified new bone fractures per patient-years (pt-yrs) in PPI users compared to non-PPI users. PPI use was defined as those taking a PPI for ≥360 days. Pt-yrs of exposure for PPI users began on the first PPI prescription date, and pt-yrs of exposure for non-PPI users began with first date of any non-PPI prescription. For both HCV groups, the final date of patients' study duration was defined by end of PPI exposure, bone fracture occurrence, death or end of study evaluation period. Exclusion criteria included use of bone health modifying medications ≥30 days. Statistical differences in fracture incidence between groups were determined by multivariate regression analysis. Among the total study population analyzed (n = 2,573), 109 bone fractures occurred. Unadjusted bone fracture incidences were 13.99/1,000 pt-yrs vs. 5.86/1,000 pt-yrs in PPI and non-PPI users, respectively. The adjusted hazard ratio for new bone fractures was 3.87 (95 % CI 2.46-6.08) (p < 0.001) in PPI users. In patients with chronic HCV, use of PPI for >1 year increased the risk of new bone fractures by more than threefold.

Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS)

PubMed Central

Cauley, Jane A; Cawthon, Peggy M; Peters, Katherine E; Cummings, Steven R; Ensrud, Kristine E; Bauer, Douglas C; Taylor, Brent C; Shikany, James M; Hoffman, Andrew R; Lane, Nancy E; Kado, Deborah M; Stefanick, Marcia L; Orwoll, Eric S

2017-01-01

Almost 30% of hip fractures occur in men; the mortality, morbidity, and loss of independence after hip fractures are greater in men than in women. To comprehensively evaluate risk factors for hip fracture in older men, we performed a prospective study of 5994 men, primarily white, age 65+ years recruited at six US clinical centers. During a mean of 8.6 years of 97% complete follow-up, 178 men experienced incident hip fractures. Information on risk factors including femoral neck bone mineral density (FNBMD) was obtained at the baseline visit. Cox proportional hazards models were used to calculate the hazard ratio (HR) with 95% confidence intervals; Fine and Gray models adjusted for competing mortality risk. Older age (≥75 years), low FNBMD, currently smoking, greater height and height loss since age 25 years, history of fracture, use of tricyclic antidepressants, history of myocardial infarction or angina, hyperthyroidism or Parkinson’s disease, lower protein intake, and lower executive function were all associated with an increased hip fracture risk. Further adjustment for competing mortality attenuated HR for smoking, hyperthyroidism, and Parkinson’s disease. The incidence rate of hip fracture per 1000 person-years (PY) was greatest in men with FNBMD T-scores <−2.5 (white women reference database) who also had 4+ risk factors, 33.4. Men age ≥80 years with 3+ major comorbidities experienced hip fracture at rates of 14.52 versus 0.88 per 1000 PY in men age <70 years with zero comorbidities. Older men with low FNBMD, multiple risk factors, and multimorbidity have a high risk of hip fracture. Many of these assessments can easily be incorporated into routine clinical practice and may lead to improved risk stratification. PMID:26988112

Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

PubMed Central

2011-01-01

Background Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated. Results The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength. Conclusion Malunion after distal radius fracture was associated with higher arm-related disability regardless of age. PMID:21232088

[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases].

PubMed

Cáceres-Sánchez, L; Mesa-Mateo, A; Barrionuevo-Sánchez, F J; García-Benítez, B; Expósito-Triano, S

2015-01-01

To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Delaying Surgical Treatment of Penile Fracture Results in Poor Functional Outcomes: Results from a Large Retrospective Multicenter European Study.

PubMed

Bozzini, Giorgio; Albersen, Maarten; Otero, Javier Romero; Margreiter, Markus; Cruz, Eduard Garcia; Mueller, Alexander; Gratzke, Christian; Serefoglu, Ege Can; Salamanca, Juan Ignacio Martinez; Verze, Paolo

2018-01-01

Penile fracture is a rare clinical entity that represents a urologic emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients to investigate the impact of surgical delay on functional outcomes. A retrospective analysis was performed using data obtained from 137 patients presenting with penile fracture at seven different European academic medical centers between 1996 and 2013. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect, and surgical technique were recorded. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. The median age of the patients was 34.50 yr (interquartile range [IQR]: 28.0-46.5 yr). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound, and 5 patients (3.64%) were evaluated with magnetic resonance imaging. All patients were treated surgically, and the duration between emergency room admission and surgical intervention was 5.0h (IQR: 3.6-8.0h). The median length of tunica albuginea defect was 10mm (IQR: 8-20mm). Postoperative IIEF-5 scores were 21 (IQR: 12-23) and 23 (IQR: 15-24) at the first and third postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed >8.23hours after emergency room admission, postoperative erectile function was significantly worse (p=0.0051 at first month and p=0.0057 at third month postoperatively). Our multicenter study showed that delaying surgical intervention results in significantly impaired erectile function. Surgical treatment must be planned as soon as possible to avoid postoperative erectile dysfunction. We looked at sexual outcomes following the repair of penile fracture in a large European population. We found that outcomes worsened if surgical repair was delayed. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

PubMed Central

2017-01-01

Purpose. The purpose of this study is to evaluate the learning curve of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures, to provide valuable information and experience for surgeons who decide to learn a new procedure. Methods. We retrospectively analyzed data from 53 patients who underwent surgery using an InterTan intramedullary nail at our hospital between July 2012 and September 2015. The negative exponential curve-fit regression analysis was used to evaluate the learning curve. According to 90% learning milestone, patients were divided into two group, and the outcomes were compared. Results. The mean operative time was 69.28 (95% CI 64.57 to 74.00) minutes; with the accumulation of surgical experience, the operation time was gradually decreased. 90% of the potential improvement was expected after 18 cases. In terms of operative time, intraoperative blood loss, hospital stay, and Harris hip score significant differences were found between two groups (p = 0.009, p = 0.000, p = 0.030, and p = 0.002, resp.). Partial weight bearing time, fracture union time, tip apex distance, and the number of blood transfusions and complications were similar between two groups (p > 0.5). Conclusion. This study demonstrated that the learning curve of performing surgery with the InterTan intramedullary nail is acceptable and 90% of the expert's proficiency level is achieved at around 18 cases. PMID:28503572

Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pusceddu, Claudio, E-mail: clapusceddu@gmail.com; Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com; Fele, Rosa Maria, E-mail: rosellafele@tiscali.it

2016-01-15

PurposeTo retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture.Materials and MethodsThirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure.ResultsIn all patients, painmore » reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients’ walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites.ConclusionOur results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.« less

Progressive Fracture of Composite Structures

NASA Technical Reports Server (NTRS)

Chamis, Christos C.; Minnetyan, Levon

2008-01-01

A new approach is described for evaluating fracture in composite structures. This approach is independent of classical fracture mechanics parameters like fracture toughness. It relies on computational simulation and is programmed in a stand-alone integrated computer code. It is multiscale, multifunctional because it includes composite mechanics for the composite behavior and finite element analysis for predicting the structural response. It contains seven modules; layered composite mechanics (micro, macro, laminate), finite element, updating scheme, local fracture, global fracture, stress based failure modes, and fracture progression. The computer code is called CODSTRAN (Composite Durability Structural ANalysis). It is used in the present paper to evaluate the global fracture of four composite shell problems and one composite built-up structure. Results show that the composite shells and the built-up composite structure global fracture are enhanced when internal pressure is combined with shear loads.

Dynamic compressive properties obtained from a split Hopkinson pressure bar test of Boryeong shale

NASA Astrophysics Data System (ADS)

Kang, Minju; Cho, Jung-Woo; Kim, Yang Gon; Park, Jaeyeong; Jeong, Myeong-Sik; Lee, Sunghak

2016-09-01

Dynamic compressive properties of a Boryeong shale were evaluated by using a split Hopkinson pressure bar, and were compared with those of a Hwangdeung granite which is a typical hard rock. The results indicated that the dynamic compressive loading reduced the resistance to fracture. The dynamic compressive strength was lower in the shale than in the granite, and was raised with increasing strain rate by microcracking effect as well as strain rate strengthening effect. Since the number of microcracked fragments increased with increasing strain rate in the shale having laminated weakness planes, the shale showed the better fragmentation performance than the granite at high strain rates. The effect of transversely isotropic plane on compressive strength decreased with increasing strain rate, which was desirable for increasing the fragmentation performance. Thus, the shale can be more reliably applied to industrial areas requiring good fragmentation performance as the striking speed of drilling or hydraulic fracturing machines increased. The present dynamic compressive test effectively evaluated the fragmentation performance as well as compressive strength and strain energy density by controlling the air pressure, and provided an important idea on which rock was more readily fragmented under dynamically processing conditions such as high-speed drilling and blasting.

The EGS Collab Project: Stimulation Investigations for Geothermal Modeling Analysis and Validation

NASA Astrophysics Data System (ADS)

Blankenship, D.; Kneafsey, T. J.

2017-12-01

The US DOE's EGS Collab project team is establishing a suite of intermediate-scale ( 10-20 m) field test beds for coupled stimulation and interwell flow tests. The multiple national laboratory and university team is designing the tests to compare measured data to models to improve measurement and modeling toolsets available for use in field sites and investigations such as DOE's Frontier Observatory for Research in Geothermal Energy (FORGE) Project. Our tests will be well-controlled, in situexperiments focused on rock fracture behavior, seismicity, and permeability enhancement. Pre- and post-test modeling will allow for model prediction and validation. High-quality, high-resolution geophysical and other fracture characterization data will be collected, analyzed, and compared with models and field observations to further elucidate the basic relationships between stress, induced seismicity, and permeability enhancement. Coring through the stimulated zone after tests will provide fracture characteristics that can be compared to monitoring data and model predictions. We will also observe and quantify other key governing parameters that impact permeability, and attempt to understand how these parameters might change throughout the development and operation of an Enhanced Geothermal System (EGS) project with the goal of enabling commercial viability of EGS. The Collab team will perform three major experiments over the three-year project duration. Experiment 1, intended to investigate hydraulic fracturing, will be performed in the Sanford Underground Research Facility (SURF) at 4,850 feet depth and will build on kISMET Project findings. Experiment 2 will be designed to investigate hydroshearing. Experiment 3 will investigate changes in fracturing strategies and will be further specified as the project proceeds. The tests will provide quantitative insights into the nature of stimulation (e.g., hydraulic fracturing, hydroshearing, mixed-mode fracturing, thermal fracturing) in crystalline rock under reservoir-like stress conditions and generate high-quality, high-resolution, diverse data sets to be simulated allowing model validation. Monitoring techniques will also be evaluated under controlled conditions identifying technologies appropriate for deeper full-scale EGS sites.

Stability of cervical spine fractures after gunshot wounds to the head and neck.

PubMed

Medzon, Ron; Rothenhaus, Todd; Bono, Christopher M; Grindlinger, Gene; Rathlev, Niels K

2005-10-15

Retrospective chart review. To determine the frequency of stable and unstable cervical spine fractures after gunshot wounds to the head or neck; to identify potential risk factor(s) for an unstable versus stable cervical spine fracture. Cervical spine fractures after gunshot wounds to the head and neck are common. Because of the nature of their injuries, patients often present with concomitant airway obstruction and large blood vessel injury that can necessitate emergent procedures. In some cases, acute treatment of these problems can be hindered by the presence of a cervical collar or strict adherence to spinal precautions (i.e., patient laying supine). In such situations, information regarding the probability of a stable versus unstable cervical spine fracture would be useful in emergency treatment decision making. A search for patients with gunshot wounds to the head or neck potentially involving the cervical spine over a 13-year period was performed using a trauma registry. Individuals with cervical spine fractures were identified and their records reviewed in detail. Data collected included information about neurologic deficits, mental status, airway treatment, entrance wounds, fracture level/type, initial/definitive fracture treatment, and final disposition at hospital discharge. A total of 81 patients were identified; 19 had cervical spine fractures. There were 5 patients who were not examinable because of altered mental status (severe head trauma, hemorrhagic shock, or intoxication). All 5 patients had stable cervical spine fractures. There were 11 patients who had an acute spinal cord injury, 3 (30%) of whom underwent surgery for an unstable fracture. Of the 65 awake, alert patients without a neurologic deficit, only 3 (5%) had a fracture, none of which were unstable. Gunshot wounds to the head and neck had a high rate of concomitant cervical spine fracture. Neurologically intact patients have a lower rate of fracture than those presenting with a spinal cord injury or altered mental status. In this small series of patients, the only unstable cervical spine injuries were detected in patients with a spinal cord injury. The data suggest that spinal precautions and/or a hard cervical collar should not be maintained at the expense of delaying or hindering emergent life-saving airway or hemodynamically stabilizing procedures, particularly in awake, neurologically intact patients. However, the cervical collar and spinal precautions should be resumed after such procedures are completed and continued until a more definitive evaluation of spinal stability can be performed.

Pattern of Cortical Fracture following Corticotomy for Distraction Osteogenesis

PubMed Central

Luvan, M; Roshan, G; Saw, A

2015-01-01

Corticotomy is an essential procedure for deformity correction and there are many techniques described. However there is no proper classification of the fracture pattern resulting from corticotomies to enable any studies to be conducted. We performed a retrospective study of corticotomy fracture patterns in 44 patients (34 tibias and 10 femurs) performed for various indications. We identified four distinct fracture patterns, Type I through IV classification based on the fracture propagation following percutaneous corticotomy. Type I transverse fracture, Type II transverse fracture with a winglet, Type III presence of butterfly fragment and Type IV fracture propagation to a fixation point. No significant correlation was noted between the fracture pattern and the underlying pathology or region of corticotomy. PMID:28611907

The Assessment and Validation of Mini-Compact Tension Test Specimen Geometry and Progress in Establishing Technique for Fracture Toughness Master Curves for Reactor Pressure Vessel Steels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sokolov, Mikhail A.; Nanstad, Randy K.

Small specimens are playing the key role in evaluating properties of irradiated materials. The use of small specimens provides several advantages. Typically, only a small volume of material can be irradiated in a reactor at desirable conditions in terms of temperature, neutron flux, and neutron dose. A small volume of irradiated material may also allow for easier handling of specimens. Smaller specimens reduce the amount of radioactive material, minimizing personnel exposures and waste disposal. However, use of small specimens imposes a variety of challenges as well. These challenges are associated with proper accounting for size effects and transferability of smallmore » specimen data to the real structures of interest. Any fracture toughness specimen that can be made out of the broken halves of standard Charpy specimens may have exceptional utility for evaluation of reactor pressure vessels (RPVs) since it would allow one to determine and monitor directly actual fracture toughness instead of requiring indirect predictions using correlations established with impact data. The Charpy V-notch specimen is the most commonly used specimen geometry in surveillance programs. Assessment and validation of mini-CT specimen geometry has been performed on previously well characterized HSST Plate 13B, an A533B class 1 steel. It was shown that the fracture toughness transition temperature measured by these Mini-CT specimens is within the range of To values that were derived from various large fracture toughness specimens. Moreover, the scatter of the fracture toughness values measured by Mini-CT specimens perfectly follows the Weibull distribution function providing additional proof for validation of this geometry for the Master Curve evaluation of rector pressure vessel steels. Moreover, the International collaborative program has been developed to extend the assessment and validation efforts to irradiated weld metal. The program is underway and involves ORNL, CRIEPI, and EPRI.« less

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

PubMed

McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

2017-03-01

Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. © 2017 American Physical Therapy Association

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures

PubMed Central

Colla, Carrie H.; Carmichael, Donald; Tosteson, Anna N. A.; Tosteson, Tor D.; Bell, John-Erik; Cantu, Robert V.; Lurie, Jonathan D.; Bynum, Julie P. W.

2017-01-01

Abstract Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna (“wrist”) fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007–2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. PMID:28340130

The influence of renal dialysis and hip fracture sites on the 10-year mortality of elderly hip fracture patients

PubMed Central

Hung, Li-Wei; Hwang, Yi-Ting; Huang, Guey-Shiun; Liang, Cheng-Chih; Lin, Jinn

2017-01-01

Abstract Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13–3.13), 2.95 (2.48–3.51), 2.84 (2.55–3.15), and 2.39 (1.94–2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0–10 years’ log-rank test, P < .001). In the dialysis group, survival of patients with femoral neck fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0–6 years’ log-rank, P < .001). Dialysis was a significant risk factor of mortality in geriatric hip fracture patients. Survival outcome was better for non-dialysis patients with femoral neck fractures compared to those with trochanteric fractures throughout 10 years. However, the survival advantage of femoral neck fractures was limited to the first 6 years postinjury among dialysis patients. PMID:28906354

Efficacy of Kirschner-wires and tension band in hip arthroplasty for aged patients with unstable intertrochanteric osteoporotic fracture

PubMed Central

Zhang, Hua; Xu, Zhongwei; Zhou, Aiguo; Yan, Wenlong; Zhao, Pei; Huang, Xiao; Zhang, Jian

2017-01-01

Abstract The aim of this study was to evaluate the efficacy of supplementary fixation in hip arthroplasty with the use of Kirschner-wires and tension band for geriatric patients suffering unstable intertrochanteric osteoporotic fractures. A total of 103 patients aged more than 75 years were recruited. A bipolar or total hip replacement was performed with additional application of Kirschner-wires and tension band, and the participants were followed up for 2 to 11 years. Physical component summary (PCS), mental component summary (MCS), visual analog scale (VAS), and Harris hip score were utilized to evaluate patients’ hip pain and function, as well as the mental condition postoperatively after 1.5 months, 3 months, 6 months, 1 year, and annually thereafter until the latest follow-up in 2015. Patients showed a significant improvement in all scores between 1.5 months and 1 year (P < 0.001), with the good efficacy lasting at least until the 2-year follow-up. None of the patients showed dislocation, implant loosening, or nonunion of the fracture throughout the follow-up period. In conclusion, it was beneficial to treat unstable intertrochanteric osteoporotic fractures in aged patients with hip arthroplasty coupled with Kirschner-wires and tension band. PMID:28072698

Development of an Ultrasonic Phased Array System for Wellbore Integrity Evaluation and Near-Wellbore Fracture Network Mapping of Injection and Production Wells in Geothermal Energy Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Almansouri, Hani; Foster, Benjamin; Kisner, Roger A

2016-01-01

This paper documents our progress developing an ultrasound phased array system in combination with a model-based iterative reconstruction (MBIR) algorithm to inspect the health of and characterize the composition of the near-wellbore region for geothermal reservoirs. The main goal for this system is to provide a near-wellbore in-situ characterization capability that will significantly improve wellbore integrity evaluation and near well-bore fracture network mapping. A more detailed image of the fracture network near the wellbore in particular will enable the selection of optimal locations for stimulation along the wellbore, provide critical data that can be used to improve stimulation design, andmore » provide a means for measuring evolution of the fracture network to support long term management of reservoir operations. Development of such a measurement capability supports current hydrothermal operations as well as the successful demonstration of Engineered Geothermal Systems (EGS). The paper will include the design of the phased array system, the performance specifications, and characterization methodology. In addition, we will describe the MBIR forward model derived for the phased array system and the propagation of compressional waves through a pseudo-homogenous medium.« less

The Effect of Isometric Massage on Global Grip Strength after Conservative Treatment of Distal Radial Fractures. Pilot Study.

PubMed

Ratajczak, Karina; Płomiński, Janusz

2015-01-01

The most common fracture of the distal end of the radius is Colles' fracture. Treatment modalities available for use in hand rehabilitation after injury include massage. The aim of this study was to evaluate the effect of isometric massage on the recovery of hand function in patients with Colles fractures. For this purpose, the strength of the finger flexors was assessed as an objective criterion for the evaluation of hand function. The study involved 40 patients, randomly divided into Group A of 20 patients and Group B of 20 patients. All patients received physical therapy and exercised individually with a physiotherapist. Isometric massage was additionally used in Group A. Global grip strength was assessed using a pneumatic force meter on the first and last day of therapy. Statistical analysis was performed using STATISTICA. Statistical significance was defined as a P value of less than 0.05. In both groups, global grip strength increased significantly after the therapy. There was no statistically significant difference between the groups. The men and women in both groups equally improved grip strength. A statistically significant difference was demonstrated between younger and older patients, with younger patients achieving greater gains in global grip strength in both groups. The incorporation of isometric massage in the rehabilitation plan of patients after a distal radial fracture did not significantly contribute to faster recovery of hand function or improve their quality of life.

Fixed-angle plate osteosynthesis of the patella - an alternative to tension wiring?

PubMed

Wild, M; Eichler, C; Thelen, S; Jungbluth, P; Windolf, J; Hakimi, M

2010-05-01

The goal of this study is carry out a biomechanical evaluation of the stability of a bilateral, polyaxial, fixed-angle 2.7 mm plate system specifically designed for use on the patella. The results of this approach are then compared to the two currently most commonly used surgical techniques for patella fractures: modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring. A transient biomechanical analysis determining material failure points of all osteosyntheses were conducted on 21 identical left polyurethane foam patellae, which were osteotomized horizontally. Evaluated were load (N), displacement (mm) and run-time (s) as well as elastic modulus (MPa), tensile strength (MPa) and strain at failure (%). With a maximum load capacity of 2396 (SD 492) N, the fixed-angle plate proved to be significantly stronger than the cannulated lag screws with anterior tension wiring (1015 (SD 246) N) and the modified anterior tension wiring (625 (SD 84.9) N). The fixed-angle plate displayed significantly greater stiffness and lower fracture gap dehiscence than the other osteosyntheses. Additionally, osteosynthesis deformation was found to be lower for the fixed-angle plate. A bilateral fixed-angle plate was the most rigid and stable osteosynthesis for horizontal patella fractures with the least amount of fracture gap dehiscence. Further biomechanical trials performed under cycling loading with fresh cadaver specimen should be done to figure out if a fixed-angle plate may be an alternative in the surgical treatment of patella fractures. Copyright 2009 Elsevier Ltd. All rights reserved.

Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury.

PubMed

Lalande, Élizabeth; Guimont, Chantal; Émond, Marcel; Parent, Marc Charles; Topping, Claude; Kuimi, Brice Lionel Batomen; Boucher, Valérie; Le Sage, Natalie

2017-05-01

The main objective of this study was to evaluate the feasibility of emergency department (ED) point-of-care ultrasound (PoCUS) for rib fracture diagnosis in patients with minor thoracic injury (mTI). Secondary objectives were to 1) evaluate patients' pain during the PoCUS procedure, 2) identify the limitations of the use of PoCUS technique, and 3) compare the diagnosis obtained with PoCUS to radiography results. Adult patients who presented with clinical suspicion of rib fractures after mTI were included. All patients underwent PoCUS performed by emergency physicians (EPs) prior to a rib view X-ray. A visual analogue scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients' pain and clinicians' degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We documented the radiologists' interpretation of rib view X-ray. Radiologists were blinded to the PoCUS results. Ninety-six patients were included. A majority (65%) of EPs concluded that the PoCUS technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range [IQR] 5-57) for patients' pain related to the PoCUS. The main limiting factor of the PoCUS technique was pain during patient examination (15%). PoCUS examination appears to be a feasible technique for a rib fracture diagnosis in the ED.

Comparative Analysis of Body Radiologist to Neuroradiologist Evaluation of the Spine in Trauma Settings.

PubMed

Zhou, Alice L; Bonham, Luke W; Verde, Franco

2018-05-24

CT is routinely performed to evaluate trauma patients. When a radiologist misses an acute finding, there could be serious adverse consequences. In many subspecialty settings, body radiologists and neuroradiologists both interpret the thoracic and lumbar spine. RADPEER has estimated general disagreement rates between radiologists to be 2.9%, but the disagreement rate between neuroradiologists and body radiologists in trauma settings remains unknown. This retrospective case review examined reports from the past 10 years of adult CT scans of the chest, abdomen, and pelvis interpreted by body radiologists, with concurrent thoracic and lumbar spine reconstructions interpreted by neuroradiologists. Reports were scrutinized for disagreement on the presence of acute fractures visible to both radiologists. 1,497 report pairs were analyzed. Of them, 33 pairs (2.2%) disagreed on the presence of an unequivocal acute fracture. In scans where only one miss occurred, the body radiologist and neuroradiologist were attributed with 27 (82%) and 6 (18%) of 32 disagreements, respectively. One scan contained a miss by both the body radiologist and neuroradiologist. Transverse processes were most commonly missed, followed by vertebral body fractures. Misses by body radiologists comprised the majority of disagreements. Neuroradiologists are more sensitive for detecting spinal fractures likely secondary to experience, education, small field of view reconstructed, and more detailed reporting protocols. Additional studies are needed to determine whether emulating neuroradiology practices may help body radiologists detect subtle fractures. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair.

PubMed

Grayson, Jessica W; Jeyarajan, Hari; Illing, Elisa A; Cho, Do-Yeon; Riley, Kristen O; Woodworth, Bradford A

2017-05-01

Management of frontal sinus trauma includes coronal or direct open approaches through skin incisions to either ablate or obliterate the frontal sinus for posterior table fractures and openly reduce/internally fixate fractured anterior tables. The objective of this prospective case-series study was to evaluate outcomes of frontal sinus anterior and posterior table trauma using endoscopic techniques. Prospective evaluation of patients undergoing surgery for frontal sinus fractures was performed. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of skull base defects, complications, and clinical follow-up. Forty-six patients (average age, 42 years) with frontal sinus fractures were treated using endoscopic techniques from 2008 to 2016. Mean follow-up was 26 (range, 0.5 to 79) months. Patients were treated primarily with a Draf IIb frontal sinusotomies. Draf III was used in 8 patients. Average fracture defect (length vs width) was 17.1 × 9.1 mm, and the average length involving the posterior table was 13.1 mm. Skull base defects were covered with either nasoseptal flaps or free tissue grafts. One individual required Draf IIb revision, but all sinuses were patent on final examination and all closed reductions of anterior table defects resulted in cosmetically acceptable outcomes. Frontal sinus trauma has traditionally been treated using open approaches. Our findings show that endoscopic management should become part of the management algorithm for frontal sinus trauma, which challenges current surgical dogma regarding mandatory open approaches. © 2017 ARS-AAOA, LLC.

[Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle].

PubMed

Liu, Chang-kui; Tan, Xin-ying; Xu, Juan; Liu, Hua-wei; Liu, San-xia; Hu, Min

2013-11-01

To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.

Influence of electric field exposure on bone growth and fracture repair in rats

DOE Office of Scientific and Technical Information (OSTI.GOV)

McClanahan, B.J.; Phillips, R.D.

1983-01-01

Rats were exposed to a 60-Hz electric field at an unperturbed field strength of 100 kV/m to determine its affect on bone growth and fracture repair. Exposure of immature male and female rats for 20 h/day for 30 days did not alter growth rate, cortical bone area, or medullary cavity area of the tibia. In another experiment, midfibular osteotomies were performed and the juvenile rats were exposed at 100 kV/m for 14 days. Evaluation by resistance to deformation and breaking strength indicated that fracture repair was not as advanced in the exposed animals as in the sham-exposed animals. In anothermore » experiment measurements of resistance to deformation were made in adult rats at 16, 20 and 26 days after osteotmy. Fracture repair was slower in exposed compared to control animals at day 20 and, to a lesser extent, at day 16, but not at day 26. 28 references, 6 tables.« less

Post-traumatic in situ fusion after calcaneal fractures: a retrospective study with 7-28 years follow-up.

PubMed

Ågren, Per-Henrik; Tullberg, Tycho; Mukka, Sebastian; Wretenberg, Per; Sayed-Noor, Arkan S

2015-03-01

In situ fusion as salvage operation after calcaneal fractures has been used. In this retrospective investigation, a group of in situ fused patients is analyzed with long-term follow-up. Twenty-nine patients with in situ single or multiple fusions performed between 1970 and 1990 were included. In 1998 these patients were examined with plain radiographs and computerized tomography (CT) scan of the affected foot. Also, a visual analogue score (VAS) for calcaneal fractures, short form health survey (SF-36), Olerud Molander score and American Orthopaedic Foot and Ankle society (AOFAS) hindfoot score were evaluated. The plain radiographs and CT scan showed severe remaining deformities in these patients. The outcome parameters were generally poor and correlated to the degree of remaining deformity. Simple in situ fusion, without consideration of the deformity at hand, after a calcaneal fracture is not an adequate treatment and generally associated with poor outcome. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

A study on tensile deformation at room temperature and 650 °C in the directional solidified Ni-base superalloy GTD-111

NASA Astrophysics Data System (ADS)

Pauzi, AA; Ghaffar, MH Abdul; Chang, SY; Ng, GP; Husin, S.

2017-10-01

GTD-111 DS generally used for gas turbine blades is a high performance Ni-base superalloy. This alloy, with high volume of γ’ phase, has excellent tensile properties at high temperature. The effect of temperature on the tensile deformation of GTD-111 DS was investigated by using tensile test and microstructure evaluation of the fractured specimens. The tensile behaviour of GTD-111 DS was studied in the room temperature (RT) and 650 °C. From the yield strength results, the yield strength decreases from the average of 702.72 MPa to the average of 645.62 MPa with the increase of temperature from RT to 650 °C. The scanning electron microscope (SEM) results on fractured specimens confirmed that the tensile behaviour affected by deformation of the surface at 650 °C compared to fractured surface at RT. Based on the laboratory testing results, the correlation between tensile deformation of fractured surface and yield strength were discussed.

Pregnancy-associated osteoporosis presenting severe vertebral fractures.

PubMed

Ozturk, Cihat; Atamaz, Funda Calis; Akkurt, Halil; Akkoc, Yesim

2014-01-01

The syndrome of pregnancy-associated osteoporosis (PAO) is a rare disorder which occurs either in late pregnancy or early post-partum period leading to fragility fracture(s), most commonly in the vertebral bodies. We presented two cases with PAO who had compression fractures at multiple levels involving five vertebrae in one case and 10 vertebrae in the other. Their spinal bone mineral density values were below -2.5 standard deviations. Anti-osteoporotic treatments with nasal calcitonin 400 IU/day, vitamin D 300.000 IU single dose, calcium 1000 mg/day, vitamin D 880 IU/day were initiated. In one case, kyphoplasty was performed by a spinal surgeon. In addition to a thoracolumbosacral orthosis, a rehabilitation program including muscle strengthening, range of motion, relaxation and weight-bearing exercises was started for both cases. These cases emphasize that all pregnant women with complaints of back/lumbar pain should be carefully evaluated. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

[Outcome of endoscopically assisted surgical treatment of mandibular condyle fractures: a retrospective study of 22 patients].

PubMed

Prade, V; Seguin, P; Boutet, C; Alix, T

2014-12-01

The condylar region is a frequent localization of mandibular fractures; there are various types of management. Mini-invasive endoscopic surgery is an alternative to open reduction. We had as goal to evaluate the outcome of this technique. We performed a monocentric retrospective study of patients consecutively operated for a condylar fracture (type II to V in the Spiessl and Schroll classification) with intraoral route and endoscopic assistance, during 30 months. We assessed the functional and radiological outcomes, and the complications. Twenty-two patients (25 fractures) were included. Seventeen patients (19 fractures) could be followed (mean follow-up: 16.7 months). The mean values were: interincisal opening, 45mm (±8.4); protrusion, 8.3mm (±1.9); ipsilateral excursion of the jaw: 8.6mm (±2); contralateral excursion: 8.7mm (±4). Three routes were used combined with a preauricular approach. The fracture reduction was good for 10 of the 19 fractures and poor for 3. The complications were: 3 cases of infection, 1 case of fixation failure with good consolidation; for combined approaches: 2 cases of temporary facial palsy and 2 cases of Frey syndrome. Endoscopic assistance for the surgical management of the fracture of mandibular condyle is a reliable technique, with a good functional outcome, and a low rate of specific complications, especially for facial nerve lesion or esthetic outcome. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: A prospective cohort study.

PubMed

Cheung, Wing-Hoi; Shen, Wan-Yiu; Dai, David Lok-Kwan; Lee, Kin Bong; Zhu, Tracy Y; Wong, Ronald Man-Yeung; Leung, Kwok-Sui

2018-02-28

To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP) for fragility hip fracture patients. Prospective cohort study. Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care. CFFMP provided geri-orthopaedic co-management, physician consultations, group-exercise and vibration-therapy. Timed-up-and-go test (TUG), Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and fall risk screening (FS) were used to assess functional performance. Incidences of falls and secondary fractures, the cost of the programme and related healthcare resources were recorded. A total of 76 patients were included in the intervention group (mean age 77.9 years ((standard deviation; SD) 6.1) ) and 77 in the control group (79.9 (SD 7.2)), respectively. The re-fracture rate in the control group (10.39%) was significantly higher than in the intervention group (1.32%) (p = 0.034). The intervention group improved significantly in TUG, EMS and FS after a 1-year programme. The overall healthcare costs per patient in the intervention and control groups were US$22,450 and US$25,313, respectively. Multi-disciplinary CFFMP is effective, with reduced overall cost, reduced length of hospital stay and reduced secondary fracture rate. The rehabilitation community service favours rehabilitation and improved quality of life of hip fracture patients.

Experience with alendronate treatment for 7 years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures.

PubMed

Iwamoto, Jun; Uzawa, Mitsuyoshi

2016-01-01

A retrospective study was performed to evaluate the outcome of alendronate treatment for 7 years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures. Thirty-five Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures (mean age at baseline 58.2 years) who had been treated with alendronate for over 7 years in our outpatient clinic were analyzed. The lumbar spine or total hip bone mineral density (BMD) was measured using dual energy X-ray absorptiometry; the urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX) and the serum levels of alkaline phosphatase (ALP) were monitored; the incidence of fractures during the 7-year treatment period was then assessed. The urinary NTX and serum ALP levels decreased (-46.1% at 3 months and -21.1% at 7 years, respectively) and the lumbar spine and total hip BMD increased (+14.2 and +10.1% at 7 years, respectively), compared with the baseline values. Four patients (11.4%) experienced vertebral fractures, and one patient (2.9%) experienced a nonvertebral fracture. No serious adverse events were observed, including osteonecrosis of the jaw or atypical femoral fractures. These results suggested that alendronate suppressed bone turnover and increased the lumbar spine and total hip BMD from the baseline values over the course of the 7-year treatment period without causing any severe adverse events in Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures.

Treatment of open fractures of the hand in the emergency department.

PubMed

Basat, Nofar Ben; Allon, Raviv; Nagmi, Ahmad; Wollstein, Ronit

2017-04-01

Current guidelines suggest early surgical treatment of open fractures. This rule in open hand fractures is not well supported and may be unpractical. Furthermore, desirable debridement and washout can be obtained in the emergency department (ED). The purpose of this study was to evaluate the relationship between the level of contamination, quality of washout in the emergency room, and the development of infection. Sixty-one patients with open fractures of the hand were retrospectively reviewed for demographic and fracture characteristics, and other complications. The infection rate was 14.8%. Contamination was present in 43 patients (70.5%). One thousand milliliters or more were used to obtain a grossly clean wound in 43 patients (70.5%). No significant relationship was found between fracture type, finger involved, hand dominance, comorbidities, and development of infection. The amount of fluid used for washout was significantly related to infection (P = 0.047), whereas wound contamination was not (P = 0.259). Type of oral antibiotic was significantly related to infection (P = 0.039). The level of contamination was not a significant factor in predicting infection, whereas the amount of fluid used for washout and the oral antibiotic type were significant factors in preventing infection. Since administration of intravenous antibiotics and thorough wound cleansing can be performed on open hand fractures in the ED under adequate anesthesia, most open fractures in the hand do not need to be treated early in the operating theater.

Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing.

PubMed

Dexel, Julian; Fritzsche, Hagen; Beyer, Franziska; Harman, Melinda K; Lützner, Jörg

2017-03-01

Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates. Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing. In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023). With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture. III.

Stainless steel versus titanium volar multi-axial locking plates for fixation of distal radius fractures: a randomised clinical trial

PubMed Central

2014-01-01

Background Distal radius fractures are among the most common fractures seen in the hospital emergency department. Of these, over 40% are considered unstable and require some form of fixation. In recent years with the advent of low profile plating, open reduction and internal fixation (ORIF) using volar plates has become the surgical treatment of choice in many hospitals. However, it is currently unknown which plating system has the lowest complication rate and/or superior clinical and radiological outcomes following surgery. Few studies have compared different types of plates, which may have various features, different plate and screw designs or may be manufactured from different materials (for example, stainless steel or titanium). This study will specifically investigate and compare the clinical and radiological outcomes and complication rates of two commonly used volar plating systems for fixation of distal radius fractures: one made from stainless steel (Trimed™ Volar Plate, Trimed™, California, USA) and the other made from titanium (Medartis® Aptus Volar Plate, Medartis®, Basel, Switzerland). The primary aim of this study is to determine if there is a difference on the Patient Reported Wrist Evaluation six months following ORIF using a volar plate for adult patients with a distal radius fracture. Methods/Design This study will implement a randomized prospective clinical trial study design evaluating the outcomes of two different types of volar plates: one plate manufactured from stainless steel (Trimed™ Volar Plate) and one plate manufactured from titanium (Medartis® Aptus Volar Plate). The surgery will be performed at a major trauma hospital in Brisbane, Australia. Outcome measures including function, adverse events, range of movement, strength, disability, radiological findings and health-related quality of life will be collected at 6 weeks, 3, 6, 12 and 24 months following surgery. A parallel economic analysis will also be performed. This randomized clinical trial is due to deliver results in December 2016. Discussion Results from this trial will contribute to the evidence on operative management of distal radius fractures and plate material type. Trial registration ACTRN12612000969864 PMID:24612524

Multiscale Multifunctional Progressive Fracture of Composite Structures

NASA Technical Reports Server (NTRS)

Chamis, C. C.; Minnetyan, L.

2012-01-01

A new approach is described for evaluating fracture in composite structures. This approach is independent of classical fracture mechanics parameters like fracture toughness. It relies on computational simulation and is programmed in a stand-alone integrated computer code. It is multiscale, multifunctional because it includes composite mechanics for the composite behavior and finite element analysis for predicting the structural response. It contains seven modules; layered composite mechanics (micro, macro, laminate), finite element, updating scheme, local fracture, global fracture, stress based failure modes, and fracture progression. The computer code is called CODSTRAN (Composite Durability Structural ANalysis). It is used in the present paper to evaluate the global fracture of four composite shell problems and one composite built-up structure. Results show that the composite shells. Global fracture is enhanced when internal pressure is combined with shear loads. The old reference denotes that nothing has been added to this comprehensive report since then.

Fracture properties of concrete specimens made from alkali activated binders

NASA Astrophysics Data System (ADS)

Šimonová, Hana; Kucharczyková, Barbara; Topolář, Libor; Bílek, Vlastimil, Jr.; Keršner, Zbyněk

2017-09-01

The aim of this paper is to quantify crack initiation and other fracture properties - effective fracture toughness and specific fracture energy - of two types of concrete with an alkali activated binder. The beam specimens with a stress concentrator were tested in a three-point bending test after 28, 90, and 365 days of maturing. Records of fracture tests in the form of load versus deflection (P-d) diagrams were evaluated using effective crack model and work-of-fracture method and load versus mouth crack opening displacement (P-CMOD) diagrams were evaluated using the Double-K fracture model. The initiation of cracks during the fracture tests for all ages was also monitored by the acoustic emission method. The higher value of monitored mechanical fracture parameters of concrete with alkali activated blast furnace slag were achieved with substitution blast furnace slag by low calcium fly ash in comparison with substitution by cement kiln dust.

Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review.

PubMed

Al Ansari, A; Talib, R A; Shamsodini, A; Hayati, A; Canguven, O; Al Naimi, A

2013-01-01

Penile fracture is a well-recognized and relatively uncommon clinical entity. It was previously reported that the incidence of penile fracture varies according to various geographic regions. In order to determine whether marital status or culture other than geographic region is involved in the etiology of penile fracture in our country, the charts of 122 men diagnosed with penile fracture were retrospectively reviewed. Detailed history including cause, symptoms, country of origin and a single-question self-report of erectile dysfunction was used for all cases. Diagnosis of our cases was mainly based on history and physical examination and ultrasonography. Immediate or delayed surgical repair of penile fracture included a degloving circumferential, and an additional direct incision, if the site of the tear could not be reached via degloving, was performed. The patients were evaluated after 1 week and 1, 3, and 6 months follow-up by penile examination, recording complications, and with a single-question self-report questionnaire after 3 and 6 months. The most common cause of penile fracture was manual bending of the erected penis in 66 out of 122 (54.1%) of our study patients. In our study, we believe that the prime causes of bending the penis are single status and culture, which are influencing factors irrespective of the geographic distribution.

The use of resorbable plates in association with dental arch stabilization in the treatment of mandibular fractures in children.

PubMed

Li, Zhi; David, Ongodia; Li, Zu-Bing

2014-07-01

The purpose of this study was to investigate the effect of resorbable plate fixation in association with dental arch stabilization in the treatment of displaced mandibular fractures in children. Thirteen children (5 girls and 8 boys, age range 2 years 5 months to 12 years 2 months) with displaced mandibular fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using resorbable plates and monocortical screws placed at the lower border of the mandible. At the same time, an arch bar or orthodontic wire splint was anchored using stainless steel wires or resin on the teeth to stabilize the whole mandibular dental arch. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mandible movement, and mandible growth. Postoperatively, all patients achieved uneventful healing; premorbid occlusion restoration and wound healing were achieved, along with unimpaired function and normal growth and development of the mandible. Complications such as damage to tooth buds, infection, malunion, and nonunion were not encountered in these patients. Resorbable plates use in association with dental arch stabilization can provide good stabilization for mandibular fractures and is a promising approach for the treatment of displaced mandibular fractures in children. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Modified tension band fixation and coracoclavicular stabilisation for unstable distal clavicle fracture.

PubMed

Choi, Sungwook; Kim, Sang-Rim; Kang, Hyunseong; Kim, Donghee; Park, Yong-Geun

2015-02-01

The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified tension band fixation (MTBF) and coracoclavicular (CC) stabilisation, and evaluate the radiologic and clinical outcome of these patients. Thirteen patients who had a fracture of the distal clavicle (Neer classification type IIb) were treated with MTBF and CC stabilisation. After the CC stabilisation was performed with a suture anchor or flip button, internal fixation using MTBF was carried out. Each patient was followed up for a minimum of 12 months and their clinical and radiological results were analysed. The mean period required for fracture union was 12.6 (range, 8-24) weeks and union was successfully completed in all cases. The mean Constant score at the final follow-up was 94.7 (88-100); the modified University of California, Los Angeles (UCLA) shoulder rating scale was 31.3 points (range, 22-35). All patients returned to normal daily activities at an average of 3.7 months postoperatively (range, 3-5 months). One patient had a new fracture around drilled holes for CC stabilisation by inappropriate tunnelling. MTBF and CC stabilisation is a useful technique for treating an unstable distal clavicle fracture. This procedure provides minimal incision and stable fixation without causing any further acromioclavicular joint injury to those with distal clavicle fractures. Copyright © 2014 Elsevier Ltd. All rights reserved.

Supracondylar fracture in children. Rehabilitation in occupational therapy. Yes or no?

NASA Astrophysics Data System (ADS)

Costa, Maria J.; Pires, Mafalda; Neves, Cassiano; Tavares, Delfin; Quintas, Alexandra M.; Ferreira, Ana I.; Espirito Santo, M. J.; Castro, Alexandra; Cabral, M. Salomé; João Gomes, J. F.

2013-10-01

The aim of this study was to evaluate the recovery time of elbow range of motion after treatment of Gartland's type II and III supracondylar fractures of distal humerus in children who attended a program of occupational therapy (OT). A randomized control design (RCD) was conducted to compare the two groups (OT group and Control group) and several statistical methodologies have been used to compare them. In all the cases the results point out to a faster recover in the OT group. All the analysis were performed using the package R version 3.0.1.

Advanced Reservoir Characterization and Evaluation of CO2 Gravity Drainage in the Naturally Fractured Spraberry Trend Area, Class III

DOE Office of Scientific and Technical Information (OSTI.GOV)

Knight, Bill; Schechter, David S.

The goal of this project was to assess the economic feasibility of CO2 flooding the naturally fractured Spraberry Trend Area in west Texas. This objective was accomplished through research in four areas: (1) extensive characterization of the reservoirs, (2) experimental studies of crude oil/brine/rock (COBR) interactions in the reservoirs, (3) reservoir performance analysis, and (4) experimental investigations on CO2 gravity drainage in Spraberry whole cores. This provides results of the final year of the six-year project for each of the four areas.

Penile fracture and its treatment: is retrograde urethrograghy necessary for management of penile fracture?

PubMed

Ahmadnia, Hassan; Younesi Rostami, Mehdi; Kamalati, Ali; Imani, Mohammad Mehdi

2014-01-01

Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography. From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable (3-0 nylon) sutures and the ties were placed on the internal surface (continuous method). All patients were followed up for 12 months. Patients' mean age was (32.78 ± 10.61) years and ranged (16-62) years. The mechanism of trauma was sexual intercourse in 103 patients (89%) and masturbation in 13 patients (11%). The most common site of injury found after exploration was right (55%) and lateral (74%) of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm (mean 1.88 ± 0.72). Three of the patients had Marphan's syndrome. Urethral injury was detected by retrograde urethrography in 4 patients (3%) who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen. There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.

Association factor analysis between osteoporosis with cerebral artery disease: The STROBE study.

PubMed

Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

2017-03-01

The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified cerebral artery disease. Some clinical factors such as age, hypertension, and osteoporotic hip fracture, smoking history and anti-osteoporosis drug use were associated with cerebral artery disease.

Method for detecting moment connection fracture using high-frequency transients in recorded accelerations

USGS Publications Warehouse

Rodgers, J.E.; Elebi, M.

2011-01-01

The 1994 Northridge earthquake caused brittle fractures in steel moment frame building connections, despite causing little visible building damage in most cases. Future strong earthquakes are likely to cause similar damage to the many un-retrofitted pre-Northridge buildings in the western US and elsewhere. Without obvious permanent building deformation, costly intrusive inspections are currently the only way to determine if major fracture damage that compromises building safety has occurred. Building instrumentation has the potential to provide engineers and owners with timely information on fracture occurrence. Structural dynamics theory predicts and scale model experiments have demonstrated that sudden, large changes in structure properties caused by moment connection fractures will cause transient dynamic response. A method is proposed for detecting the building-wide level of connection fracture damage, based on observing high-frequency, fracture-induced transient dynamic responses in strong motion accelerograms. High-frequency transients are short (<1 s), sudden-onset waveforms with frequency content above 25 Hz that are visually apparent in recorded accelerations. Strong motion data and damage information from intrusive inspections collected from 24 sparsely instrumented buildings following the 1994 Northridge earthquake are used to evaluate the proposed method. The method's overall success rate for this data set is 67%, but this rate varies significantly with damage level. The method performs reasonably well in detecting significant fracture damage and in identifying cases with no damage, but fails in cases with few fractures. Combining the method with other damage indicators and removing records with excessive noise improves the ability to detect the level of damage. ?? 2010 Elsevier B.V. All rights reserved.

Environmentally Friendly, Rheoreversible, Hydraulic-fracturing Fluids for Enhanced Geothermal Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shao, Hongbo; Kabilan, Senthil; Stephens, Sean A.

Cost-effective creation of high-permeability reservoirs inside deep crystalline bedrock is the primary challenge for the feasibility of enhanced geothermal systems (EGS). Current reservoir stimulation entails adverse environmental impacts and substantial economic costs due to the utilization of large volumes of water “doped” with chemicals including rheology modifiers, scale and corrosion inhibitors, biocides, friction reducers among others where, typically, little or no information of composition and toxicity is disclosed. An environmentally benign, CO2-activated, rheoreversible fracturing fluid has recently been developed that significantly enhances rock permeability at effective stress significantly lower than current technology. We evaluate the potential of this novel fracturingmore » fluid for application on geothermal sites under different chemical and geomechanical conditions, by performing laboratory-scale fracturing experiments with different rock sources under different confining pressures, temperatures, and pH environments. The results demonstrate that CO2-reactive aqueous solutions of environmentally amenable Polyallylamine (PAA) represent a highly versatile fracturing fluid technology. This fracturing fluid creates/propagates fracture networks through highly impermeable crystalline rock at significantly lower effective stress as compared to control experiments where no PAA was present, and permeability enhancement was significantly increased for PAA compared to conventional hydraulic fracturing controls. This was evident in all experiments, including variable rock source/type, operation pressure and temperature (over the entire range for EGS applications), as well as over a wide range of formation-water pH values. This versatile novel fracturing fluid technology represents a great alternative to industrially available fracturing fluids for cost-effective and competitive geothermal energy production.« less

Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review

PubMed Central

Pron, Gaylene; Holubowich, Corinne; Kaulback, Kellee

2016-01-01

Background Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures. Methods We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions. Results The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled trial comparing kyphoplasty with usual care, improvements in pain scores, pain-related disability, and health-related quality of life were significantly better in the kyphoplasty group than in the usual care group. Bone cement leakage, mostly asymptomatic, was commonly reported after vertebroplasty and kyphoplasty. Major adverse events, however, were uncommon. Conclusions Both vertebroplasty and kyphoplasty significantly and rapidly reduced pain intensity in cancer patients with vertebral compression fractures. The procedures also significantly decreased the need for opioid pain medication, and functional disabilities related to back and neck pain. Pain palliative improvements and low complication rates were consistent across the various cancer populations and vertebral fractures that were investigated. PMID:27298655

Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review.

PubMed

2016-01-01

Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures. We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions. The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled trial comparing kyphoplasty with usual care, improvements in pain scores, pain-related disability, and health-related quality of life were significantly better in the kyphoplasty group than in the usual care group. Bone cement leakage, mostly asymptomatic, was commonly reported after vertebroplasty and kyphoplasty. Major adverse events, however, were uncommon. Both vertebroplasty and kyphoplasty significantly and rapidly reduced pain intensity in cancer patients with vertebral compression fractures. The procedures also significantly decreased the need for opioid pain medication, and functional disabilities related to back and neck pain. Pain palliative improvements and low complication rates were consistent across the various cancer populations and vertebral fractures that were investigated.

Gas Transport through Fractured Rock near the U20az Borehole, Pahute Mesa, Nevada.

NASA Astrophysics Data System (ADS)

Rockhold, M.; Lowrey, J. D.; Kirkham, R.; Olsen, K.; Waichler, S.; White, M. D.; Wurstner White, S.

2017-12-01

Field experiments were performed in 2012-13 and 2016-17 at the U-20az testbed at the Nevada National Security Site to develop and evaluate capabilities for monitoring and modeling noble gas transport associated with underground nuclear explosions (UNE). Experiments were performed by injecting both chemical (CF2BR2, SF6) and radioactive (37Ar, 127Xe) gas species into the deep subsurface at this legacy UNE site and monitoring the breakthrough of the gases at different locations on or near the ground surface. Gas pressures were also monitored in both the chimney and at ground surface. Field experiments were modeled using the parallel, non-isothermal, two-phase flow and transport simulator, STOMP-GT. A site conceptual-numerical model was developed from a geologic framework model, and using a dual-porosity/permeability model for the constitutive relative permeability-saturation-capillary pressure relations of the fractured rock units. Comparisons of observed and simulated gas species concentrations show that diffusion is a highly effective transport mechanism under ambient conditions in the water-unsaturated fractured rock. Over-pressurization of the cavity during one of the field campaigns, and barometric pressure fluctuations are shown to result in enhanced gas transport by advection through fractures.

[Relative fracture toughness of differents dental ceramics].

PubMed

Pagani, Clovis; Miranda, Carolina Baptista; Bottino, Marco Cícero

2003-03-01

Although ceramics present high compressive strength, they are brittle materials due to their low tensile strength so they have lower capacity to absorb shocks. This study evaluated the fracture toughness of different ceramic systems, which refers to the ability of a friable material to absorb defformation energy. Three ceramic systems were investigated. Ten cylindrical samples (5,0mm x 3,0mm), were obtained from each ceramic material as follows: G1- 10 samples of Vitadur Alpha (Vita-Zahnfabrik); G2- 10 samples of IPS Empress2 (Ivoclar-Vivadent); G3- 10 samples of In-Ceram Alumina (Vita-Zahnfabrik). Fracture toughness values were collected upon indentation tests that were performed under a heavy load. A microhardness tester (Digital Microhardness Tester FM) utilized a 500gf load cell during 10seconds to perform four impressions on each sample. Statistically significant results were observed (ANOVA and Kruskal-Wallis tests). In-Ceram Alumina presented the highest median toughness values (2,96N/m3/2), followed by Vitadur Alpha (2,08N/m3/2) and IPS Empress2 (1,05N/m3/2). It may be concluded that different ceramic systems present distinct fracture toughness values, thus In-Ceram is capable of absorbing superior stress when compared to Vitadur Alpha and IPS Empress2.

Validation of the Ottawa Knee Rules.

PubMed

Emparanza, J I; Aginaga, J R

2001-10-01

We sought to validate the Ottawa Knee Rules for determining the need for radiography in patients with acute knee injury. A prospective cohort study was performed in emergency departments of 11 hospitals of the Osakidetza-Basque Country Health Service. The patient population was composed of a convenience sample of 1,522 eligible adults of 2,315 patients with acute knee injuries. The attending emergency physicians assessed each patient for standardized clinical variables and determined the need for radiography according to the decision rule. Radiography was performed in each patient, irrespective of the determination of the rule, after clinical evaluation findings were recorded. The rule was assessed for the ability to correctly identify fracture of the knee. The decision rule had a sensitivity of 1.0 (95% confidence interval [CI] 0.96 to 1.0), identifying 89 patients with clinically important fractures. The potential reduction in use of radiography was estimated to be 49%. The probability of fracture, if the decision rules were negative, is estimated to be 0% (95% CI 0% to 0.5%). Prospective validation has shown the Ottawa Knee Rules to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physicians to reduce the use of radiography in patients with acute knee injuries.

Influence of medial parapatellar nail insertion on alignment in proximal tibia fractures--special consideration of the fracture level.

PubMed

Weninger, Patrick; Tschabitscher, Manfred; Traxler, Hannes; Pfafl, Veronika; Hertz, Harald

2010-04-01

Although a lateral starting point for tibial nailing is recommended to avoid valgus misalignment, higher rates of intra-articular damage were described compared with a medial parapatellar approach. The aim of this anatomic study was to evaluate the fracture level allowing for a safe medial nail entry point without misalignment or dislocation of fragments. Thirty-two fresh-frozen cadaver lower extremities were used to create 1-cm osteotomies at four different levels (n = 8) from 2 cm to 8 cm below the tibial tuberosity. Nine-millimeter unreamed solid titanium tibial nails (Connex, I.T.S. Spectromed, Lassnitzhohe, Austria) were inserted from a medial parapatellar incision. Misalignment (degree) and dislocation of the distal fragment were measured in the frontal and sagittal plane. A medial parapatellar approach for tibial nail insertion mainly caused valgus and anterior bow misalignment and ventral and medial fragment displacement. Mean misalignment and fragment displacement did not exceed 0.5 degree if the osteotomy was performed 8 cm to 9 cm below the tibial tuberosity. According to the results of this study, a medial parapatellar approach can be performed without misalignment and fragment dislocation in proximal tibia fractures extending 8 cm or more below the tibial tuberosity.

Prevalence of Retinal Hemorrhages in Infants Presenting with Isolated Long Bone Fractures and Evaluation for Abuse.

PubMed

Payne, Brian S; Kutz, Timothy J; Di Maio, Ann; Gerard, James M

2016-10-01

Fractures are a frequent reason for emergency department visits and evaluation for abusive head trauma is an associated concern in infants. Recent guidelines have suggested that retinal examination may not be necessary in the absence of intracranial injury, but there is a lack of empirical evidence in infants < 1 year of age. Our aim was to evaluate the prevalence of retinal hemorrhages in infants with isolated long bone fractures. Retrospective chart review of infants < 1 year of age who presented to an urban, tertiary care pediatric hospital between January 2004 and April 2014 with the diagnosis of an acute long bone fracture or retinal hemorrhages. Patients were excluded for head injury, altered mental status, injury mechanism of motor vehicle accident, multiple fractures or injuries outside the fracture area. Patients were identified through trauma registry data and International Classification of Diseases codes. One hundred and forty-six patients had isolated long bone fractures, of which 68 patients did not undergo a retinal examination and 78 patients had dilated eye examinations, with no patients identified as having retinal hemorrhages. There were 46 patients identified with retinal hemorrhages concerning for abuse. No patients with retinal hemorrhages had isolated long bone fractures. In infants < 1 year of age presenting with isolated long bone fractures, a dilated eye examination to evaluate for retinal hemorrhages is not likely to yield additional information. Our results support recent studies that a subset of children and infants may not require dilated eye examinations in the evaluation of possible abuse. Copyright © 2016 Elsevier Inc. All rights reserved.

Metallic artifacts from internal scaphoid fracture fixation screws: comparison between C-arm flat-panel, cone-beam, and multidetector computed tomography.

PubMed

Finkenstaedt, Tim; Morsbach, Fabian; Calcagni, Maurizio; Vich, Magdalena; Pfirrmann, Christian W A; Alkadhi, Hatem; Runge, Val M; Andreisek, Gustav; Guggenberger, Roman

2014-08-01

The aim of this study was to compare image quality and extent of artifacts from scaphoid fracture fixation screws using different computed tomography (CT) modalities and radiation dose protocols. Imaging of 6 cadaveric wrists with artificial scaphoid fractures and different fixation screws was performed in 2 screw positions (45° and 90° orientation in relation to the x/y-axis) using multidetector CT (MDCT) and 2 flat-panel CT modalities, C-arm flat-panel CT (FPCT) and cone-beam CT (CBCT), the latter 2 with low and standard radiation dose protocols. Mean cartilage attenuation and metal artifact-induced absolute Hounsfield unit changes (= artifact extent) were measured. Two independent radiologists evaluated different image quality criteria using a 5-point Likert-scale. Interreader agreements (Cohen κ) were calculated. Mean absolute Hounsfield unit changes and quality ratings were compared using Friedman and Wilcoxon signed-rank tests. Artifact extent was significantly smaller for MDCT and standard-dose FPCT compared with CBCT low- and standard-dose acquisitions (all P < 0.05). No significant differences in artifact extent among different screw types and scanning positions were noted (P > 0.05). Both MDCT and FPCT standard-dose protocols showed equal ratings for screw bone interface, fracture line, and trabecular bone evaluation (P = 0.06, 0.2, and 0.2, respectively) and performed significantly better than FPCT low- and CBCT low- and standard-dose acquisitions (all P < 0.05). Good interreader agreement was found for image quality comparisons (Cohen κ = 0.76-0.78). Both MDCT and FPCT standard-dose acquisition showed comparatively less metal-induced artifacts and better overall image quality compared with FPCT low-dose and both CBCT acquisitions. Flat-panel CT may provide sufficient image quality to serve as a versatile CT alternative for postoperative imaging of internally fixated wrist fractures.

[Kirschner wire osteosynthesis for fractures in childhood: bury wires or not? : Results of a survey on care reality in Germany].

PubMed

Schneidmueller, D; Kertai, M; Bühren, V; von Rüden, C

2018-02-20

Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e. g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires. A web-based survey of members of the DGU, DGOU, DGOOC, and the pediatric traumatology section of the DGU (SKT) was performed to evaluate current treatment concepts in Germany. The pros and cons for each technique were recorded and the need for a clinical study was examined. In addition, a cost analysis was performed for both methods. The results from the literature are summarized and discussed. A total of 710 questionnaires were evaluated. The majority of the respondents were trauma surgeons working in a hospital (80%). The buried technique was superior in both fracture groups (supracondylar humeral fractures 73% and distal radius fractures 69%), whereas a relevant difference could be found depending on the profession. The main reason for the subcutaneous technique was anxiety or observed higher infections using the epicutaneous technique. In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.

Whole bone mechanics and bone quality.

PubMed

Cole, Jacqueline H; van der Meulen, Marjolein C H

2011-08-01

The skeleton plays a critical structural role in bearing functional loads, and failure to do so results in fracture. As we evaluate new therapeutics and consider treatments to prevent skeletal fractures, understanding the basic mechanics underlying whole bone testing and the key principles and characteristics contributing to the structural strength of a bone is critical. We therefore asked: (1) How are whole bone mechanical tests performed and what are the key outcomes measured? (2) How do the intrinsic characteristics of bone tissue contribute to the mechanical properties of a whole bone? (3) What are the effects of extrinsic characteristics on whole bone mechanical behavior? (4) Do environmental factors affect whole bone mechanical properties? We conducted a PubMed search using specific search terms and limiting our included articles to those related to in vitro testing of whole bones. Basic solid mechanics concepts are summarized in the context of whole bone testing and the determinants of whole bone behavior. Whole bone mechanical tests measure structural stiffness and strength from load-deformation data. Whole bone stiffness and strength are a function of total bone mass and the tissue geometric distribution and material properties. Age, sex, genetics, diet, and activity contribute to bone structural performance and affect the incidence of skeletal fractures. Understanding and preventing skeletal fractures is clinically important. Laboratory tests of whole bone strength are currently the only measures for in vivo fracture prediction. In the future, combined imaging and engineering models may be able to predict whole bone strength noninvasively.

Semi-closed reduction of tripod fractures of zygoma under intraoperative assessment using ultrasonography.

PubMed

Soejima, Kazutaka; Sakurai, Hiroyuki; Nozaki, Motohiro; Kitazawa, Yoshihiko; Takeuchi, Masaki; Yamaki, Takashi; Kono, Taro

2009-04-01

We conducted semi-closed reduction of isolated tripod fractures of the zygoma through only a brow incision under intraoperative assessment with ultrasonography. Twenty-three patients with unilateral, non-comminuted tripod fractures of zygoma were selected for application of this method at Tokyo Women's Medical University and Tokyo Metropolitan Hiroo General Hospital between April 2002 and April 2006. Patients with orbital floor blowout fractures were excluded. A skin incision was made only at the lateral brow region and the reduction was performed by inserting an elevator beneath the zygomatic arch. The bone alignment was intraoperatively assessed by ultrasonography. When the reduction was accurate, the frontozygomatic suture was immobilised with a mini-plate under direct visualisation and transmaler Kirshner wire fixation was performed. The accuracy of the reduction and postoperative movement were evaluated by computed tomography (CT) scans taken at 1 and 6 months. In five cases, the DICOM (Digital Imaging and Communication in Medicine) data from the CT were analysed with 3D imaging software (V-works, CyberMed Co., Korea). In all cases, accurate reduction was obtained. The analysis of the 3D imaging data revealed that postoperative movement of bone fragment was minimal. When the accurate reduction was obtained under intraoperative assessment, the semi-closed reduction and one-plate fixation with transmaler Kirshner wire is enough to treat the simple tripod fractures of zygoma. This method is minimally invasive and takes less operative time.

Fracturing and brittleness index analyses of shales

NASA Astrophysics Data System (ADS)

Barnhoorn, Auke; Primarini, Mutia; Houben, Maartje

2016-04-01

The formation of a fracture network in rocks has a crucial control on the flow behaviour of fluids. In addition, an existing network of fractures , influences the propagation of new fractures during e.g. hydraulic fracturing or during a seismic event. Understanding of the type and characteristics of the fracture network that will be formed during e.g. hydraulic fracturing is thus crucial to better predict the outcome of a hydraulic fracturing job. For this, knowledge of the rock properties is crucial. The brittleness index is often used as a rock property that can be used to predict the fracturing behaviour of a rock for e.g. hydraulic fracturing of shales. Various terminologies of the brittleness index (BI1, BI2 and BI3) exist based on mineralogy, elastic constants and stress-strain behaviour (Jin et al., 2014, Jarvie et al., 2007 and Holt et al., 2011). A maximum brittleness index of 1 predicts very good and efficient fracturing behaviour while a minimum brittleness index of 0 predicts a much more ductile shale behaviour. Here, we have performed systematic petrophysical, acoustic and geomechanical analyses on a set of shale samples from Whitby (UK) and we have determined the three different brittleness indices on each sample by performing all the analyses on each of the samples. We show that each of the three brittleness indices are very different for the same sample and as such it can be concluded that the brittleness index is not a good predictor of the fracturing behaviour of shales. The brittleness index based on the acoustic data (BI1) all lie around values of 0.5, while the brittleness index based on the stress strain data (BI2) give an average brittleness index around 0.75, whereas the mineralogy brittleness index (BI3) predict values below 0.2. This shows that by using different estimates of the brittleness index different decisions can be made for hydraulic fracturing. If we would rely on the mineralogy (BI3), the Whitby mudstone is not a suitable candidate for hydraulic fracturing while if we would rely on stress-strain data (BI2) the Whitby mudstone would be a very good candidate. We are aiming to perform these kind of measurements on a wide variety of shales with varying compositions and origins etc. and compare all results and come up with a better brittleness index, as well as link the brittleness indices to the fracturing behaviour seen in the samples. References: Holt, R., Fjaer, E., Nes, O. & Alassi, H., 2011. A shaly look at brittleness. 45th U.S. Rock Mechanics / Geomechanics Symposium, ARMA-11-366 Jarvie, D., Hill, J., Ruble, T. & Pollastro, R., 2007. Unconventional shale-gas system: The Mississippian Barnett Shale of North-Central Texas as one model for thermogenic shale-gas assessment. AAPG, 91(doi: 10.1306/12190606068), pp. 475-499. Jin, X., Shah, S. N., Rogiers, J.-C. & Zhang, B., 2014. Fraccability Evaluation in Shale Reservoirs - An Integrated Petrophysics and Geomechanics Approach. Woodlands, Texas, SPE.

Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children.

PubMed

Rizk, Ahmed Shawkat

2015-06-01

Supracondylar humeral fractures are one of the most common skeletal injuries in children. In cases of displacement and instability, the standard procedure is early closed reduction and percutaneous Kirschner wire fixation. However, between 10 and 20 % of patients present late. According to the literature, patients with neglected fractures are those patients who presented for treatment after 14 days of injury. The delay is either due to lack of medical facilities or social and financial constraints. The neglected cases are often closed injuries with no vascular compromise. However, the elbow may still be tense and swollen with abrasions or crusts. In neglected cases, especially after early appearance of callus, there is no place for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with surgical approaches that disrupt the extensor mechanism with less satisfactory functional outcome due to triceps weakness and elbow stiffness. The aim of this study is to evaluate the outcome of delayed open reduction using the triceps-sparing approach and Kirschner wire fixation for treatment of neglected, displaced supracondylar and distal humeral fractures in children. This prospective study included 15 children who had neglected displaced supracondylar and distal humeral fractures. All patients were completely evaluated clinically and radiologically before intervention, after surgery and during the follow-up. The follow-up period ranged from 8 to 49 months, with a mean period of 17 months. Functional outcome was evaluated according to the Mayo Elbow Performance Index (MEPI) and Mark functional criteria. All fractures united in a mean duration of 7.2 weeks (range 5-10 weeks) with no secondary displacement or mal-union. Excellent results were found at the last follow-up in 13 of the 15 patients studied (86.66 %), while good results were found in two patients (13.33 %) according to the MEPI scale. According to the Mark functional criteria, there was one patient with a fair result (6.66 %). The results were very satisfactory if compared with traditional operative techniques, with many advantages including anatomical reduction and fixation of the fractures, avoidance of ulnar nerve injury, preservation of the extensor mechanism, decrease in incidence of myositis ossificans around the elbow and decrease in post-operative stiffness. IV.

Titanium Mesh Shaping and Fixation for the Treatment of Comminuted Mandibular Fractures.

PubMed

Dai, Jiewen; Shen, Guofang; Yuan, Hao; Zhang, Wenbin; Shen, Shunyao; Shi, Jun

2016-02-01

Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures. Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction-internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up. Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis. We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of tailored educational intervention to improve self-care maintenance and quality of life in postmenopausal osteoporotic women after a fragility fracture: the Guardian Angel® study.

PubMed

Basilici Zannetti, Emanuela; D'Agostino, Fabio; Cittadini, Noemi; Feola, Maurizio; Pennini, Annalisa; Rao, Cecilia; Vellone, Ercole; Tarantino, Umberto; Alvaro, Rosaria

2017-01-01

Osteoporosis has a significant impact on affected patients. Healthcare providers should encourage postmenopausal women to improve self-care maintenance behaviors and quality of life following a fragility fracture. The aims of this study were to a) develop two new instruments for measuring, respectively, self-care maintenance and quality of life, in postmenopausal women with osteoporosis; b) evaluate the effectiveness of a tailored educational intervention to improve self-care maintenance and quality of life after a fragility fracture in postmenopausal women. For the first aim, a cross-sectional study will be performed; for the second aim, a multicenter, quasi-experimental, interventional design will be used. A convenience sample of postmenopausal women admitted to 44 hospitals in Italy with a diagnosis of bone fragility fracture will be enrolled and surveyed at 7, 30, 60 and 180 days after discharge. Trained nurses will conduct the educational intervention. The new instruments will allow the measurement of self-care and quality of life in postmenopausal women following a fragility fracture. Through tailored educational interventions, women can be helped to take their medications correctly, adopt a healthy lifestyle, reduce the occurrence of bone fractures, and have a better quality of life.

Influence of curvature location along an artificial canal on cyclic fatigue of a rotary nickel-titanium endodontic instrument.

PubMed

Lopes, Hélio Pereira; Chiesa, Wanderson Miguel Maia; Correia, Norbi Rodrigues; de Souza Navegante, Núbia Carvalho; Elias, Carlos Nelson; Moreira, Edson Jorge Lima; Chiesa, Bianca Esther Cabral

2011-06-01

This study evaluated the effects of curvature location along an artificial canal on cyclic fatigue (CF) of an Mtwo rotary instrument, verifying the number of cycles to fatigue fracture (NCF) and morphologic characteristics of the fractured instruments. CF testing of instruments was performed in artificial canals with curvature radii of 10 mm and arc lengths of 11 mm. Mtwo rotary instruments size 40, 0.04 taper were used in 2 groups (n = 10): group A, curvature positioned on middle part; group B, apical curvature. All instruments were rotated until fracture. The number of cycles to failure was registered. Data were analyzed by independent sample t test. Fractured surfaces and the helical shafts of the instruments were analyzed by scanning electron microscopy. NCF for groups A and B had significant statistic differences (P < .05). The highest values were found in the group where the curvature was positioned on the apical part of the canal. No plastic deformation was observed on the helical shafts. The number of cycles to fracture of the Mtwo instruments increased when the arc was changed from the middle to the apical part of the canal. The morphologic characteristics of the fractured surfaces were of the ductile type. Copyright © 2011 Mosby, Inc. All rights reserved.

Effect of Porosity on Deformation, Damage, and Fracture of Cast Steel

NASA Astrophysics Data System (ADS)

Hardin, R. A.; Beckermann, C.

2013-12-01

A combined experimental and computational study is performed to investigate the effect of centerline shrinkage porosity on deformation, damage, and fracture of cast steel under tensile testing. Steel plates containing shrinkage porosity are cast in sand molds, machined into test coupons, and tensile tested to fracture. The average volumetric porosity in the gage section of the specimens with porosity ranges from 0.10 to 0.27 pct. Ductility in the test castings with porosity is markedly reduced with the percent elongation data ranging from 12.8 to 19.6 pct; vs 22 pct elongation for the sound material. Radiographic imaging is used to measure and reconstruct the porosity field in the test specimens. The reconstructed porosity field is then used in a finite-element stress analysis simulating the tensile testing. Local elastic properties are reduced according to the porosity fraction present. Porous metal plasticity theory is used to model the damage due to porosity and the fracture. Good agreement is obtained between the measured and predicted stress-strain curves and fracture behaviors. The reduction in ductility is predicted well by comparing the measured and the simulated elongations. The computational modeling approach used in this study allows for a detailed evaluation of the effect of porosity, including its size, shape, and location, on the fracture behavior of steel castings.

Evaluation of Fracture and Osteotomy Union in the Setting of Osteogenesis Imperfecta: Reliability of the Modified Radiographic Union Score for Tibial Fractures (RUST).

PubMed

Franzone, Jeanne M; Finkelstein, Mark S; Rogers, Kenneth J; Kruse, Richard W

2017-09-08

Evaluation of the union of osteotomies and fractures in patients with osteogenesis imperfecta (OI) is a critical component of patient care. Studies of the OI patient population have so far used varied criteria to evaluate bony union. The radiographic union score for tibial fractures (RUST), which was subsequently revised to the modified RUST, is an objective standardized method of evaluating fracture healing. We sought to evaluate the reliability of the modified RUST in the setting of the tibias of patients with OI. Tibial radiographs of 30 patients with OI fractures, or osteotomies were scored by 3 observers on 2 separate occasions. Each of the 4 cortices was given a score (1=no callus, 2=callus present, 3=bridging callus, and 4=remodeled, fracture not visible) and the modified RUST is the sum of these scores (range, 4 to 16). The interobserver and intraobserver reliabilities were evaluated using intraclass coefficients (ICC) with 95% confidence intervals. The ICC representing the interobserver reliability for the first iteration of scores was 0.926 (0.864 to 0.962) and for the second series was 0.915 (0.845 to 0.957). The ICCs representing the intraobserver reliability for each of the 3 reviewers for the measurements in series 1 and 2 were 0.860 (0.707 to 0.934), 0.994 (0.986 to 0.997), and 0.974 (0.946 to 0.988). The modified RUST has excellent interobserver and intraobserver reliability in the setting of OI despite challenges related to the poor quality of the bone and its dysplastic nature. The application and routine use of the modified RUST in the OI population will help standardize our evaluation of osteotomy and fracture healing. Level III-retrospective study of nonconsecutive patients.

Clinical and radiographic outcomes of femoral head fractures: excision vs. fixation of fragment in Pipkin type I: what is the optimal choice for femoral head fracture?

PubMed

Park, Kyung-Soon; Lee, Keun-Bae; Na, Bo-Ram; Yoon, Taek-Rim

2015-07-01

In this work, we present relatively long-term results of femoral head fractures with a specific focus on Pipkin type I fractures. Fifty-nine femoral head fractures were treated according to modified Pipkin's classification as follows: type I, small fragment distal to the fovea centralis (FC); type II, large fragment distal to the FC; type III, large fragment proximal to the FC; type IV, comminuted fracture. There were 15 cases of type I, 28 of type II, 9 of type III, and 7 of type IV fractures. Conservative treatment with skeletal traction was performed in 4 type II cases, excision of the fragment in 15 type I and 10 type II cases, fixation of the fragment in 14 type II and all 9 type III cases, and total hip replacement in all 7 type IV cases. The overall clinical and radiographic outcomes were evaluated using previously published criteria, focusing on the results in Pipkin type I fractures with relatively large fragments. Based on Epstein criteria, in type II fractures, excellent or good clinical results were seen in 6 of 10 patients (60.0 %) treated by excision of the fragment and 12 of 14 patients (85.7 %) treated by internal fixation (p = 0.05). Also, excellent or good radiologic results were seen in 4 of 10 (40.0 %) patients treated by excision of the fragment and 12 of 14 (85.7 %) patients treated by internal fixation (p = 0.03). Even in Pipkin type I fractures, if the fragment is large (modified Pipkin type II), early reduction and internal fixation can produce good results.

Effect of Restraining Devices on Facial Fractures in Motor Vehicle Collisions.

PubMed

Hwang, Kun; Kim, Joo Ho

2015-09-01

The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on facial fractures in motor vehicle collisions (MVCs).In a PubMed search, the search terms "facial bone fracture and seat belt," "facial bone fracture and air bag," and "facial bone fracture and restraining" were used. The authors abstracted the odds ratio (OR) and 95% confidence intervals (CIs) from each study. Weighted mean differences and 95% CIs were also calculated. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre).The authors found 30 potentially relevant articles, of which 6 articles met our inclusion criteria. Five studies were subgrouped, and a meta-analysis of these data suggested beneficial effects of seat belts on decreasing facial fractures in MVCs (n = 15,768,960, OR, 0.46, 95% CI = 0.35-0.60). Three studies were subgrouped, and a meta-analysis of these data suggested that there were beneficial effects of seat belts and air bags on decreasing facial fractures in MVCs (n = 15,768,021, OR, 0.59, 95% CI = 0.47-0.74). Four studies were subgrouped, and a meta-analysis of these data suggested there were no significant effects of an air bag on decreasing facial fracture in MVCs (n = 15,932,259, OR, 1.00, 95% CI = 0.72-1.39).A seat belt alone (OR, 0.46) or a seat belt and an air bag (OR, 0.59) were effective to decrease facial fractures in MVCs. However, air bags alone had no significant effect (OR, 1.00). In using air bags, seat belt should be applied together to prevent facial fractures in motor vehicle injuries.

Management of neglected open extremity fractures in low-resource settings: Experience of the French Army Medical Service in Chad.

PubMed

Mathieu, L; Mottier, F; Bertani, A; Danis, J; Rongiéras, F; Chauvin, F

2014-11-01

The purpose of this study was to report the experience of the French Army Medical Service in the management of neglected open extremity fractures and related-complications in Chad. Delayed treatment of open extremity fractures is possible in a low-resource setting. An observational prospective study was performed in a French Forward Surgical Team deployed in N'Djamena for six months. Twenty-seven patients, 24 men and three women, mean age 30 years old with an open fracture that was managed more than 24 hours after it occurred were included. The mean treatment delay was 83 days. Fractures were located in the tibia in 20 cases. There were 15 non-infected and twelve infected fractures. The number of cases of debridement, flap coverage, and the overall number of procedures were higher in the group with infection, but the difference was not significant. Treatment of infected fractures was complicated by six early recurrent infections, while there were no complications in the group without infection. The mean follow-up was 4.4 months. Infection was controlled in eleven cases, however evaluation of fracture healing was limited because of the short follow-up in the group with infection. Functional outcome of the lower extremities was often complicated by knee stiffness. Delayed management of open fractures depends on the available resources. In low-resource settings, the goals of surgery should be modest. Treatment of non-infected injuries and osteomyelitis is possible. On the other hand, treatment of infected fractures and septic nonunions should be undertaken with caution if all the necessary aspects of treatment, in particular extended antibiotic treatment and sequential procedures are not possible. level IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Effect of 3D printing technology on pelvic fractures:a Meta-analysis].

PubMed

Zhang, Yu-Dong; Wu, Ren-Yuan; Xie, Ding-Ding; Zhang, Lei; He, Yi; Zhang, Hong

2018-05-25

To evaluate the effect of 3D printing technology applied in the surgical treatment of pelvic fractures through the published literatures by Meta-analysis. The PubMed database, EMCC database, CBM database, CNKI database, VIP database and Wanfang database were searched from the date of database foundation to August 2017 to collect the controlled clinical trials in wich 3D printing technology was applied in preoperative planning of pelvic fracture surgery. The retrieved literatures were screened according to predefined inclusion and exclusion criteria, and quality evaluation were performed. Then, the available data were extracted and analyzed with the RevMan5.3 software. Totally 9 controlled clinical trials including 638 cases were chosen. Among them, 279 cases were assigned to the 3D printing technology group and 359 cases to the conventional group. The Meta-analysis results showed that the operative time[SMD=-2.81, 95%CI(-3.76, -1.85)], intraoperative blood loss[SMD=-3.28, 95%CI(-4.72, -1.85)] and the rate of complication [OR=0.47, 95%CI(0.25, 0.87)] in the 3D printing technology were all lower than those in the conventional group;the excellent and good rate of pelvic fracture reduction[OR=2.09, 95%CI(1.32, 3.30)] and postoperative pelvic functional restoration [OR=1.94, 95%CI(1.15, 3.28) in the 3D printing technology were all superior to those in the conventional group. 3D printing technology applied in the surgical treatment of pelvic fractures has the advantage of shorter operative time, less intraoperative blood loss and lower rate of complication, and can improve the quality of pelvic fracture reduction and the recovery of postoperative pelvic function. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

A comparison of two reciprocating instruments using bending stress and cyclic fatigue tests.

PubMed

Scelza, Pantaleo; Harry, Davidowicz; Silva, Licinio Esmeraldo da; Barbosa, Igor Bastos; Scelza, Miriam Zaccaro

2015-01-01

The aim of this study was to comparatively evaluate the bending resistance at 45º, the static and dynamic cyclic fatigue life, and the fracture type of the WaveOne (Dentsply Maillefer, Ballaigues, Switzerland) 25-08 and Reciproc (VDW, Munich, Germany) 25-08 instruments. A total of 60 nickel-titanium (NiTi) instruments (30 Reciproc and 30 WaveOne) from three different lots, each of which was 25 mm in length, were tested. The bending resistance was evaluated through the results of a cantilever-bending test conducted using a universal testing machine. Static and dynamic cyclic fatigue testing was conducted using a custom-made device. For the static and dynamic tests, a cast Ni-Cr-Mo-Ti alloy metal block with an artificial canal measuring 1.77 mm in diameter and 20.00 mm in total length was used. A scanning electron microscope was used to determine the type of fracture. Statistical analyses were performed on the results. The WaveOne instrument was less flexible than the Reciproc (p < 0.05). The Reciproc instrument showed better resistance in the static and dynamic cyclic fatigue tests (p < 0.05). The transverse cross-section and geometry of the instruments were important factors in their resistance to bending and cyclic fracture. Both of the instruments showed ductile-type fracture characteristics. It can be concluded that the Reciproc 25-08 instrument was more resistant to static and dynamic cyclic fatigue than the WaveOne 25-08 instrument, while the WaveOne 25-08 instrument was less flexible. Bending and resistance to cyclic fracture were influenced by the instruments' geometries and transverse cross-sections. Both of the instruments showed ductile-type fracture characteristics.

Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries.

PubMed

Wu, Peng Sen; Matoo, Reshvin; Sun, Hong; Song, Li Yuan; Kikkawa, Don O; Lu, Wei

2017-02-01

Orbital fractures with open periorbital wounds cause significant morbidity. Timing of debridement with fracture repair and soft tissue reconstruction is controversial. This study focuses on the efficacy of early single-stage repair in combined bony and soft tissue injuries. Retrospective review. Twenty-three patients with combined open soft tissue wounds and orbital fractures were studied for single-stage orbital reconstruction and periorbital soft tissue repair. Inclusion criteria were open soft tissue wounds with clinical and radiographic evidence of orbital fractures and repair performed within 48 h after injury. Surgical complications and reconstructive outcomes were assessed over 6 months. The main outcome measures were enophthalmos, pre- and post-CT imaging of orbits, scar evaluation, presence of diplopia, and eyelid position. Enophthalmos was corrected in 16/19 cases and improved in 3/19 cases. 3D reconstruction of CT images showed markedly improved orbital alignment with objective measurements of the optic foramen to cornea distance (mm) in reconstructed orbits relative to intact orbits of 0.66, 95% confidence interval [CI] (lower 0.33, upper 0.99) mm. The mean baseline of Stony Brook Scar Evaluation Scale was 0.6, 95%CI (0.30-0.92), and for 6 months, the mean score was 3.4, 95%CI (3.05-3.73). Residual diplopia in secondary gazes was present in two patients; one patient had ectropion. Complications included one case of local wound infection. An early single-stage repair of combined soft tissue and orbital fractures yields satisfactory functional and aesthetic outcomes. Complications are low and likely related to trauma severity. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Fracture resistance of Nd:YAG laser-welded cast titanium joints with various clinical thicknesses and welding pulse energies.

PubMed

Lin, Mau-Chin; Lin, Sheng-Chieh; Wang, Yu-Tsai; Hu, Suh-Woan; Lee, Tzu-Hsin; Chen, Li-Kai; Huang, Her-Hsiung

2007-05-01

The purpose of this study was to evaluate the fracture resistance of Nd:YAG laser-welded cast titanium (Ti) joints with various clinical thicknesses and welding pulse energies. A four-point bending test was used to assess the effects of various specimen thicknesses (1-3 mm) and welding pulse energies (11-24 J) on the fracture resistance of Nd:YAG laser-welded Ti dental joints. Fracture resistance was evaluated in terms of the ratio of the number of fractured specimens to the number of tested specimens. As for the fracture frequencies, they were compared using the Cochran-Mantel-Haenszel test. Morphology of the fractured Ti joints was observed using a scanning electron microscope. Results showed that decreasing the specimen thickness and/or increasing the welding pulse energy, i.e., increasing the welded area percentage, resulted in an increase in the fracture resistance of the Ti joint. Where fracture occurred, the fracture site would be at the center of the weld metal.

Case Studies in Fracture Mechanics

DTIC Science & Technology

1977-06-01

34, Proceedings of the JANNAF OSWG & SMBWG Combined Annual Meeting, CPIA Publication No. 264 , The John Hopkins Uriversity, p. 383, May 1975. 9. Macbeth, A...Performing Structural Analyses", Bettis Atomic Power Laboratory, WAPD -TM-1140, February 1975. 3. J. L. Gordon, "OUTCUR: An Automated Evaluation of Two

Introduction of fracture resistance to the design and evaluation of open graded friction courses in Florida : final report, July 2009.

DOT National Transportation Integrated Search

2009-07-01

A dog-bone direct tension test (DBDT) to accurately determine tensile properties of asphalt concrete, : including OGFC, was conceived, developed and validated. Resilient modulus, creep, and strength tests : were performed at multiple temperatures on ...

Application of Discrete Fracture Modeling and Upscaling Techniques to Complex Fractured Reservoirs

NASA Astrophysics Data System (ADS)

Karimi-Fard, M.; Lapene, A.; Pauget, L.

2012-12-01

During the last decade, an important effort has been made to improve data acquisition (seismic and borehole imaging) and workflow for reservoir characterization which has greatly benefited the description of fractured reservoirs. However, the geological models resulting from the interpretations need to be validated or calibrated against dynamic data. Flow modeling in fractured reservoirs remains a challenge due to the difficulty of representing mass transfers at different heterogeneity scales. The majority of the existing approaches are based on dual continuum representation where the fracture network and the matrix are represented separately and their interactions are modeled using transfer functions. These models are usually based on idealized representation of the fracture distribution which makes the integration of real data difficult. In recent years, due to increases in computer power, discrete fracture modeling techniques (DFM) are becoming popular. In these techniques the fractures are represented explicitly allowing the direct use of data. In this work we consider the DFM technique developed by Karimi-Fard et al. [1] which is based on an unstructured finite-volume discretization. The mass flux between two adjacent control-volumes is evaluated using an optimized two-point flux approximation. The result of the discretization is a list of control-volumes with the associated pore-volumes and positions, and a list of connections with the associated transmissibilities. Fracture intersections are simplified using a connectivity transformation which contributes considerably to the efficiency of the methodology. In addition, the method is designed for general purpose simulators and any connectivity based simulator can be used for flow simulations. The DFM technique is either used standalone or as part of an upscaling technique. The upscaling techniques are required for large reservoirs where the explicit representation of all fractures and faults is not possible. Karimi-Fard et al. [2] have developed an upscaling technique based on DFM representation. The original version of this technique was developed to construct a dual-porosity model from a discrete fracture description. This technique has been extended and generalized so it can be applied to a wide range of problems from reservoirs with a few or no fracture to highly fractured reservoirs. In this work, we present the application of these techniques to two three-dimensional fractured reservoirs constructed using real data. The first model contains more than 600 medium and large scale fractures. The fractures are not always connected which requires a general modeling technique. The reservoir has 50 wells (injectors and producers) and water flooding simulations are performed. The second test case is a larger reservoir with sparsely distributed faults. Single-phase simulations are performed with 5 producing wells. [1] Karimi-Fard M., Durlofsky L.J., and Aziz K. 2004. An efficient discrete-fracture model applicable for general-purpose reservoir simulators. SPE Journal, 9(2): 227-236. [2] Karimi-Fard M., Gong B., and Durlofsky L.J. 2006. Generation of coarse-scale continuum flow models from detailed fracture characterizations. Water Resources Research, 42(10): W10423.