Impairment of wound healing after operative treatment of mandibular fractures, and the influence of dexamethasone.

PubMed

Snäll, Johanna; Kormi, Eeva; Lindqvist, Christian; Suominen, Anna Liisa; Mesimäki, Karri; Törnwall, Jyrki; Thorén, Hanna

2013-12-01

Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p=0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Prediction of Fracture Initiation in Hot Compression of Burn-Resistant Ti-35V-15Cr-0.3Si-0.1C Alloy

NASA Astrophysics Data System (ADS)

Zhang, Saifei; Zeng, Weidong; Zhou, Dadi; Lai, Yunjin

2015-11-01

An important concern in hot working of metals is whether the desired deformation can be accomplished without fracture of the material. This paper builds a fracture prediction model to predict fracture initiation in hot compression of a burn-resistant beta-stabilized titanium alloy Ti-35V-15Cr-0.3Si-0.1C using a combined approach of upsetting experiments, theoretical failure criteria and finite element (FE) simulation techniques. A series of isothermal compression experiments on cylindrical specimens were conducted in temperature range of 900-1150 °C, strain rate of 0.01-10 s-1 first to obtain fracture samples and primary reduction data. Based on that, a comparison of eight commonly used theoretical failure criteria was made and Oh criterion was selected and coded into a subroutine. FE simulation of upsetting experiments on cylindrical specimens was then performed to determine the fracture threshold values of Oh criterion. By building a correlation between threshold values and the deforming parameters (temperature and strain rate, or Zener-Hollomon parameter), a new fracture prediction model based on Oh criterion was established. The new model shows an exponential decay relationship between threshold values and Zener-Hollomon parameter (Z), and the relative error of the model is less than 15%. This model was then applied successfully in the cogging of Ti-35V-15Cr-0.3Si-0.1C billet.

The Extravehicular Suit Impact Load Attenuation Study for Use in Astronaut Bone Fracture Prediction

NASA Technical Reports Server (NTRS)

Lewandowski, Beth E.; Gilkey, Kelly M.; Sulkowski, Christina M.; Samorezov, Sergey; Myers, Jerry G.

2011-01-01

The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fracture of the proximal femur is a traumatic injury that would likely result in loss of mission if it were to happen during spaceflight. The low gravity exposure causes decreases in bone mineral density which heightens the concern. Researchers at the NASA Glenn Research Center have quantified bone fracture probability during spaceflight with a probabilistic model. It was assumed that a pressurized extravehicular activity (EVA) suit would attenuate load during a fall, but no supporting data was available. The suit impact load attenuation study was performed to collect analogous data. METHODS: A pressurized EVA suit analog test bed was used to study how the offset, defined as the gap between the suit and the astronaut s body, impact load magnitude and suit operating pressure affects the attenuation of impact load. The attenuation data was incorporated into the probabilistic model of bone fracture as a function of these factors, replacing a load attenuation value based on commercial hip protectors. RESULTS: Load attenuation was more dependent on offset than on pressurization or load magnitude, especially at small offsets. Load attenuation factors for offsets between 0.1 - 1.5 cm were 0.69 +/- 0.15, 0.49 +/- 0.22 and 0.35 +/- 0.18 for mean impact forces of 4827, 6400 and 8467 N, respectively. Load attenuation factors for offsets of 2.8 - 5.3 cm were 0.93 +/- 0.2, 0.94 +/- 0.1 and 0.84 +/- 0.5, for the same mean impact forces. Reductions were observed in the 95th percentile confidence interval of the bone fracture probability predictions. CONCLUSIONS: The reduction in uncertainty and improved confidence in bone fracture predictions increased the fidelity and credibility of the fracture risk model and its benefit to mission design and operational decisions.

Fracture Risk and Areal Bone Mineral Density in Adolescent Females with Anorexia Nervosa

PubMed Central

Faje, Alexander T.; Fazeli, Pouneh K.; Miller, Karen K.; Katzman, Debra K.; Ebrahimi, Seda; Lee, Hang; Mendes, Nara; Snelgrove, Deirdre; Meenaghan, Erinne; Misra, Madhusmita; Klibanski, Anne

2014-01-01

Objective To (i) compare fracture prevalence in adolescent females with anorexia nervosa (AN) vs. normal-weight controls and (ii) examine whether reductions in areal bone mineral density (aBMD) predict fracture risk in females with AN. Methods 418 females (310 with active AN and 108 normal-weight controls) 12–22 years old were studied cross-sectionally. Lifetime fracture history was recorded by a physician during participant interviews. Body composition and aBMD measurements of the whole body, whole body less head, lumbar spine, and hip were assessed by dual-energy x-ray absorptiometry (DXA), and bone mineral apparent density (BMAD) was calculated for the lumbar spine. Results Participants with AN and normal-weight controls did not differ for chronological age, sexual maturity, or height. The lifetime prevalence of prior fracture was 59.8% higher in those with AN compared to controls (31.0 % versus 19.4 %, p = 0.02), and the fracture incidence rate peaked in our cohort after the diagnosis of AN. Lower aBMD and lumbar BMAD were not associated with a higher prevalence of fracture in the AN or control group on univariate or multivariate analyses. Compared to controls, fracture prevalence was significantly higher in the subgroup of girls with AN who had normal aBMD or only modest reductions of aBMD (Z-scores > −1 or −1.5). Discussion This is the first study to show that the risk of fracture during childhood and adolescence is significantly higher in patients with AN than in normal-weight controls. Fracture prevalence is increased in this cohort of subjects with AN even without significant reductions in aBMD. PMID:24430890

Fracture risk and areal bone mineral density in adolescent females with anorexia nervosa.

PubMed

Faje, Alexander T; Fazeli, Pouneh K; Miller, Karen K; Katzman, Debra K; Ebrahimi, Seda; Lee, Hang; Mendes, Nara; Snelgrove, Deirdre; Meenaghan, Erinne; Misra, Madhusmita; Klibanski, Anne

2014-07-01

To (i) compare fracture prevalence in adolescent females with anorexia nervosa (AN) versus normal-weight controls and (ii) examine whether reductions in areal bone mineral density (aBMD) predict fracture risk in females with AN. Four-hundred eighteen females (310 with active AN and 108 normal-weight controls) 12- to 22-years-old were studied cross-sectionally. Lifetime fracture history was recorded by a physician during participant interviews. Body composition and aBMD measurements of the whole body, whole body less head, lumbar spine, and hip were assessed by dual-energy X-ray absorptiometry, and bone mineral apparent density (BMAD) was calculated for the lumbar spine. Participants with AN and normal-weight controls did not differ for chronological age, sexual maturity, or height. The lifetime prevalence of prior fracture was 59.8% higher in those with AN as compared to controls (31.0% vs. 19.4%, p = 0.02), and the fracture incidence rate peaked in our cohort after the diagnosis of AN. Lower aBMD and lumbar BMAD were not associated with a higher prevalence of fracture in the AN or control group on univariate or multivariate analyses. Compared to controls, fracture prevalence was significantly higher in the subgroup of girls with AN who had normal aBMD or only modest reductions of aBMD (Z-scores > -1 or -1.5). This is the first study to show that the risk of fracture during childhood and adolescence is significantly higher in patients with AN than in normal-weight controls. Fracture prevalence is increased in this cohort of participants with AN even without significant reductions in aBMD. © 2014 Wiley Periodicals, Inc.

Accuracy of specimen-specific nonlinear finite element analysis for evaluation of radial diaphysis strength in cadaver material.

PubMed

Matsuura, Yusuke; Kuniyoshi, Kazuki; Suzuki, Takane; Ogawa, Yasufumi; Sukegawa, Koji; Rokkaku, Tomoyuki; Thoreson, Andrew Ryan; An, Kai-Nan; Takahashi, Kazuhisa

2015-01-01

The feasibility of a user-specific finite element model for predicting the in situ strength of the radius after implantation of bone plates for open fracture reduction was established. The effect of metal artifact in CT imaging was characterized. The results were verified against biomechanical test data. Fourteen cadaveric radii were divided into two groups: (1) intact radii for evaluating the accuracy of radial diaphysis strength predictions with finite element analysis and (2) radii with a locking plate affixed for evaluating metal artifact. All bones were imaged with CT. In the plated group, radii were first imaged with the plates affixed (for simulating digital plate removal). They were then subsequently imaged with the locking plates and screws removed (actual plate removal). Fracture strength of the radius diaphysis under axial compression was predicted with a three-dimensional, specimen-specific, nonlinear finite element analysis for both the intact and plated bones (bones with and without the plate captured in the scan). Specimens were then loaded to failure using a universal testing machine to verify the actual fracture load. In the intact group, the physical and predicted fracture loads were strongly correlated. For radii with plates affixed, the physical and predicted (simulated plate removal and actual plate removal) fracture loads were strongly correlated. This study demonstrates that our specimen-specific finite element analysis can accurately predict the strength of the radial diaphysis. The metal artifact from CT imaging was shown to produce an overestimate of strength.

Numerical Analysis of AHSS Fracture in a Stretch-bending Test

NASA Astrophysics Data System (ADS)

Luo, Meng; Chen, Xiaoming; Shi, Ming F.; Shih, Hua-Chu

2010-06-01

Advanced High Strength Steels (AHSS) are increasingly used in the automotive industry due to their superior strength and substantial weight reduction advantage. However, their limited ductility gives rise to numerous manufacturing issues. One of them is the so-called `shear fracture' often observed on tight radii during stamping processes. Since traditional approaches, such as the Forming Limit Diagram (FLD), are unable to predict this type of fracture, efforts have been made to develop failure criteria that can predict shear fractures. In this paper, a recently developed Modified Mohr-Coulomb (MMC) ductile fracture criterion[1] is adopted to analyze the failure behavior of a Dual Phase (DP) steel sheet during stretch bending operations. The plasticity and ductile fracture of the present sheet are fully characterized by the Hill'48 orthotropic model and the MMC fracture model respectively. Finite Element models with three different element types (3D, shell and plane strain) were built for a Stretch Forming Simulator (SFS) test and numerical simulations with four different R/t ratios (die radius normalized by sheet thickness) were performed. It has been shown that the 3D and shell element models can accurately predict the failure location/mode, the upper die load-displacement responses as well as the wall stress and wrap angle at the onset of fracture for all R/t ratios. Furthermore, a series of parametric studies were conducted on the 3D element model, and the effects of tension level (clamping distance) and tooling friction on the failure modes/locations were investigated.

An extravehicular suit impact load attenuation study to improve astronaut bone fracture prediction.

PubMed

Sulkowski, Christina M; Gilkey, Kelly M; Lewandowski, Beth E; Samorezov, Sergey; Myers, Jerry G

2011-04-01

Understanding the contributions to the risk of bone fracture during spaceflight is essential for mission success. A pressurized extravehicular activity (EVA) suit analogue test bed was developed, impact load attenuation data were obtained, and the load at the hip of an astronaut who falls to the side during an EVA was characterized. Offset (representing the gap between the EVA suit and the astronaut's body), impact load magnitude, and EVA suit operating pressure were factors varied in the study. The attenuation data were incorporated into a probabilistic model of bone fracture risk during spaceflight, replacing the previous load attenuation value that was based on commercial hip protector data. Load attenuation was more dependent on offset than on pressurization or load magnitude, especially at small offset values. Load attenuation factors for offsets between 0.1-1.5 cm were 0.69 +/- 0.15, 0.49 +/- 0.22, and 0.35 +/- 0.18 for mean impact forces of 4827, 6400, and 8467 N, respectively. Load attenuation factors for offsets of 2.8-5.3 cm were 0.93 +/- 0.2, 0.94 +/- 0.1, and 0.84 +/- 0.5 for the same mean impact forces. The mean and 95th percentile bone fracture risk index predictions were each reduced by 65-83%. The mean and 95th percentile bone fracture probability predictions were both reduced approximately 20-50%. The reduction in uncertainty and improved confidence in bone fracture predictions increased the fidelity and credibility of the fracture risk model and its benefit to mission design and in-flight operational decisions.

Fracture sealing caused by mineral precipitation: The role of aperture and mineral heterogeneity on precipitation-induced permeability loss

NASA Astrophysics Data System (ADS)

Jones, T.; Detwiler, R. L.

2017-12-01

Fractures act as dominant pathways for fluid flow in low-permeability rocks. However, in many subsurface environments, fluid rock reactions can lead to mineral precipitation, which alters fracture surface geometry and reduces fracture permeability. In natural fractures, surface mineralogy and roughness are often heterogeneous, leading to variations in both velocity and reactive surface area. The combined effects of surface roughness and mineral heterogeneity can lead to large disparities in local precipitation rates that are difficult to predict due to the strong coupling between dissolved mineral transport and reactions at the fracture surface. Recent experimental observations suggest that mineral precipitation in a heterogeneous fracture may promote preferential flow and focus large dissolved ion concentrations into regions with limited reactive surface area. Here, we build on these observations using reactive transport simulations. Reactive transport is simulated with a quasi-steady-state 2D model that uses a depth-averaged mass-transfer relationship to describe dissolved mineral transport across the fracture aperture and local precipitation reactions. Mineral precipitation-induced changes to fracture surface geometry are accounted for using two different approaches: (1) by only allowing reactive minerals to grow vertically, and (2) by allowing three-dimensional mineral growth at reaction sites. Preliminary results from simulations using (1) suggest that precipitation-induced aperture reduction focuses flow into thin flow paths. This flow focusing causes a reduction in the fracture-scale precipitation rate, and precipitation ceases when the reaction zone extends the entire length of the fracture. This approach reproduces experimental observations at early time reasonably well, but as precipitation proceeds, reaction sites can grow laterally along the fracture surfaces, which is not predicted by (1). To account for three-dimensional mineral growth (2), we have incorporated a level-set-method based approach for tracking the mineral interfaces in three dimensions. This provides a mechanistic approach for simulating the dynamics of the formation, and eventual closing, of preferential flow paths by precipitation-induced aperture alteration, that do not occur using (1).

The Predictive Capability of Conditioned Simulation of Discrete Fracture Networks using Structural and Hydraulic Data from the ONKALO Underground Research Facility, Finland

NASA Astrophysics Data System (ADS)

Williams, T. R. N.; Baxter, S.; Hartley, L.; Appleyard, P.; Koskinen, L.; Vanhanarkaus, O.; Selroos, J. O.; Munier, R.

2017-12-01

Discrete fracture network (DFN) models provide a natural analysis framework for rock conditions where flow is predominately through a series of connected discrete features. Mechanistic models to predict the structural patterns of networks are generally intractable due to inherent uncertainties (e.g. deformation history) and as such fracture characterisation typically involves empirical descriptions of fracture statistics for location, intensity, orientation, size, aperture etc. from analyses of field data. These DFN models are used to make probabilistic predictions of likely flow or solute transport conditions for a range of applications in underground resource and construction projects. However, there are many instances when the volumes in which predictions are most valuable are close to data sources. For example, in the disposal of hazardous materials such as radioactive waste, accurate predictions of flow-rates and network connectivity around disposal areas are required for long-term safety evaluation. The problem at hand is thus: how can probabilistic predictions be conditioned on local-scale measurements? This presentation demonstrates conditioning of a DFN model based on the current structural and hydraulic characterisation of the Demonstration Area at the ONKALO underground research facility. The conditioned realisations honour (to a required level of similarity) the locations, orientations and trace lengths of fractures mapped on the surfaces of the nearby ONKALO tunnels and pilot drillholes. Other data used as constraints include measurements from hydraulic injection tests performed in pilot drillholes and inflows to the subsequently reamed experimental deposition holes. Numerical simulations using this suite of conditioned DFN models provides a series of prediction-outcome exercises detailing the reliability of the DFN model to make local-scale predictions of measured geometric and hydraulic properties of the fracture system; and provides an understanding of the reduction in uncertainty in model predictions for conditioned DFN models honouring different aspects of this data.

Comparison of arthroscopic reduction and percutaneous fixation and open reduction and internal fixation for tibial plateau fractures.

PubMed

Sun, Yufu; Sun, Kai; Jiang, Wenxue

2018-06-01

To conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of arthroscopic reduction and percutaneous fixation(ARPF) and open reduction and internal fixation(ORIF) for tibial plateau fractures to provide the predictive diagnosis for clinic. Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to June 2017. RCTs comparing the benefits and risks of ARPF with those of ORIF in tibial plateau fractures were included. Statistical heterogeneity was quantitatively evaluated by X 2 test with the significance set P < 0.10 or I 2  > 50%. Seven RCTs consisting of 571 patients were included.(288 ARPF patients; 283 ORIF patients;). Pooled results showed that ORIF was related to a greater increase in operative time, incision length, hospital stay, perioperative complications, and full weight bearing compared with ARPF. The results showed that ARPF was related to a greater increase in ROM Rasmussen Scores compared with ORIF (WMD = 10.38; 95% CI, 8.31, 12.45; P < 0.10). This meta-analysis showed that arthroscopic reduction and percutaneous fixation for tibial plateau fractures, compared with open reduction and internal fixation, could demonstrate an decreased risk of perioperative and postoperative complications and improve clinical outcome in operative time, incision length, hospital stay, perioperative complications, full weight bearing and Rasmussen Scores. Copyright © 2018 Elsevier Ltd. All rights reserved.

Rib fractures predict incident limb fractures: results from the European prospective osteoporosis study.

PubMed

Ismail, A A; Silman, A J; Reeve, J; Kaptoge, S; O'Neill, T W

2006-01-01

Population studies suggest that rib fractures are associated with a reduction in bone mass. While much is known about the predictive risk of hip, spine and distal forearm fracture on the risk of future fracture, little is known about the impact of rib fracture. The aim of this study was to determine whether a recalled history of rib fracture was associated with an increased risk of future limb fracture. Men and women aged 50 years and over were recruited from population registers in 31 European centres for participation in a screening survey of osteoporosis (European Prospective Osteoporosis Study). Subjects were invited to complete an interviewer-administered questionnaire that included questions about previous fractures including rib fracture, the age of their first fracture and also the level of trauma. Lateral spine radiographs were performed and the presence of vertebral deformity was determined morphometrically. Following the baseline survey, subjects were followed prospectively by annual postal questionnaire to determine the occurrence of clinical fractures. The subjects included 6,344 men, with a mean age of 64.2 years, and 6,788 women, with a mean age of 63.6 years, who were followed for a median of 3 years (range 0.4-5.9 years), of whom 135 men (2.3%) and 101 women (1.6%) reported a previous low trauma rib fracture. In total, 138 men and 391 women sustained a limb fracture during follow-up. In women, after age adjustment, those with a recalled history of low trauma rib fracture had an increased risk of sustaining 'any' limb fracture [relative hazard (RH)=2.3; 95% CI 1.3, 4.0]. When stratified by fracture type the predictive risk was more marked for hip (RH=7.7; 95% CI 2.3, 25.9) and humerus fracture (RH=4.5; 95% CI 1.4, 14.6) than other sites (RH=1.6; 95% CI 0.6, 4.3). Additional adjustment for prevalent vertebral deformity and previous (non-rib) low trauma fractures at other sites slightly reduced the strength of the association between rib fracture and subsequent limb fracture. In men, after age adjustment, there was a small though non-significant association between recalled history of rib fracture and future limb fracture. Our data highlight the importance of rib fracture as a marker of bone fragility in women.

Emergency ultrasound in the detection of pediatric long-bone fractures.

PubMed

Barata, Isabel; Spencer, Robert; Suppiah, Ara; Raio, Christopher; Ward, Mary Frances; Sama, Andrew

2012-11-01

Long-bone fractures represent one of the most commonly sustained injuries following trauma and account for nearly 4% of emergency department visits in the United States each year. These fractures are associated with a significant risk of bleeding and neurovascular compromise. Delays in their identification and treatment can lead to loss of limb and even death. Although emergency physicians currently rely predominantly on radiography for the examination of long-bone injuries, emergency ultrasound has several advantages over radiography and may be useful in the identification of long-bone fractures. Ultrasound is rapid, noninvasive, and cost-effective. Unlike radiography, ultrasound does not expose children to ionizing radiation, which has been linked to cancer. The goal of this study was to assess the agreement between emergency physicians' and radiologists' final assessments of suspected long-bone fractures using emergency ultrasound and radiography, respectively, in the pediatric population. This is a prospective study involving a convenience sample of pediatric patients (<18 years of age) who presented to the emergency department of a university-affiliated, level I trauma center between March 2008 and January 2009 with at least 1 suspected long-bone fracture. Suspected fractures were characterized by swelling, erythema, and localized pain. Patients who had a history of fracture, extremity deformity, orthopedic hardware in the traumatized area, or an open fracture were excluded from this study. Each investigator received limited, focused training in the use of ultrasonography for fracture identification and localization. This training consisted of a brief didactic session and video review of normal and fractured long-bones. A total of 53 subjects (mean age, 10.2 [SD, 3.8] years; 56.6% were male) were enrolled, which corresponded to 98 ultrasound examinations. Sixty-nine scans (70.4%) involved bones of the upper extremity, and 29 (29.6%) the lower extremity. Radiography identified a total of 43 fractures. The sensitivity and specificity of ultrasound in the detection of long-bone fractures were 95.3% (95% confidence interval [CI], 82.9%-99.2%) and 85.5% (95% CI, 72.8%-93.1%), respectively, and the positive and negative predictive values were 83.7% (95% CI, 68.8%-92.2%) and 96% (95% CI, 84.9%-99.3%), respectively. Overall, ultrasound detected 100.0% of diaphyseal fractures and 27 (93.1%) of 29 end-of-bone or near-joint fractures.Radiography revealed 6 displacements that met the published criteria for reduction, all of which were also revealed by ultrasound. The overall sensitivity and specificity for ultrasound identifying the need for reduction were 100.0% (95% CI, 51.7%-100.0%) and 97.3% (95% CI, 84.2%-99.9%), respectively, and positive and negative predictive values were 85.7% (95% CI, 42.0%-99.2%) and 100.0% (95% CI, 88.0%-100.0%), respectively. Emergency department physician-performed focused ultrasound was more accurate in detecting diaphyseal fractures than in detecting fractures in the metaphysis and/or epiphysis. The high sensitivity and specificity of ultrasound in the detection of long-bone fractures and the need for reduction support the use of ultrasound in the evaluation of suspected long-bone fractures in children.

Predictions of first passage times in sparse discrete fracture networks using graph-based reductions

NASA Astrophysics Data System (ADS)

Hyman, J.; Hagberg, A.; Srinivasan, G.; Mohd-Yusof, J.; Viswanathan, H. S.

2017-12-01

We present a graph-based methodology to reduce the computational cost of obtaining first passage times through sparse fracture networks. We derive graph representations of generic three-dimensional discrete fracture networks (DFNs) using the DFN topology and flow boundary conditions. Subgraphs corresponding to the union of the k shortest paths between the inflow and outflow boundaries are identified and transport on their equivalent subnetworks is compared to transport through the full network. The number of paths included in the subgraphs is based on the scaling behavior of the number of edges in the graph with the number of shortest paths. First passage times through the subnetworks are in good agreement with those obtained in the full network, both for individual realizations and in distribution. Accurate estimates of first passage times are obtained with an order of magnitude reduction of CPU time and mesh size using the proposed method.

Predictions of first passage times in sparse discrete fracture networks using graph-based reductions

NASA Astrophysics Data System (ADS)

Hyman, Jeffrey D.; Hagberg, Aric; Srinivasan, Gowri; Mohd-Yusof, Jamaludin; Viswanathan, Hari

2017-07-01

We present a graph-based methodology to reduce the computational cost of obtaining first passage times through sparse fracture networks. We derive graph representations of generic three-dimensional discrete fracture networks (DFNs) using the DFN topology and flow boundary conditions. Subgraphs corresponding to the union of the k shortest paths between the inflow and outflow boundaries are identified and transport on their equivalent subnetworks is compared to transport through the full network. The number of paths included in the subgraphs is based on the scaling behavior of the number of edges in the graph with the number of shortest paths. First passage times through the subnetworks are in good agreement with those obtained in the full network, both for individual realizations and in distribution. Accurate estimates of first passage times are obtained with an order of magnitude reduction of CPU time and mesh size using the proposed method.

[Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction].

PubMed

Müller, M; Freude, T; Stöckle, U; Kraus, T M

2017-02-01

Closed reduction and intramedullary nailing is common in diaphyseal clavicle fractures. The aim of this report is to demonstrate a surgical method with minimally invasive percutaneous reduction in cases where closed reduction fails. The procedure is associated with good cosmetic results. Percutaneous reduction using two reduction forceps enables intramedullary nailing without an open procedure. Open, multifragmented or non-dislocated fractures, oblique fractures due to postoperative dislocation or shortening risk, fracture having potential to become compound fractures, neurovascular complications, pseudoarthroses. The patient is in beach-chair position. After an incision, the nail is entered from medial, two reduction forceps are mounted percutaneously at the lateral and medial fragment. After reduction the nail is pushed forward into the lateral fragment. Thereby, the fracture hematoma is not disturbed for the most part. Early functional rehabilitation with maximal abduction and anteversion of 90° for 6 weeks. Anatomic reduction can be achieved with mild cosmetic impairment.

Diabetes, bone and glucose-lowering agents: clinical outcomes.

PubMed

Schwartz, Ann V

2017-07-01

Older adults with diabetes are at higher risk of fracture and of complications resulting from a fracture. Hence, fracture risk reduction is an important goal in diabetes management. This review is one of a pair discussing the relationship between diabetes, bone and glucose-lowering agents; an accompanying review is provided in this issue of Diabetologia by Beata Lecka-Czernik (DOI 10.1007/s00125-017-4269-4 ). Specifically, this review discusses the challenges of accurate fracture risk assessment in diabetes. Standard tools for risk assessment can be used to predict fracture but clinicians need to be aware of the tendency for the bone mineral density T-score and the fracture risk assessment tool (FRAX) to underestimate risk in those with diabetes. Diabetes duration, complications and poor glycaemic control are useful clinical markers of increased fracture risk. Glucose-lowering agents may also affect fracture risk, independent of their effects on glycaemic control, as seen with the negative skeletal effects of the thiazolidinediones; in this review, the potential effects of glucose-lowering medications on fracture risk are discussed. Finally, the current understanding of effective fracture prevention in older adults with diabetes is reviewed.

Insights into the epidemiology of postmenopausal osteoporosis: the Women's Health Initiative.

PubMed

Jackson, Rebecca D; Mysiw, W Jerry

2014-11-01

Osteoporosis and its associated increased risk for fragility fracture is one of the most disabling consequences of aging in women. To successfully reduce the public health burden of this pervasive disease, it is necessary to develop strategies that permit the earlier identification of women at risk for fracture and ensure that preventive interventions to reduce the risk for fracture are both safe and effective. The Women's Health Initiative offers the unprecedented opportunity to systematically address both of these issues. Eleven clinically available risk factors (age, race/ethnicity, self-reported health, weight, height, physical activity, parental hip fracture, fracture history after age 54, current smoking, corticosteroid use, and history of treated diabetes), have been identified to predict 5-year hip fracture risk in white women. Two of these factors (age and fracture history) also predict risk for total fractures in women irrespective of race-ethnicity. Biomarkers including low vitamin D or bioavailable testosterone and/or high cystatin C, pro-inflammatory cytokines, osteoprotegerin and sex hormone-binding globulin also predict risk for hip fracture independent of clinical risk factors. Two cornerstones of therapy for postmenopausal osteoporosis-postmenopausal hormone therapy and calcium plus vitamin D supplementation- were rigorously studied. Estrogen with or without a progestin was effective at preventing bone loss and reducing risk for hip, clinical vertebral and total fractures but the balance of risks and benefits failed to show an overall benefit of taking estrogen-alone or estrogen plus progestin as a preventive strategy for skeletal health. Calcium plus vitamin D supplementation also demonstrated a small but significant favorable effect on hip bone density but in contrast, the modest effect did not translate into a significant reduction in the risk of fractures in intent-to-treat analyses. Data such as these have helped to lay a foundation for the more effective management of postmenopausal osteoporosis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Open versus closed reduction: diacapitular fractures of the mandibular condyle.

PubMed

Chrcanovic, Bruno Ramos

2012-09-01

The purpose of the study was to review the literature regarding the evolution of current thoughts on management of diacapitular fractures (DFs) of the mandibular condyle. An electronic search in PubMed was undertaken in March 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies reporting clinical series of DFs, including both animal and human studies, without date or language restrictions. The search strategy initially yielded 108 references. Twenty-eight studies were identified without repetition within the selection criteria. Additional hand-searching of the reference lists of selected studies yielded three additional papers. The current indications for open reduction and internal fixation (ORIF) of DFs described in the literature are: (a) fractures affecting the lateral condyle with reduction of mandibular height; (b) fractures in which the proximal fragment dislocates laterally out of the glenoid fossa, which cannot be reduced by closed or open treatment of another part of the mandibular fracture. The indications for conservative treatment are: (a) fractures that do not shorten the condylar height (a fracture with displacement of the medial parts of the condyle); (b) undisplaced fractures; (c) comminution of the condylar head, when the bony fragments are too small for stable fixation; and (d) fractures in children. As the temporomandibular joint disk plays an important role as a barrier preventing ankylosis, it is important to reposition the disk (if displaced/dislocated) during the surgical treatment of DFs. The lateral pterygoid muscle should never be stripped from the medially displaced fragment because its desinsertion disrupts circulation to the medial bony fragment, and also because this muscle helps to restore the muscle function after surgery. ORIF of selected DFs improves prognosis by anatomical bone and soft tissue recovery when combined with physical therapy. If conducted properly, surgical treatment of DFs is a safe and predictable procedure and yields good results.

Assessing edge cracking resistance in AHSS automotive parts by the Essential Work of Fracture methodology

NASA Astrophysics Data System (ADS)

Frómeta, D.; Tedesco, M.; Calvo, J.; Lara, A.; Molas, S.; Casellas, D.

2017-09-01

Lightweight designs and demanding safety requirements in automotive industry are increasingly promoting the use of Advanced High Strength Steel (AHSS) sheets. Such steels present higher strength (above 800 MPa) but lower ductility than conventional steels. Their great properties allow the reduction of the thickness of automobile structural components without compromising the safety, but also introduce new challenges to parts manufacturers. The fabrication of most cold formed components starts from shear cut blanks and, due to the lower ductility of AHSS, edge cracking problems can appear during forming operations, forcing the stop of the production and slowing down the industrial process. Forming Limit Diagrams (FLD) and FEM simulations are very useful tools to predict fracture problems in zones with high localized strain, but they are not able to predict edge cracking. It has been observed that the fracture toughness, measured through the Essential Work of Fracture (EWF) methodology, is a good indicator of the stretch flangeability in AHSS and can help to foresee this type of fractures. In this work, a serial production automotive component has been studied. The component showed cracks in some flanged edges when using a dual phase steel. It is shown that the conventional approach to explain formability, based on tensile tests and FLD, fails in the prediction of edge cracking. A new approach, based on fracture mechanics, help to solve the problem by selecting steel grades with higher fracture toughness, measured by means of EWF. Results confirmed that fracture toughness, in terms of EWF, can be readily used as a material parameter to rationalize cracking related problems and select AHSS with improved edge cracking resistance.

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.

Application of 3D printed customized external fixator in fracture reduction.

PubMed

Qiao, Feng; Li, Dichen; Jin, Zhongmin; Gao, Yongchang; Zhou, Tao; He, Jinlong; Cheng, Li

2015-01-01

Long bone fracture is common in traumatic osteopathic patients. Good reduction is beneficial for bone healing, preventing the complications such as delayed union, nonunion, malunion, but is hard to achieve. Repeated attempts during the surgery would increase the operation time, cause new damage to the fracture site and excessive exposure to radiation. Robotic and navigation techniques can help improve the reduction accuracy, however, the high cost and complexity of operation have limited their clinical application. We combined 3D printing with computer-assisted reduction technique to develop a customised external fixator with the function of fracture reduction. The original CT data obtained by scanning the fracture was imported to computer for reconstructing and reducing the 3D image of the fracture, based on which the external fixator (named as Q-Fixator) was designed and then fabricated by 3D printing techniques. The fracture reduction and fixation was achieved by connecting the pins inserted in the bones with the customised Q-Fixator. Experiments were conducted on three fracture models to demonstrate the reduction results. Good reduction results were obtained on all three fractured bone models, with an average rotation of 1.21°(± 0.24), angulation of 1.84°(± 0.28), and lateral displacement of 2.22 mm(± 0.62). A novel customised external fixator for long bone fracture reduction was readily developed using 3D printing technique. The customised external fixator had the advantages of easy manipulation, accurate reduction, minimally invasion and experience-independence. Future application of the customised external fixator can be extended to include the fixation function with stress adjustment and potentially optimise the fracture healing process. Copyright © 2015 Elsevier Ltd. All rights reserved.

Haptic computer-assisted patient-specific preoperative planning for orthopedic fractures surgery.

PubMed

Kovler, I; Joskowicz, L; Weil, Y A; Khoury, A; Kronman, A; Mosheiff, R; Liebergall, M; Salavarrieta, J

2015-10-01

The aim of orthopedic trauma surgery is to restore the anatomy and function of displaced bone fragments to support osteosynthesis. For complex cases, including pelvic bone and multi-fragment femoral neck and distal radius fractures, preoperative planning with a CT scan is indicated. The planning consists of (1) fracture reduction-determining the locations and anatomical sites of origin of the fractured bone fragments and (2) fracture fixation-selecting and placing fixation screws and plates. The current bone fragment manipulation, hardware selection, and positioning processes based on 2D slices and a computer mouse are time-consuming and require a technician. We present a novel 3D haptic-based system for patient-specific preoperative planning of orthopedic fracture surgery based on CT scans. The system provides the surgeon with an interactive, intuitive, and comprehensive, planning tool that supports fracture reduction and fixation. Its unique features include: (1) two-hand haptic manipulation of 3D bone fragments and fixation hardware models; (2) 3D stereoscopic visualization and multiple viewing modes; (3) ligaments and pivot motion constraints to facilitate fracture reduction; (4) semiautomatic and automatic fracture reduction modes; and (5) interactive custom fixation plate creation to fit the bone morphology. We evaluate our system with two experimental studies: (1) accuracy and repeatability of manual fracture reduction and (2) accuracy of our automatic virtual bone fracture reduction method. The surgeons achieved a mean accuracy of less than 1 mm for the manual reduction and 1.8 mm (std [Formula: see text] 1.1 mm) for the automatic reduction. 3D haptic-based patient-specific preoperative planning of orthopedic fracture surgery from CT scans is useful and accurate and may have significant advantages for evaluating and planning complex fractures surgery.

Screw-Wire Osteo-Traction: An Adjunctive or Alternative Method of Anatomical Reduction of Multisegment Midfacial Fractures? A Description of Technique and Prospective Study of 40 Patients

PubMed Central

O'Regan, Barry; Devine, Maria; Bhopal, Sats

2013-01-01

Stable anatomical fracture reduction and segment control before miniplate fixation can be difficult to achieve in comminuted midfacial fractures. Fracture mobilization and reduction methods include Gillies elevation, malar hook, and Dingman elevators. No single method is used universally. Disadvantages include imprecise segment alignment and poor segment stability/control. We have employed screw-wire osteo-traction (SWOT) to address this problem. A literature review revealed two published reports. The aims were to evaluate the SWOT technique effectiveness as a fracture reduction method and to examine rates of revision fixation and plate removal. We recruited 40 consecutive patients requiring open reduction and internal fixation of multisegment midfacial fractures (2009–2012) and employed miniplate osteosynthesis in all patients. SWOT was used as a default reduction method in all patients. The rates of successful fracture reduction achieved by SWOT alone or in combination and of revision fixation and plate removal, were used as outcome indices of the reduction method effectiveness. The SWOT technique achieved satisfactory anatomical reduction in 27/40 patients when used alone. Other reduction methods were also used in 13/40 patients. No patient required revision fixation and three patients required late plate removal. SWOT can be used across the midface fracture pattern in conjunction with other methods or as a sole reduction method before miniplate fixation. PMID:24436763

Open Reduction in Pediatric Condylar Fracture.

PubMed

Barbosa, Alexandre Agostini; Mariano, Ronaldo Célio

2017-05-01

Facial fractures in children are rare. Lack of pneumatization, fat pockets, mixed dentition, contribute to the elasticity and bone stability. When mandibular fractures occur in children, most often involve the condyle by indirect trauma. Such fractures are the center of discussion on the form of treatment if this should be performed conservatively, or held the reduction and fixation of the fracture with surgical exposure of the fragments. In condylar fractures in children, in most patients, the proposed treatment is closed reduction. Treatment with open reduction and fixation has its specific indications. In this case, the authors report a patient cycling accident victim, with cut-contusion injury in ment with limited mouth opening and left condylar fracture with medial rotation. The treatment was the reduction and fixation of fragments by open process.

Radial and tibial fracture repair with external skeletal fixation. Effects of fracture type, reduction, and complications on healing.

PubMed

Johnson, A L; Kneller, S K; Weigel, R M

1989-01-01

Twenty-eight consecutive fractures of the canine radius and tibia were treated with external skeletal fixation as the primary method of stabilization. The time of fixation removal (T1) and the time to unsupported weight-bearing (T2) were correlated with: (1) bone involved; (2) communication of the fracture with the external environment; (3) severity of the fracture; (4) proximity of the fracture to the nutrient artery; (5) method of reduction; (6) diaphyseal displacement after reduction; and (7) gap between cortical fragments after reduction. The Kruskal-Wallis one-way analysis of variance was used to test the correlation with p less than .05 set as the criterion for significance. The median T1 was 10 weeks and the median T2 was 11 weeks. None of the variables correlated significantly with either of the healing times; however, there was a strong trend toward longer healing times associated with open fractures and shorter healing times associated with closed reduction. Periosteal and endosteal callus uniting the fragments were observed radiographically in comminuted fractures, with primary bone union observed in six fractures in which anatomic reduction was achieved. Complications observed in the treatment of these fractures included: bone lysis around pins (27 fractures), pin track drainage (27 fractures), pin track hemorrhage (1 fracture), periosteal reaction around pins (27 fractures), radiographic signs consistent with osteomyelitis (12 fractures), degenerative joint disease (2 dogs), and nonunion (1 fracture). Valgus or rotational malalignment resulted in 16 malunions of fractures. One external fixation device was replaced and four loose pins were removed before the fractures healed. One dog was treated with antibiotics during the postoperative period because clinical signs of osteomyelitis appeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of PITFL injuries in rotationally unstable ankle fractures.

PubMed

Warner, Stephen J; Garner, Matthew R; Schottel, Patrick C; Hinds, Richard M; Loftus, Michael L; Lorich, Dean G

2015-04-01

Reduction and stabilization of the syndesmosis in unstable ankle fractures is important for ankle mortise congruity and restoration of normal tibiotalar contact forces. Of the syndesmotic ligaments, the posterior inferior tibiofibular ligament (PITFL) provides the most strength for maintaining syndesmotic stability, and previous work has demonstrated the significance of restoring PITFL function when it remains attached to a posterior malleolus fracture fragment. However, little is known regarding the nature of a PITFL injury in the absence of a posterior malleolus fracture. The goal of this study was to describe the PITFL injury pattern based on magnetic resonance imaging (MRI) and intraoperative observation. A prospective database of all operatively treated ankle fractures by a single surgeon was used to identify all supination-external rotation (SER) types III and IV ankle fracture patients with complete preoperative orthogonal ankle radiographs and MRI. All patients with a posterior malleolus fracture were excluded. Using a combination of preoperative imaging and intraoperative findings, we analyzed the nature of injuries to the PITFL. In total, 185 SER III and IV operatively treated ankle fractures with complete imaging were initially identified. Analysis of the preoperative imaging and operative reports revealed 34% (63/185) had a posterior malleolus fracture and were excluded. From the remaining 122 ankle fractures, the PITFL was delaminated from the posterior malleolus in 97% (119/122) of cases. A smaller proportion (3%; 3/122) had an intrasubstance PITFL rupture. Accurate and stable syndesmotic reduction is a significant component of restoring the ankle mortise after unstable ankle fractures. In our large cohort of rotationally unstable ankle fractures without posterior malleolus fractures, we found that most PITFL injuries occur as a delamination off the posterior malleolus. This predictable PITFL injury pattern may be used to guide new methods for stabilizing the syndesmosis in these patients. Level IV, case series. © The Author(s) 2014.

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.

Haematoma block in reduction of distal radial fractures.

PubMed

Ogunlade, S O; Omololu, A B; Alonge, T O; Salawu, S A; Bamgboye, E A

2002-01-01

A total of 35 patients who presented in the Accident and Emergency Department of University College Hospital with displaced distal radial fracture between January 2000 and March 2001 had reduction of the fracture under haematoma block using 10ml of 2% lignocaine. There was significant reduction of the pain following infiltration of the fracture site with lignocaine and significant pain reduction during manipulation compared to pain score at presentation. All the patients had satisfactory reduction of the fracture. The fracture was mobilised in Plaster of Paris 6 weeks in patients with Collens' fracture and 3 weeks in patients with distal radial epiphyseal injury. All patients had good range of movement at 8 weeks after removal of Plaster of Paris and patients expressed satisfaction with this method. We recommend the use of Haematoma block for patients of 15 years and above with displaced distal radial fracture in the Accident and Emergency Department.

Predictions of first passage times in sparse discrete fracture networks using graph-based reductions

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

Hyman, Jeffrey De'Haven; Hagberg, Aric Arild; Mohd-Yusof, Jamaludin

Here, we present a graph-based methodology to reduce the computational cost of obtaining first passage times through sparse fracture networks. We also derive graph representations of generic three-dimensional discrete fracture networks (DFNs) using the DFN topology and flow boundary conditions. Subgraphs corresponding to the union of the k shortest paths between the inflow and outflow boundaries are identified and transport on their equivalent subnetworks is compared to transport through the full network. The number of paths included in the subgraphs is based on the scaling behavior of the number of edges in the graph with the number of shortest paths.more » First passage times through the subnetworks are in good agreement with those obtained in the full network, both for individual realizations and in distribution. We obtain accurate estimates of first passage times with an order of magnitude reduction of CPU time and mesh size using the proposed method.« less

Predictions of first passage times in sparse discrete fracture networks using graph-based reductions

DOE PAGES

Hyman, Jeffrey De'Haven; Hagberg, Aric Arild; Mohd-Yusof, Jamaludin; ...

2017-07-10

Here, we present a graph-based methodology to reduce the computational cost of obtaining first passage times through sparse fracture networks. We also derive graph representations of generic three-dimensional discrete fracture networks (DFNs) using the DFN topology and flow boundary conditions. Subgraphs corresponding to the union of the k shortest paths between the inflow and outflow boundaries are identified and transport on their equivalent subnetworks is compared to transport through the full network. The number of paths included in the subgraphs is based on the scaling behavior of the number of edges in the graph with the number of shortest paths.more » First passage times through the subnetworks are in good agreement with those obtained in the full network, both for individual realizations and in distribution. We obtain accurate estimates of first passage times with an order of magnitude reduction of CPU time and mesh size using the proposed method.« less

Assessment of two-phase flow on the chemical alteration and sealing of leakage pathways in cemented wellbores

DOE PAGES

Iyer, Jaisree; Walsh, Stuart D. C.; Hao, Yue; ...

2018-01-08

Wellbore leakage tops the list of perceived risks to the long-term geologic storage of CO 2, because wells provide a direct path between the CO 2 storage reservoir and the atmosphere. In this paper, we have coupled a two-phase flow model with our original framework that combined models for reactive transport of carbonated brine, geochemistry of reacting cement, and geomechanics to predict the permeability evolution of cement fractures. Additionally, this makes the framework suitable for field conditions in geological storage sites, permitting simulation of contact between cement and mixtures of brine and supercritical CO 2. Due to lack of conclusivemore » experimental data, we tried both linear and Corey relative permeability models to simulate flow of the two phases in cement fractures. The model also includes two options to account for the inconsistent experimental observations regarding cement reactivity with two-phase CO 2-brine mixtures. One option assumes that the reactive surface area is independent of the brine saturation and the second option assumes that the reactive surface area is proportional to the brine saturation. We have applied the model to predict the extent of cement alteration, the conditions under which fractures seal, the time it takes to seal a fracture, and the leakage rates of CO 2 and brine when damage zones in the wellbore are exposed to two-phase CO 2-brine mixtures. Initial brine residence time and the initial fracture aperture are critical parameters that affect the fracture sealing behavior. We also evaluated the importance of the model assumptions regarding relative permeability and cement reactivity. These results illustrate the need to understand how mixtures of carbon dioxide and brine flow through fractures and react with cement to make reasonable predictions regarding well integrity. For example, a reduction in the cement reactivity with two-phase CO 2-brine mixture can not only significantly increase the sealing time for fractures but may also prevent fracture sealing.« less

Assessment of two-phase flow on the chemical alteration and sealing of leakage pathways in cemented wellbores

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

Iyer, Jaisree; Walsh, Stuart D. C.; Hao, Yue

Wellbore leakage tops the list of perceived risks to the long-term geologic storage of CO 2, because wells provide a direct path between the CO 2 storage reservoir and the atmosphere. In this paper, we have coupled a two-phase flow model with our original framework that combined models for reactive transport of carbonated brine, geochemistry of reacting cement, and geomechanics to predict the permeability evolution of cement fractures. Additionally, this makes the framework suitable for field conditions in geological storage sites, permitting simulation of contact between cement and mixtures of brine and supercritical CO 2. Due to lack of conclusivemore » experimental data, we tried both linear and Corey relative permeability models to simulate flow of the two phases in cement fractures. The model also includes two options to account for the inconsistent experimental observations regarding cement reactivity with two-phase CO 2-brine mixtures. One option assumes that the reactive surface area is independent of the brine saturation and the second option assumes that the reactive surface area is proportional to the brine saturation. We have applied the model to predict the extent of cement alteration, the conditions under which fractures seal, the time it takes to seal a fracture, and the leakage rates of CO 2 and brine when damage zones in the wellbore are exposed to two-phase CO 2-brine mixtures. Initial brine residence time and the initial fracture aperture are critical parameters that affect the fracture sealing behavior. We also evaluated the importance of the model assumptions regarding relative permeability and cement reactivity. These results illustrate the need to understand how mixtures of carbon dioxide and brine flow through fractures and react with cement to make reasonable predictions regarding well integrity. For example, a reduction in the cement reactivity with two-phase CO 2-brine mixture can not only significantly increase the sealing time for fractures but may also prevent fracture sealing.« less

Surgical treatment of intra-articular calcaneal fractures.

PubMed

Stapleton, John J; Zgonis, Thomas

2014-10-01

Most intra-articular calcaneal fractures are a result of high-energy trauma. The operative management of calcaneal fractures has been based on achieving anatomic reduction and minimizing complications of the compromised soft tissue envelope. The traditional extensile lateral approach offers advantages of achieving adequate fracture reduction with the risk of wound-healing complications and infection. Limited open reduction and internal fixation techniques with or without using external fixation focuses on achieving fracture reduction with less risk of wound complications but higher risk of malunion. This article discusses key points of operative management for various intra-articular calcaneal fracture patterns and clinical presentations. Copyright © 2014 Elsevier Inc. All rights reserved.

Results of operative fixation of unstable ankle fractures in geriatric patients.

PubMed

Pagliaro, A J; Michelson, J D; Mizel, M S

2001-05-01

It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.

Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

PubMed Central

Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

2012-01-01

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle. PMID:22872831

Navigation system for robot-assisted intra-articular lower-limb fracture surgery.

PubMed

Dagnino, Giulio; Georgilas, Ioannis; Köhler, Paul; Morad, Samir; Atkins, Roger; Dogramadzi, Sanja

2016-10-01

In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. 3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon's virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text], when the robot reduced the fracture. Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text], and meeting the clinical requirements for distal femur fracture reduction procedures.

Predictors of Time to Union After Operative Fixation of Closed Ankle Fractures.

PubMed

Matson, Andrew P; Hamid, Kamran S; Adams, Samuel B

2017-08-01

Ankle fractures are common and represent a significant burden to society. We aim to report the rate of union as determined by clinical and radiographic data, and to identify factors that predict time to union. A cohort of 112 consecutive patients with isolated, closed, operative malleolar ankle fractures treated with open reduction and internal fixation was retrospectively reviewed for time to clinical union. Clinical union was defined based on radiographic and clinical parameters, and delayed union was defined by time to union >12 weeks. Injury characteristics, patient factors and treatment variables were recorded, and statistical techniques employed included the Chi-square test, the Student's T-test, and multivariate linear regression modeling. Forty-two (37.5%) of patients who achieved union did so in less than 12 weeks, and 69 (61.6%) of these patients demonstrated delayed union at a mean of 16.7 weeks (range, 12.1-26.7 weeks), and the remaining patient required revision surgery. Factors associated with higher rates of delayed union or increased time to union included tobacco use, bimalleolar fixation, and high energy mechanism (all p<0.05). In regression analysis, statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p<0.05). Patient characteristics, injury factors and treatment variables are predictive of time to union following open reduction and internal fixation of closed ankle fractures. These findings should assist with patient counseling, and help guide the provider when considering adjunctive therapies that promote bone healing. Prognostic, Level IV: Case series.

The relative contributions of non-enzymatic glycation and cortical porosity on the fracture toughness of aging bone

PubMed Central

Tang, S.Y.; Vashishth, D.

2010-01-01

The risk of fracture increases with age due to the decline of bone mass and bone quality. One of the age-related changes in bone quality occurs through the formation and accumulation of advanced glycation end-products (AGEs) due to non-enzymatic glycation (NEG). However as a number of other changes including increased porosity occur with age and affect bone fragility, the relative contribution of AGEs on the fracture resistance of aging bone is unknown. Using a high-resolution nonlinear finite element model that incorporate cohesive elements and micro-computed tomography-based 3d meshes, we investigated the contribution of AGEs and cortical porosity on the fracture toughness of human bone. The results show that NEG caused a 52% reduction in propagation fracture toughness (R-curve slope). The combined effects of porosity and AGEs resulted in an 88% reduction in propagation toughness. These findings are consistent with previous experimental results. The model captured the age-related changes in the R-curve toughening by incorporating bone quantity and bone quality changes, and these simulations demonstrate the ability of the cohesive models to account for the irreversible dynamic crack growth processes affected by the changes in post-yield material behavior. By decoupling the matrix-level effects due to NEG and intracortical porosity, we are able to directly determine the effects of NEG on fracture toughness. The outcome of this study suggests that it may be important to include the age-related changes in the material level properties by using finite element analysis towards the prediction of fracture risk. PMID:21056419

Effectiveness of various isometric exercises at improving bone strength in cortical regions prone to distal tibial stress fractures.

PubMed

Florio, C S

2018-06-01

A computational model was used to compare the local bone strengthening effectiveness of various isometric exercises that may reduce the likelihood of distal tibial stress fractures. The developed model predicts local endosteal and periosteal cortical accretion and resorption based on relative local and global measures of the tibial stress state and its surface variation. Using a multisegment 3-dimensional leg model, tibia shape adaptations due to 33 combinations of hip, knee, and ankle joint angles and the direction of a single or sequential series of generated isometric resultant forces were predicted. The maximum stress at a common fracture-prone region in each optimized geometry was compared under likely stress fracture-inducing midstance jogging conditions. No direct correlations were found between stress reductions over an initially uniform circular hollow cylindrical geometry under these critical design conditions and the exercise-based sets of active muscles, joint angles, or individual muscle force and local stress magnitudes. Additionally, typically favorable increases in cross-sectional geometric measures did not guarantee stress decreases at these locations. Instead, tibial stress distributions under the exercise conditions best predicted strengthening ability. Exercises producing larger anterior distal stresses created optimized tibia shapes that better resisted the high midstance jogging bending stresses. Bent leg configurations generating anteriorly directed or inferiorly directed resultant forces created favorable adaptations. None of the studied loads produced by a straight leg was significantly advantageous. These predictions and the insight gained can provide preliminary guidance in the screening and development of targeted bone strengthening techniques for those susceptible to distal tibial stress fractures. Copyright © 2018 John Wiley & Sons, Ltd.

Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study.

PubMed

Weber-Spickschen, T S; Oszwald, M; Westphal, R; Krettek, C; Wahl, F; Gosling, T

2010-01-01

Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.

[Balloon osteoplasty as reduction technique in the treatment of tibial head fractures].

PubMed

Freude, T; Kraus, T M; Sandmann, G H

2015-10-01

Tibial plateau fractures requiring surgery are severe injuries of the lower extremities. Depending on the fracture pattern, the age of the patient, the range of activity and the bone quality there is a broad variation in adequate treatment.  This article reports on an innovative treatment concept to address split depression fractures (Schatzker type II) and depression fractures (Schatzker type III) of the tibial head using the balloon osteoplasty technique for fracture reduction. Using the balloon technique achieves a precise and safe fracture reduction. This internal osteoplasty combines a minimal invasive percutaneous approach with a gently rise of the depressed area and the associated protection of the stratum regenerativum below the articular cartilage surface. This article lights up the surgical procedure using the balloon technique in tibia depression fractures. Using the balloon technique a precise and safe fracture reduction can be achieved. This internal osteoplasty combines a minimally invasive percutaneous approach with a gentle raising of the depressed area and the associated protection of the regenerative layer below the articular cartilage surface. Fracture reduction by use of a tamper results in high peak forces over small areas, whereas by using the balloon the forces are distributed over a larger area causing less secondary stress to the cartilage tissue. This less invasive approach might help to achieve a better long-term outcome with decreased secondary osteoarthritis due to the precise and chondroprotective reduction technique.

A remediation performance model for enhanced metabolic reductive dechlorination of chloroethenes in fractured clay till

NASA Astrophysics Data System (ADS)

Manoli, Gabriele; Chambon, Julie C.; Bjerg, Poul L.; Scheutz, Charlotte; Binning, Philip J.; Broholm, Mette M.

2012-04-01

A numerical model of metabolic reductive dechlorination is used to describe the performance of enhanced bioremediation in fractured clay till. The model is developed to simulate field observations of a full scale bioremediation scheme in a fractured clay till and thereby to assess remediation efficiency and timeframe. A relatively simple approach is used to link the fermentation of the electron donor soybean oil to the sequential dechlorination of trichloroethene (TCE) while considering redox conditions and the heterogeneous clay till system (clay till matrix, fractures and sand stringers). The model is tested on lab batch experiments and applied to describe sediment core samples from a TCE-contaminated site. Model simulations compare favorably to field observations and demonstrate that dechlorination may be limited to narrow bioactive zones in the clay matrix around fractures and sand stringers. Field scale simulations show that the injected donor is expected to be depleted after 5 years, and that without donor re-injection contaminant rebound will occur in the high permeability zones and the mass removal will stall at 18%. Long remediation timeframes, if dechlorination is limited to narrow bioactive zones, and the need for additional donor injections to maintain dechlorination activity may limit the efficiency of ERD in low-permeability media. Future work should address the dynamics of the bioactive zones, which is essential to understand for predictions of long term mass removal.

Poromechanical response of naturally fractured sorbing media

NASA Astrophysics Data System (ADS)

Kumar, Hemant

The injection of CO2 in coal seams has been utilized for enhanced gas recovery and potential CO2 sequestration in unmineable coal seams. It is advantageous because as it enhances the production and significant volumes of CO2 may be stored simultaneously. The key issues for enhanced gas recovery and geologic sequestration of CO2 include (1) Injectivity prediction: The chemical and physical processes initiated by the injection of CO2 in the coal seam leads to permeability/porosity changes (2) Up scaling: Development of full scale coupled reservoir model which may predict the enhanced production, associated permeability changes and quantity of sequestered CO2. (3) Reservoir Stimulation: The coalbeds are often fractured and proppants are placed into the fractures to prevent the permeability reduction but the permeability evolution in such cases is poorly understood. These issues are largely governed by dynamic coupling of adsorption, fluid exchange, transport, water content, stress regime, fracture geometry and physiomechanical changes in coals which are triggered by CO 2 injection. The understanding of complex interactions in coal has been investigated through laboratory experiments and full reservoir scale models are developed to answer key issues. (Abstract shortened by ProQuest.).

Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction.

PubMed

Luo, Huasong; Chen, Liaobin; Liu, Kebin; Peng, Songming; Zhang, Jien; Yi, Yang

2016-01-01

The aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator. Thirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system. Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%. Arthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.

Managing Osteoporosis Patients after Long-Term Bisphosphonate Treatment

PubMed Central

Adler, Robert A.; Fuleihan, Ghada El-Hajj; Bauer, Douglas C.; Camacho, Pauline M.; Clarke, Bart L.; Clines, Gregory A.; Compston, Juliet E.; Drake, Matthew T.; Edwards, Beatrice J.; Favus, Murray J.; Greenspan, Susan L.; McKinney, Ross; Pignolo, Robert J.; Sellmeyer, Deborah E.

2016-01-01

Bisphosphonates (BPs) are the most commonly used medications for osteoporosis, but optimal duration of therapy is unknown. This ASBMR report provides guidance on BP therapy duration with a risk benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score between −2 and −2.5 in FLEX and below −2.5 in HORIZON extension predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, women should be reassessed. Women with previous major osteoporotic fracture, those who fracture on therapy, or others at high risk should generally continue therapy for up to 10 years (oral) or 6 years (intravenous), with periodic risk-benefit evaluation. Older women, those with a low hip T-score or high fracture risk score are considered high risk. The risk of osteonecrosis of the jaw and atypical femoral fracture increases with BP therapy duration, but such rare events are far outweighed by fracture risk reduction with BPs in high risk patients. For women not at high fracture risk after 3–5 years of BP treatment, a drug holiday of 2–3 years can be considered, with periodic reassessment. The algorithm provided for long term BP use is based on limited evidence in mostly Caucasian postmenopausal women and only for vertebral fracture reduction. It is probably applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future osteoporosis trials will provide data for formulating definitive recommendations. PMID:26350171

Is Surgical Navigation Useful During Closed Reduction of Nasal Bone Fractures?

PubMed

Kim, Seon Tae; Jung, Joo Hyun; Kang, Il Gyu

2017-05-01

To report the case of a 42-year-old woman with a nasal bone fracture that was easily treated using a surgical navigation system. In this clinical report, the authors suggest that intraoperative surgical navigation systems are useful diagnostically and for localizing sites of nasal bone fractures exactly. The patient underwent successful closed reduction of the nasal bone fracture. Surgical navigation is a useful tool for identifying nasal bone fracture locations and for guiding closed reduction. Surgical navigation is recommended when nasal bone fractures are complicated or not well reduced using the ordinary method.

[Arthroscopy-guided fracture management. Ankle joint and calcaneus].

PubMed

Schoepp, C; Rixen, D

2013-04-01

Arthroscopic fracture management of the ankle and calcaneus requires a differentiated approach. The aim is to minimize surgical soft tissue damage and to visualize anatomical fracture reduction arthroscopically. Moreover, additional cartilage damage can be detected and treated. The arthroscopic approach is limited by deep impressions of the joint surface needing cancellous bone grafting, by multiple fracture lines on the articular side and by high-grade soft tissue damage. An alternative to the minimally invasive arthroscopic approach is open arthroscopic reduction in conventional osteosynthesis. This facilitates correct assessment of surgical reduction of complex calcaneal fractures, otherwise remaining non-anatomical reduction might not be fluoroscopically detected during surgery.

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study.

PubMed

Hasserius, R; Karlsson, M K; Nilsson, B E; Redlund-Johnell, I; Johnell, O

2003-01-01

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50-80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6-3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3-4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4-5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1-2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1-3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7-5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.

Forecasting Proximal Femur and Wrist Fracture Caused by a Fall to the Side during Space Exploration Missions to the Moon and Mars

NASA Technical Reports Server (NTRS)

Lewandowski, Beth E.; Myers, Jerry G.; Sulkowski, C.; Ruehl, K.; Licata, A.

2008-01-01

The possibility of bone fracture in space is a concern due to the negative impact it could have on a mission. The Bone Fracture Risk Module (BFxRM) developed at the NASA Glenn Research Center is a statistical simulation that quantifies the probability of bone fracture at specific skeletal locations for particular activities or events during space exploration missions. This paper reports fracture probability predictions for the proximal femur and wrist resulting from a fall to the side during an extravehicular activity (EVA) on specific days of lunar and Martian exploration missions. The risk of fracture at the proximal femur on any given day of the mission is small and fairly constant, although it is slightly greater towards the end of the mission, due to a reduction in proximal femur bone mineral density (BMD). The risk of wrist fracture is greater than the risk of hip fracture and there is an increased risk on Mars since it has a higher gravitational environment than the moon. The BFxRM can be used to help manage the risk of bone fracture in space as an engineering tool that is used during mission operation and resource planning.

Modelling of Tc migration in an un-oxidized fractured drill core from Äspö, Sweden

NASA Astrophysics Data System (ADS)

Huber, F. M.; Totskiy, Y.; Montoya Garcia, V.; Enzmann, F.; Trumm, M.; Wenka, A.; Geckeis, H.; Schaefer, T.

2015-12-01

The radionuclide retention of redox sensitive radionuclides (e.g. Pu, Np, U, Tc) in crystalline host rock greatly depends on the rock matrix and the rock redox capacity. Preservation of drill cores concerning oxidation is therefore of paramount importance to reliably predict the near-natural radionuclide retention properties. Here, experimental results of HTO and Tc laboratory migration experiments in a naturally single fractured Äspö un-oxidized drill core are modelled using two different 2D models. Both models employ geometrical information obtained by μ-computed tomography (μCT) scanning of the drill core. The models differ in geometrical complexity meaning the first model (PPM-MD) consists of a simple parallel plate with a porous matrix adjacent to the fracture whereas the second model (MPM) uses the mid-plane of the 3D fracture only (no porous matrix). Simulation results show that for higher flow rates (Peclet number > 1), the MPM satisfactorily describes the HTO breakthrough curves (BTC) whereas the PPM-MD model nicely reproduces the HTO BTC for small Pe numbers (<1). These findings clearly highlight the influence of fracture geometry/flow field complexity on solute transport for Pe numbers > 1 and the dominating effect of matrix diffusion for Peclet numbers < 1. Retention of Tc is modelled using a simple Kd-approach in case of the PPM-MD and including 1st order sorptive reduction/desorption kinetics in case of the MPM. Batch determined sorptive reduction/desorption kinetic rates and Kd values for Tc on non-oxidized Äspö diorite are used in the model and compared to best fit values. By this approach, the transferability of kinetic data concerning sorptive reduction determined in static batch experiments to dynamic transport experiments is examined.

Use of a real-size 3D-printed model as a preoperative and intraoperative tool for minimally invasive plating of comminuted midshaft clavicle fractures.

PubMed

Kim, Hyong Nyun; Liu, Xiao Ning; Noh, Kyu Cheol

2015-06-10

Open reduction and plate fixation is the standard operative treatment for displaced midshaft clavicle fracture. However, sometimes it is difficult to achieve anatomic reduction by open reduction technique in cases with comminution. We describe a novel technique using a real-size three dimensionally (3D)-printed clavicle model as a preoperative and intraoperative tool for minimally invasive plating of displaced comminuted midshaft clavicle fractures. A computed tomography (CT) scan is taken of both clavicles in patients with a unilateral displaced comminuted midshaft clavicle fracture. Both clavicles are 3D printed into a real-size clavicle model. Using the mirror imaging technique, the uninjured side clavicle is 3D printed into the opposite side model to produce a suitable replica of the fractured side clavicle pre-injury. The 3D-printed fractured clavicle model allows the surgeon to observe and manipulate accurate anatomical replicas of the fractured bone to assist in fracture reduction prior to surgery. The 3D-printed uninjured clavicle model can be utilized as a template to select the anatomically precontoured locking plate which best fits the model. The plate can be inserted through a small incision and fixed with locking screws without exposing the fracture site. Seven comminuted clavicle fractures treated with this technique achieved good bone union. This technique can be used for a unilateral displaced comminuted midshaft clavicle fracture when it is difficult to achieve anatomic reduction by open reduction technique. Level of evidence V.

Timing of Surgical Reduction and Stabilization of Talus Fracture-Dislocations.

PubMed

Buckwalter V, Joseph A; Westermann, Robert; Mooers, Brian; Karam, Matthew; Wolf, Brian

Talus fractures with associated dislocations are rare but have high rates of complications, including avascular necrosis (AVN). Management of these injuries involves urgent surgical reduction and fixation, although there are no definitive data defining an operative time frame for preserving the blood supply and preventing complications. To determine the effect of time to surgical reduction of talus fractures and talus fracture-dislocations on rates of AVN and posttraumatic osteoarthritis (PTOA), we retrospectively reviewed talus fractures surgically managed at a level I trauma center during the 10-year period 2003 to 2013. Operative reports were obtained and reviewed, and 3 independent reviewers, using the Hawkins and AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) systems, classified the injuries on plain radiographs. Analysis of AO/OTA 81 fractures with associated tibiotalar, subtalar, or talonavicular dislocations was performed. Primary outcomes were presence of AVN/PTOA and subsequent arthrodesis of tibiotalar or subtalar joints. We identified 106 surgically managed talus fractures. Rates of AVN/PTOA were 41% for all talus fractures and 50% for talus fracture-dislocations. Mean time to surgical reduction was not significant for development of AVN/PTOA for all talus fractures (P = .45) or talus fracture-dislocations (P = .29). There was no difference in age (P = .20), body mass index (P = .45), or polytrauma (P = .79) between patients who developed AVN and those who did not. Open fractures were significantly correlated with the development of AVN/PTOA (P = .009). Talar fracture-dislocations are devastating injuries with high rates of complications. Our data suggest there is no effect of time from injury to surgical reduction of talus fractures or talus fracture-dislocations on rates of AVN and PTOA.

Dependency of the injection induced seismicity b-value on the stress state of existing fractures

NASA Astrophysics Data System (ADS)

Mukuhira, Y.; Fehler, M. C.; Ito, T.; Asanuma, H.; Häring, M. O.

2017-12-01

The Gutenberg-Richter distribution of earthquake is a power law relationship and it holds for laboratory scale earthquakes (acoustic emission) to subduction zone earthquakes as well as induced seismicity. The gradient of the power law is known as the b-value, which can be considered the ratio of the number of the larger earthquakes to small ones. Larger earthquakes are often observed in low b-value regions, or alternatively a b-value reduction has been observed before some main shocks. Some authors have argued that b-value is negatively correlated with differential stress level. Therefore, a b-value anomaly found in time-space analysis may be used for detection of an area of stress concentration and used for earthquake prediction or hazard risk assessment. In the field of induced seismicity where b-value reduction has also been observed, the physical mechanism of b-value reduction has not been understood well. Since induced seismicity related with fluid injection usually occurs at depths around 1000 5000 m, a significant tectonic mechanism to cause a stress concentration during a short time of hydraulic stimulation might not be expected. We used borehole analysis and focal mechanism information to investigate the stress state on the existing fractures that caused induced seismicity. Then we divide the catalog into the groups with varying normalized shear stress threshold and estimated the b-value. We found that b-value for the events that occurred along higher shear stress fractures were significantly lower (figure 1a) than those from the moderate/lower shear stress fractures (figure 1b). Thus, b-value dependency on the shear stress can be observed for induced seismicity on a reservoir scale. Therefore, we propose that the reason for the observed b-value reductions in induced seismicity on a reservoir scale is the events that occur along higher shear stress fractures. Supposing that the earthquakes occurs along well-orientated fractures, the b-value dependence on differential stress can be translated to dependence on increasing shear stress. Thus, our observations about b-value are consistent with the conventional interpretations of b-value.

Integration of computer-assisted fracture reduction system and a hybrid 3-DOF-RPS mechanism for assisting the orthopedic surgery

NASA Astrophysics Data System (ADS)

Irwansyah; Sinh, N. P.; Lai, J. Y.; Essomba, T.; Asbar, R.; Lee, P. Y.

2018-02-01

In this paper, we present study to integrate virtual fracture bone reduction simulation tool with a novel hybrid 3-DOF-RPS external fixator to relocate back bone fragments into their anatomically original position. A 3D model of fractured bone was reconstructed and manipulated using 3D design and modeling software, PhysiGuide. The virtual reduction system was applied to reduce a bilateral femoral shaft fracture type 32-A3. Measurement data from fracture reduction and fixation stages were implemented to manipulate the manipulator pose in patient’s clinical case. The experimental result presents that by merging both of those techniques will give more possibilities to reduce virtual bone reduction time, improve facial and shortest healing treatment.

Evaluation of Bone Atrophy After Treatment of Forearm Fracture Using Nonlinear Finite Element Analysis: A Comparative Study of Locking Plates and Conventional Plates.

PubMed

Matsuura, Yusuke; Rokkaku, Tomoyuki; Suzuki, Takane; Thoreson, Andrew Ryan; An, Kai-Nan; Kuniyoshi, Kazuki

2017-08-01

Forearm diaphysis fractures are usually managed by open reduction internal fixation. Recently, locking plates have been used for treatment. In the long-term period after surgery, some patients present with bone atrophy adjacent to the plate. However, a comparison of locking and conventional plates as a cause of atrophy has not been reported. The aim of this study was to investigate long-term bone atrophy associated with use of locking and conventional plates for forearm fracture treatment. In this study we included 15 patients with forearm fracture managed by either locking or conventional plates and with more than 5 years of follow-up. Computed tomographic imaging of both forearms was performed to assess bone thickness and local bone mineral density and to predict bone strength without plate reinforcement based on finite element analysis. Mean patient age at surgery was 48.0 years. Eight patients underwent reduction with fixed locking plates and were followed up for a mean of 79.5 months; the remaining 7 patients were treated with conventional plates and were followed up for a mean of 105.0 months. Compared with the conventional plate group, the locking plate group had the same fractured limb-contralateral limb ratio of cortex bone thickness, but had significantly lower ratios of mineral density adjacent to the plate and adjusted bone strength. This study demonstrated bone atrophy after locking plate fixation for forearm fractures. Treatment plans for forearm fracture should take into consideration the impact of bone atrophy long after plate fixation. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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.

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures.

PubMed

Shi, Hong-Fei; Xiong, Jin; Chen, Yi-Xin; Wang, Jun-Fei; Qiu, Xu-Sheng; Huang, Jie; Gui, Xue-Yang; Wen, Si-Yuan; Wang, Yin-He

2017-03-14

The optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis. Patients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS. Totally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months' follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419). The direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis. NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

Consequences of quality of reduction on osteosynthesis complications and quality of life in elderly patients with subtrochanteric fracture.

PubMed

Codesido-Vilar, P; Mejía-Casado, A; Riego-Fernández, J; Rodriguez-Casas, N; García-Cabanas, S; Rivas-Felice, J; García-Quevedo, L

2018-05-18

To compare results in terms of orthopaedic complications and quality of life in elderly patients with subtrochanteric fracture treated with intramedullary nailing according to fracture reduction status. A prospective cohort study including 90 elderly patients with subtrochanteric fractures of the femur treated with a cephalomedullary nail, with a minimum 1-year follow up. The inclusion criteria were: aged 60 years or older, without severe cognitive dysfunction and independent ambulatory capability before the fracture. We defined 3different groups in relation to fracture reduction status: good, acceptable and poor, according to modified criteria from Baumgartner et al. We compared clinical and surgical characteristics and healthy quality of life, social function and mobility according to the EQ-5D, Jensen Index and Mobility Score of Parker and Palmer questionnaires. We found differences in time to union, better in the good reduction group (P=.002); need for open reduction, more frequent in the good reduction group (P<.001), and in postoperative complications, more frequent in the poor reduction group (P=.001). We found no significant differences between the 3groups regarding scores in quality of life, social function and mobility. Reduction in subtrochanteric fractures in older people is key to obtaining better clinic and surgical results, improving time to union and decreasing surgical complications. Exposure of the focus fracture seems to be a safe manoeuvre. Quality of life had substantially deteriorated n these patients, but a there was a tendency, although not statistically significant, for it to improve in patients after good surgical reduction. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Effect of Cortical Screw Diameter on Reduction and Stabilization of Type III Distal Phalanx Fractures: An Equine Cadaveric Study.

PubMed

Kay, Alastair T; Durgam, Sushmitha; Stewart, Matthew; Joslyn, Stephen; Schaeffer, David J; Horn, Gavin; Kesler, Richard; Chew, Peter

2016-11-01

To compare reduction of type III distal phalangeal fractures using 4.5 and 5.5 mm cortical screws placed in lag fashion and an intact hoof capsule model. Cadaveric experimental study. Hooves from 12 adult horses (n=24). Sagittal fractures were created in pairs of distal phalanges after distal interphalangeal joint disarticulation and were reduced with either 4.5 or 5.5 mm cortical screws placed in lag fashion. Contralateral phalanges served as non-reduced controls. Fracture reduction following screw placement was assessed by comparing pre-reduction and post-reduction fracture gap measurements from radiographs using paired t-tests. Effects of incremental loading (0, 135, 270, 540, 800, 1070, and 1335 kg) on fracture gaps in 6 phalanges reduced with 4.5 mm screws and 5 phalanges reduced with 5.5 mm screws were measured from fluoroscopic images and assessed by 2-way ANOVA. Significance was set at P<.05. Type III distal phalanx fractures were reliably created. Only 5.5 mm cortical screws, not 4.5 mm screws, significantly reduced fracture gaps and constrained fracture gap expansion 3 cm distal to the articular surface. Compressive loading closed the fracture gaps at the articular surface in both non-reduced control groups and those reduced with either 5.5 or 4.5 mm screws. The 5.5 mm cortical screws were more effective than 4.5 mm screws in reducing type III distal phalanx fractures and restricting distal fracture gap expansion under load. © Copyright 2016 by The American College of Veterinary Surgeons.

Open reduction-internal fixation of a navicular body fracture with dorsal displacement of the first and second cuneiforms: a case report.

PubMed

Andersen, Robert C; Neiderer, Katherine; Martin, Billy; Dancho, James

2013-01-01

Body fractures of the tarsal navicular are relatively uncommon. To date, there is little literature discussing a navicular body fracture with dorsal subluxation of the first and second cuneiforms over the navicular. This case study presents a 30-year-old patient with this injury. He underwent open reduction internal fixation of the navicular body fracture successfully but failed adequate reduction of the navicular cuneiform joint after ligamentous reconstruction. After revisional surgery, he also failed 6 weeks of percutanous pinning with Kirschner-wire fixation. When comparing the literature of a similar injury, the Lisfranc fracture disclocation, the same principles may apply. One should consider rigid open reduction internal fixation or even primary fusion to treat disclocation of the naviculocuneiform joint following a navicular body fracture.

Identification of fracture zones and its application in automatic bone fracture reduction.

PubMed

Paulano-Godino, Félix; Jiménez-Delgado, Juan J

2017-04-01

The preoperative planning of bone fractures using information from CT scans increases the probability of obtaining satisfactory results, since specialists are provided with additional information before surgery. The reduction of complex bone fractures requires solving a 3D puzzle in order to place each fragment into its correct position. Computer-assisted solutions may aid in this process by identifying the number of fragments and their location, by calculating the fracture zones or even by computing the correct position of each fragment. The main goal of this paper is the development of an automatic method to calculate contact zones between fragments and thus to ease the computation of bone fracture reduction. In this paper, an automatic method to calculate the contact zone between two bone fragments is presented. In a previous step, bone fragments are segmented and labelled from CT images and a point cloud is generated for each bone fragment. The calculated contact zones enable the automatic reduction of complex fractures. To that end, an automatic method to match bone fragments in complex fractures is also presented. The proposed method has been successfully applied in the calculation of the contact zone of 4 different bones from the ankle area. The calculated fracture zones enabled the reduction of all the tested cases using the presented matching algorithm. The performed tests show that the reduction of these fractures using the proposed methods leaded to a small overlapping between fragments. The presented method makes the application of puzzle-solving strategies easier, since it does not obtain the entire fracture zone but the contact area between each pair of fragments. Therefore, it is not necessary to find correspondences between fracture zones and fragments may be aligned two by two. The developed algorithms have been successfully applied in different fracture cases in the ankle area. The small overlapping error obtained in the performed tests demonstrates the absence of visual overlapping in the figures. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Alendronate for fracture prevention in postmenopause.

PubMed

Holder, Kathryn K; Kerley, Sara Shelton

2008-09-01

Osteoporosis is an abnormal reduction in bone mass and bone deterioration leading to increased fracture risk. Alendronate (Fosamax) belongs to the bisphosphonate class of drugs, which act to inhibit bone resorption by interfering with the activity of osteoclasts. To assess the effectiveness of alendronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women. The authors searched Central, Medline, and EMBASE for relevant randomized controlled trials published from 1966 to 2007. The authors undertook study selection and data abstraction in duplicate. The authors performed meta-analysis of fracture outcomes using relative risks, and a relative change greater than 15 percent was considered clinically important. The authors assessed study quality through reporting of allocation concealment, blinding, and withdrawals. Eleven trials representing 12,068 women were included in the review. Relative and absolute risk reductions for the 10-mg dose were as follows. For vertebral fractures, a 45 percent relative risk reduction was found (relative risk [RR] = 0.55; 95% confidence interval [CI], 0.45 to 0.67). This was significant for primary prevention, with a 45 percent relative risk reduction (RR = 0.55; 95% CI, 0.38 to 0.80) and 2 percent absolute risk reduction; and for secondary prevention, with 45 percent relative risk reduction (RR = 0.55; 95% CI, 0.43 to 0.69) and 6 percent absolute risk reduction. For nonvertebral fractures, a 16 percent relative risk reduction was found (RR = 0.84; 95% CI, 0.74 to 0.94). This was significant for secondary prevention, with a 23 percent relative risk reduction (RR = 0.77; 95% CI, 0.64 to 0.92) and a 2 percent absolute risk reduction, but not for primary prevention (RR = 0.89; 95% CI, 0.76 to 1.04). There was a 40 percent relative risk reduction in hip fractures (RR = 0.60; 95% CI, 0.40 to 0.92), but only secondary prevention was significant, with a 53 percent relative risk reduction (RR = 0.47; 95% CI, 0.26 to 0.85) and a 1 percent absolute risk reduction. The only significance found for wrist fractures was in secondary prevention, with a 50 percent relative risk reduction (RR = 0.50; 95% CI, 0.34 to 0.73) and a 2 percent absolute risk reduction. For adverse events, the authors found no statistically significant difference in any included study. However, observational data raise concerns about potential risk for upper gastrointestinal injury and, less commonly, osteonecrosis of the jaw. At 10 mg of alendronate per day, clinically important and statistically significant reductions in vertebral, nonvertebral, hip, and wrist fractures were observed for secondary prevention. The authors found no statistically significant results for primary prevention, with the exception of vertebral fractures, for which the reduction was clinically important.

Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women.

PubMed

Yusuf, Akeem A; Cummings, Steven R; Watts, Nelson B; Feudjo, Maurille Tepie; Sprafka, J Michael; Zhou, Jincheng; Guo, Haifeng; Balasubramanian, Akhila; Cooper, Cyrus

2018-03-21

Studies examining real-world effectiveness of osteoporosis therapies are beset by limitations due to confounding by indication. By evaluating longitudinal changes in fracture incidence, we demonstrated that osteoporosis therapies are effective in reducing fracture risk in real-world practice settings. Osteoporosis therapies have been shown to reduce incidence of vertebral and non-vertebral fractures in placebo-controlled randomized clinical trials. However, information on the real-world effectiveness of these therapies is limited. We examined fracture risk reduction in older, post-menopausal women treated with osteoporosis therapies. Using Medicare claims, we identified 1,278,296 women age ≥ 65 years treated with zoledronic acid, oral bisphosphonates, denosumab, teriparatide, or raloxifene. Fracture incidence rates before and after treatment initiation were described to understand patients' fracture risk profile, and fracture reduction effectiveness of each therapy was evaluated as a longitudinal change in incidence rates. Fracture incidence rates increased during the period leading up to treatment initiation and were highest in the 3-month period most proximal to treatment initiation. Fracture incidence rates following treatment initiation were significantly lower than before treatment initiation. Compared with the 12-month pre-index period, there were reductions in clinical vertebral fractures for denosumab (45%; 95% confidence interval [CI] 39-51%), zoledronic acid (50%; 95% CI 47-52%), oral bisphosphonates (24%; 95% CI 22-26%), and teriparatide (72%; 95% CI 69-75%) during the subsequent 12 months. Relative to the first 3 months after initiation, clinical vertebral fractures were reduced for denosumab (51%; 95% CI 42-59%), zoledronic acid (25%; 95% CI 17-32%), oral bisphosphonates (23%; 95% CI 20-26%), and teriparatide (64%; 95% CI 58-69%) during the subsequent 12 months. In summary, reductions in fracture incidence over time were observed in cohorts of patients treated with osteoporosis therapies.

Pediatric jaw fractures: indications for open reduction.

PubMed

Krausen, A S; Samuel, M

1979-01-01

Jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment. During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow-up, no dental problems have been seen.

Anterior screw fixation of a dislocated type II odontoid fracture facilitated by transoral and posterior cervical manual reduction.

PubMed

Piedra, Mark P; Hunt, Matthew A; Nemecek, Andrew N

2009-10-01

Early fixation of type II odontoid fractures has been shown to provide high rates of long-term stabilization and osteosynthesis. In this report, the authors present the case of a patient with a locked type II odontoid fracture treated by anterior screw fixation facilitated by closed transoral and posterior cervical manual reduction. While transoral intraoperative reduction of a partially displaced odontoid fracture has previously been described, the authors present the first case utilizing this technique in the treatment of a completely dislocated type II odontoid fracture.

Male osteoporosis: clinical approach and management in family practice

PubMed Central

Goh, Lay Hoon; How, Choon How; Lau, Tang Ching

2014-01-01

In Singapore, male osteoporosis is gaining greater importance due to our ageing population. Family physicians should screen for osteoporosis in elderly men and men with risk factors or secondary causes for the condition. A bone mineral density (BMD) test is used for diagnosis. FRAX® can be used to predict the absolute ten-year fracture risk. Management includes reduction of risk factors or secondary causes, fall prevention, appropriate physical activity and a diet adequate in calcium and vitamin D. Referrals to specialists for evaluation and therapy can be considered, particularly for younger men with more severe disease. Current first-line drug treatment includes bisphosphonates and teriparatide. Testosterone increases BMD of the spine, but data on fracture risk reduction is unavailable. Public and physician education with the involvement of health authorities can create greater awareness of this silent condition, which can lead to complications, morbidity and death, if left untreated. PMID:25091882

Baseline Serum Estradiol and Fracture Reduction During Treatment With Hormone Therapy: The Women’s Health Initiative Randomized Trial

PubMed Central

Cauley, Jane A.; LaCroix, Andrea Z.; Robbins, John A.; Larson, Joseph; Wallace, Robert; Wactawski-Wende, Jean; Chen, Zhao; Bauer, Douglas C.; Cummings, Steven R.; Jackson, Rebecca

2009-01-01

Purpose To test the hypothesis that the reduction in fractures with hormone therapy (HT) is greater in women with lower estradiol levels. Methods We conducted a nested case-control study within the Women’s Health Initiative HT Trials. The sample included 231 hip fracture case-control pairs and a random sample of 519 all fracture case-control pairs. Cases and controls were matched for age, ethnicity, randomization date, fracture history and hysterectomy status. Hormones were measured prior to randomization. Incident cases of fracture identified over an average follow-up of 6.53 years. Results There was no evidence that the effect of HT on fracture differed by baseline estradiol (E2) or sex hormone binding globulin (SHBG). Across all quartiles of E2 and SHBG, women randomized to HT had about a 50% lower risk of fracture including hip fracture, compared to placebo. Conclusion The effect of HT on fracture reduction is independent of estradiol and SHBG levels. PMID:19436934

7-year follow-up after open reduction and internal screw fixation in Bennett fractures.

PubMed

Leclère, Franck Marie Patrick; Jenzer, Achat; Hüsler, Rolf; Kiermeir, David; Bignion, Dietmar; Unglaub, Frank; Vögelin, Esther

2012-07-01

Bennett fractures are unstable, and, with inadequate treatment, lead to osteoarthritis, weakness and loss of function of the first carpometacarpal joint. This study focuses on long-term functional and radiological outcomes after open reduction and internal fixation. Between June 1997 and December 2005, 24 patients with Bennett fractures were treated with open reduction and internal fixation with screws at our center. Radiological and functional assessments including range of motion of the thumb and pinch and grip strength were performed 4 months post-procedure and at the long-term follow-up, on average 83 months after surgery. Reduction of the Bennett fracture was maintained as it was at the time of the procedure in 96 % of the cases when fixation with two lag screws was performed. At the 4-month follow-up, mean pinch and grip strength reached 92 ± 3 and 89 ± 4 % of the contralateral side, respectively. Long-term follow-up demonstrated no correlation between the accuracy of the fracture reduction and the development of post-traumatic arthritis. Good clinical results could be observed, if successful reduction of the fracture was achieved and maintained. However, there was no correlation between the accuracy of the fracture reduction considering a gap and step <2 mm and the development of arthritis.

Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

PubMed

Menachem, S; Sharfman, Z T; Perets, I; Arami, A; Eyal, G; Drexler, M; Chechik, O

2016-06-01

To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1-16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.

PubMed

Repanos, Costa; Anderson, Daniel; Earnshaw, James; Mitchell, David; Coman, William

2010-06-01

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Malleolar fractures and their ligamentous injury equivalents have similar outcomes in supination-external rotation type IV fractures of the ankle treated by anatomical internal fixation.

PubMed

Berkes, M B; Little, M T M; Lazaro, L E; Sculco, P K; Cymerman, R M; Daigl, M; Helfet, D L; Lorich, D G

2012-11-01

It has previously been suggested that among unstable ankle fractures, the presence of a malleolar fracture is associated with a worse outcome than a corresponding ligamentous injury. However, previous studies have included heterogeneous groups of injury. The purpose of this study was to determine whether any specific pattern of bony and/or ligamentous injury among a series of supination-external rotation type IV (SER IV) ankle fractures treated with anatomical fixation was associated with a worse outcome. We analysed a prospective cohort of 108 SER IV ankle fractures with a follow-up of one year. Pre-operative radiographs and MRIs were undertaken to characterise precisely the pattern of injury. Operative treatment included fixation of all malleolar fractures. Post-operative CT was used to assess reduction. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and the range of movement of the ankle. There were no clinically relevant differences between the four possible SER IV fracture pattern groups with regard to the FAOS or range of movement. In this population of strictly defined SER IV ankle injuries, the presence of a malleolar fracture was not associated with a significantly worse clinical outcome than its ligamentous injury counterpart. Other factors inherent to the injury and treatment may play a more important role in predicting outcome.

Paediatric forearm fractures: functional outcome of conservative treatment.

PubMed

Tarmuzi, Nazari Ahmad; Abdullah, Shalimar; Osman, Zulkiflee; Das, Srijit

2009-01-01

Forearm fractures are common in the paediatric age group. Closed reduction and casting are the primary means of treatment in over 90% of these fractures. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational deformity and fragment displacement. Retrospectively, 48 patients aged between 4 to 12 years with forearm fractures, were treated conservatively with closed reduction and a cast during a 2-year period. Functional outcomes were measured in terms of pronation and supination. All fractures united before the final visit. Most forearm bone fractures were complete fractures at the mid shaft. Eighty-six percent of the patients had excellent functional outcomes and none had poor outcomes. There were significantly reduced angles of deformities before and after treatment (p < 0.05). Radiographically, in the frontal plane, 57.1% of radius and 73.9% of ulnar fractures achieved perfect reduction (i.e. a degree of deformity of less than 5 degrees). However, in the lateral plane, there were fewer perfect reductions for the radius and ulna, at 14.6% and 54.3%, respectively. All except for one patient were satisfied with the outcomes. The level of fracture did not influence the outcomes. Conservative treatment is still an acceptable form of treatment especially for stable forearm fractures in children achieving excellent outcomes (Tab. 1, Fig. 7, Ref. 20).

Lag screw fixation of anterior mandibular fractures: a retrospective analysis of intraoperative and postoperative complications.

PubMed

Tiwana, Paul S; Kushner, George M; Alpert, Brian

2007-06-01

To review, retrospectively, the outcomes of 102 patients who underwent lag screw technique fixation of fractures of the anterior mandible. A total of 102 consecutive, skeletally mature patients who have undergone open reduction internal fixation for fractures of the anterior mandible utilizing the lag screw technique were reviewed. All patients had a clinically mobile fracture between the mental foramina of the mandible. The patients were followed at usual postoperative intervals with shortest long-term follow-up of 2 months. Intraoperative and long-term postoperative outcomes including status of union, infection, and intraoperative surgical misadventure were recorded. Data from the 102 patients showed that there was 1 fixation failure due to inappropriate patient selection, 1 nonunion requiring bone grafting, 1 with infected screws but with union, 1 with an infected screw and delayed union treated conservatively, and 6 with broken drills from intraoperative surgical misadventures. Lag screw osteosynthesis of anterior mandibular fractures is a sensitive, facile, predictable, and relatively inexpensive method for internal fixation of indicated fractures. As with all methods of rigid internal fixation, most failures or complications are the result of operator judgment or technique.

A nonlinear fracture mechanics approach to the growth of small cracks

NASA Technical Reports Server (NTRS)

Newman, J. C., Jr.

1983-01-01

An analytical model of crack closure is used to study the crack growth and closure behavior of small cracks in plates and at notches. The calculated crack opening stresses for small and large cracks, together with elastic and elastic plastic fracture mechanics analyses, are used to correlate crack growth rate data. At equivalent elastic stress intensity factor levels, calculations predict that small cracks in plates and at notches should grow faster than large cracks because the applied stress needed to open a small crack is less than that needed to open a large crack. These predictions agree with observed trends in test data. The calculations from the model also imply that many of the stress intensity factor thresholds that are developed in tests with large cracks and with load reduction schemes do not apply to the growth of small cracks. The current calculations are based upon continuum mechanics principles and, thus, some crack size and grain structure exist where the underlying fracture mechanics assumptions become invalid because of material inhomogeneity (grains, inclusions, etc.). Admittedly, much more effort is needed to develop the mechanics of a noncontinuum. Nevertheless, these results indicate the importance of crack closure in predicting the growth of small cracks from large crack data.

Microbial communities and their predicted metabolic characteristics in deep fracture groundwaters of the crystalline bedrock at Olkiluoto, Finland

NASA Astrophysics Data System (ADS)

Bomberg, Malin; Lamminmäki, Tiina; Itävaara, Merja

2016-11-01

The microbial diversity in oligotrophic isolated crystalline Fennoscandian Shield bedrock fracture groundwaters is high, but the core community has not been identified. Here we characterized the bacterial and archaeal communities in 12 water conductive fractures situated at depths between 296 and 798 m by high throughput amplicon sequencing using the Illumina HiSeq platform. Between 1.7 × 104 and 1.2 × 106 bacterial or archaeal sequence reads per sample were obtained. These sequences revealed that up to 95 and 99 % of the bacterial and archaeal sequences obtained from the 12 samples, respectively, belonged to only a few common species, i.e. the core microbiome. However, the remaining rare microbiome contained over 3- and 6-fold more bacterial and archaeal taxa. The metabolic properties of the microbial communities were predicted using PICRUSt. The approximate estimation showed that the metabolic pathways commonly included fermentation, fatty acid oxidation, glycolysis/gluconeogenesis, oxidative phosphorylation, and methanogenesis/anaerobic methane oxidation, but carbon fixation through the Calvin cycle, reductive TCA cycle, and the Wood-Ljungdahl pathway was also predicted. The rare microbiome is an unlimited source of genomic functionality in all ecosystems. It may consist of remnants of microbial communities prevailing in earlier environmental conditions, but could also be induced again if changes in their living conditions occur.

Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people.

PubMed

Nakamura, K; Takahashi, S; Oyama, M; Oshiki, R; Kobayashi, R; Saito, T; Yoshizawa, Y; Tsuchiya, Y

2010-08-01

This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard ratio = 2.14), independent of activities of daily living (ADL), mobility, dementia, weight, and type of nursing home. Prior nonhip fractures are useful for predicting of hip fracture in institutional settings. The aim of this study was to evaluate the utility of fracture history for the prediction of hip fracture in nursing home residents. This was a cohort study with a 1-year follow-up. Subjects were 8,905 residents of nursing homes in Niigata, Japan (mean age, 84.3 years). Fracture histories were obtained from nursing home medical records. ADL levels were assessed by caregivers. Hip fracture diagnosis was based on hospital medical records. Subjects had fracture histories of upper limbs (5.0%), hip (14.0%), and nonhip lower limbs (4.6%). Among historical single fractures, only prior nonhip lower limbs significantly predicted subsequent fracture (adjusted hazard ratio, 2.43; 95% confidence interval (CI), 1.30-4.57). The stepwise method selected the best model, in which a combined historical fracture at upper limbs or nonhip lower limbs (adjusted hazard ratio, 2.14; 95% CI, 1.30-3.52), dependence, ADL levels, mobility, dementia, weight, and type of nursing home independently predicted subsequent hip fracture. A fracture history at upper or nonhip lower limbs, in combination with other known risk factors, is useful for the prediction of future hip fracture in institutional settings.

External skeletal fixator intramedullary pin tie-in for the repair of tibiotarsal fractures in raptors: 37 cases (1995-2011).

PubMed

Bueno, Irene; Redig, Patrick T; Rendahl, Aaron K

2015-11-15

To evaluate the outcome of the application of an external skeletal fixator intramedullary pin tie-in (TIF) to tibiotarsal fractures in raptors. Retrospective case series. Thirty-four raptors with 37 tibiotarsal fractures. Medical records and radiographs for raptors with tibiotarsal fractures that were treated at The Raptor Center at the University of Minnesota between 1995 and 2011 were reviewed. Descriptive statistics were generated and univariate logistic regression analyses were used to assess whether age, sex, body weight, location and nature of the fracture, and type of surgical reduction were significantly associated with whether the fracture healed following surgical reduction and TIF application. 31 of 37 (84%) tibiotarsal fractures successfully healed following surgical reduction and TIF application. The mean healing time was 38 days (range, 15 to 70 days). None of the variables assessed were significantly associated with whether the tibiotarsal fracture healed. Twenty of the 34 (59%) raptors were eventually rehabilitated and released. Results indicated that most tibiotarsal fractures were successfully managed by surgical reduction and stabilization with a TIF. However, other comorbidities (eg, systemic infections and visual deficits) negatively affected the rehabilitation of raptors and sometimes resulted in euthanasia despite the fact that the tibiotarsal fracture had healed, and those comorbidities, along with the variables evaluated (eg, age, sex, and nature of the fracture), should be used as triage criteria and prognostic indicators.

Percutaneous or Open Reduction of Closed Tibial Shaft Fractures During Intramedullary Nailing Does Not Increase Wound Complications, Infection or Nonunion Rates.

PubMed

Auston, Darryl A; Meiss, Jordan; Serrano, Rafael; Sellers, Thomas; Carlson, Gregory; Hoggard, Timothy; Beebe, Michael; Quade, Jonathan; Watson, David; Simpson, Robert Bruce; Kistler, Brian; Shah, Anjan; Sanders, Roy; Mir, Hassan R

2017-04-01

To compare the incidence of complications (wound, infection, and nonunion) among those patients treated with closed, percutaneous, and open intramedullary nailing for closed tibial shaft fractures. Retrospective review. Multiple trauma centers. Skeletally mature patients with closed tibia fractures amenable to treatment with an intramedullary device. Intramedullary fixation with closed, percutaneous, or open reduction. Superficial wound complication, deep infection, nonunion. A total of 317 tibial shaft fractures in 315 patients were included in the study. Two-hundred fractures in 198 patients were treated with closed reduction, 61 fractures in 61 patients were treated with percutaneous reduction, and 56 fractures in 56 patients were treated with formal open reduction. The superficial wound complication rate was 1% (2/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 3.6% (2/56) for the open group with no statistical difference between the groups (P = 0.179). The deep infection rate was 2% (4/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 7.1% (4/56) for the open group with no significant difference between the groups (P = 0.133). Nonunion rate was 5.0% (10/200) for the closed group, 4.9% (3/61) for the percutaneous group, and 7.1% (4/56) for the open group, with no statistical difference between the groups (P = 0.492). This is the largest reported series of closed tibial shaft fractures nailed with percutaneous and open reduction. Percutaneous or open reduction did not result in increased wound complications, infection, or nonunion rates. Carefully performed percutaneous or open approaches can be safely used in obtaining reduction of difficult tibial shaft fractures treated with intramedullary devices. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density.

PubMed

Ripamonti, C; Lisi, L; Avella, M

2014-05-01

To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

PubMed Central

Lisi, L; Avella, M

2014-01-01

Objective: To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. Methods: We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. Results: Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. Conclusion: NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. Advances in knowledge: The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures. PMID:24678889

[Manipulative reduction and external fixation with cardboard splint for the treatment of calcaneal fractures: a 60-case report].

PubMed

Hao, Bo-Chuan; Xie, Ke-Bo

2014-07-01

To investigate the therapeutic effects of manipulative reduction for calcaneal fractures. From January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus. All cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor. Manipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.

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.

Open reduction and internal fixation of patellar fractures with tension band wiring through cannulated screws.

PubMed

Malik, Mudasir; Halwai, Manzoor Ahmad

2014-10-01

The purpose of this study was to evaluate effectiveness and safety of a relatively new technique of open reduction and internal fixation of displaced transverse patellar fractures with tension band wiring (TBW) through parallel cannulated compression screws. A total of 30 patients with displaced transverse patellar fracture were enrolled in this prospective study. Of the 30 patients, 20 patients had trauma due to fall, 5 due to road traffic accident, 2 due to fall of heavy object on the knee, 2 due to forced flexion of knee, and 1 had fracture due to being beaten. All 30 patients were treated with vertical skin exposure, fracture open reduction, and internal fixation by anterior TBW through 4.0 mm cannulated screws. The postoperative rehabilitation protocol was standardized. The patients were followed postsurgery to evaluate time required for radiographic bone union, knee joint range of motion (ROM), loss of fracture reduction, material failure, and the overall functional result of knee using Bostman scoring. All the fractures healed radiologically, at an average time of 10.7 weeks (range, 8-12 weeks). The average ROM arc was 129.7 degrees (range, 115-140 degrees). No patient had loss of fracture reduction, implant migration, or material failure. The average Bostman score was 28.6 out of 30. Anterior TBW through cannulated screws for displaced transverse fractures is safe and effective alternative treatment. Good functional results and recovery can be expected. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Manipulative reduction and percutaneous Kirschner wire internal fixation for grade IV supination-external rotation ankle fractures].

PubMed

Li, Jia; Sun, Jin-Ke; Wang, Chen-Lin

2017-06-25

To investigate surgical skills and clinical effects of manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures. From May 2013 to October 2016, 35 patients with grade IV supination-external rotation ankle fractures were treated with percutaneous Kirschner wire internal fixation, involving 22 males and 13 females with an average age of 38.2 years ranged from 18 to 65 years old. The time from injury to operation ranged from 2 h to 10 d with an average of 5 d. Reduction quality was assessed by Burwell-Charnley radiological criteria. Baird-Jackson ankle scoring system was used to assess clinical effects. Thirty-three patients were followed up from 10 to 28 months with an average of 14 months. Fracture healing time ranged from 10 to 18 weeks with an average of 12 weeks. According to Burwell-Charnley radiological criteria, 30 cases were obtained anatomic reduction, 3 cases moderate. According to Baird-Jackson ankle scoring system, total score was 93.8±5.4, 17 cases got excellent result, 12 good, 2 fair and 2 poor. Manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures has advantages of reliable efficacy, less complications. But higher require techniques were required for closed reduction. It is not suitable for severe crushed fracture and compressive articular surface fracture.

Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures.

PubMed

Burnei, C; Popescu, Gh; Barbu, D; Capraru, F

2011-11-14

Due to an ever-aging population and a growing prevalence of osteoporosis and motor vehicle accidents, the number of subtrochanteric fractures is increasing worldwide. The choice of the appropriate implant continues to be critical for fixation of unstable hip fractures. The subtrochanteric region has certain anatomical and biomechanical features that can make fractures in this region difficult to treat. The preferred type of device is a matter of debate. Increased understandings of biomechanical characteristics of the hip and improvement of the implant materials have reduced the incidence of complications. The surgeons choose between the two methods according to Seinsheimer's classification and also to their personal preferences. As a general principle, the open reduction and internal fixation were performed in stable fractures, and the closed reduction and internal fixation were performed in unstable fractures. The advantages of intramedullary nailing consist in a small skin incision, lower operating times, preservation of fracture hematoma and the possibility of early weight bearing. The disadvantages consist in a difficult closed reduction due to important muscular forces, although the nail can be used as a reduction instrument, and higher implant cost. In open reduction internal fixation techniques, the advantage is represented by anatomical reduction which, in our opinion, is not necessary. The disadvantages are represented by: higher operating time, demanding surgery, large devascularization, higher infection rates, late weight bearing, medial instability, refracture after plate removal and inesthetic approach.

Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures

PubMed Central

Burnei, C; Popescu, Gh; Barbu, D; Capraru, F

2011-01-01

Due to an ever-aging population and a growing prevalence of osteoporosis and motor vehicle accidents, the number of subtrochanteric fractures is increasing worldwide. The choice of the appropriate implant continues to be critical for fixation of unstable hip fractures. The subtrochanteric region has certain anatomical and biomechanical features that can make fractures in this region difficult to treat. The preferred type of device is a matter of debate. Increased understandings of biomechanical characteristics of the hip and improvement of the implant materials have reduced the incidence of complications. The surgeons choose between the two methods according to Seinsheimer's classification and also to their personal preferences. As a general principle, the open reduction and internal fixation were performed in stable fractures, and the closed reduction and internal fixation were performed in unstable fractures. The advantages of intramedullary nailing consist in a small skin incision, lower operating times, preservation of fracture hematoma and the possibility of early weight bearing. The disadvantages consist in a difficult closed reduction due to important muscular forces, although the nail can be used as a reduction instrument, and higher implant cost. In open reduction internal fixation techniques, the advantage is represented by anatomical reduction which, in our opinion, is not necessary. The disadvantages are represented by: higher operating time, demanding surgery, large devascularization, higher infection rates, late weight bearing, medial instability, refracture after plate removal and inesthetic approach. PMID:22514563

Computational Prediction of Shock Ignition Thresholds and Ignition Probability of Polymer-Bonded Explosives

NASA Astrophysics Data System (ADS)

Wei, Yaochi; Kim, Seokpum; Horie, Yasuyuki; Zhou, Min

2017-06-01

A computational approach is developed to predict the probabilistic ignition thresholds of polymer-bonded explosives (PBXs). The simulations explicitly account for microstructure, constituent properties, and interfacial responses and capture processes responsible for the development of hotspots and damage. The specific damage mechanisms considered include viscoelasticity, viscoplasticity, fracture, post-fracture contact, frictional heating, and heat conduction. The probabilistic analysis uses sets of statistically similar microstructure samples to mimic relevant experiments for statistical variations of material behavior due to inherent material heterogeneities. The ignition thresholds and corresponding ignition probability maps are predicted for PBX 9404 and PBX 9501 for the impact loading regime of Up = 200 --1200 m/s. James and Walker-Wasley relations are utilized to establish explicit analytical expressions for the ignition probability as a function of load intensities. The predicted results are in good agreement with available experimental measurements. The capability to computationally predict the macroscopic response out of material microstructures and basic constituent properties lends itself to the design of new materials and the analysis of existing materials. The authors gratefully acknowledge the support from Air Force Office of Scientific Research (AFOSR) and the Defense Threat Reduction Agency (DTRA).

Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures.

PubMed

Ekpe, Eyo Effiong; Eyo, Catherine

2017-01-01

Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study. This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury. There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as "okada") and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates> 30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2of 96%. This improved after 1 h of administration of analgesics to SpO2of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2of < 97% (P = 0.006). Before analgesia, no patient was able to achieve peak expiratory flow rate (PEFR) value> 100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%-100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values> 100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%-100% predicted. Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through improvement in respiratory mechanics.

Assessment of non‐vertebral fracture risk in postmenopausal women

PubMed Central

Roux, Christian; Briot, Karine; Horlait, Stéphane; Varbanov, Alex; Watts, Nelson B; Boonen, Steven

2007-01-01

Background Non‐vertebral (NV) fractures are responsible for a great amount of morbidity, mortality and cost attributable to osteoporosis. Objectives To identify risk factors for NV fractures in postmenopausal women with osteoporosis, and to design an assessment tool for prediction of these fractures. Methods 2546 postmenopausal women with osteoporosis included in the placebo groups of three risedronate controlled trials were included (mean age 72 years, mean femoral T‐score −2.5; 60% and 53% of patients with prevalent vertebral and NV fractures, respectively). Over 3 years, 222 NV fractures were observed. Baseline data on 14 risk factors were included in a logistic regression analysis. Results 6 risk factors were associated with NV fracture risk: prevalent NV fracture (p = 0.004), number of prevalent vertebral fractures (p<0.001), femoral T‐score (p = 0.031), serum level of 25‐hydroxyvitamin D (p<0.001), age (p = 0.012) and height (p = 0.037). An NV risk index was developed by converting the multivariate logistic equation into an additive score. In the group of women with a score ⩾2.1, the incidence of NV fracture was 13.2% (95% CI 11.1 to 15.3), 1.5 times higher than that of the general population. Conclusions The NV risk index is a convenient tool for selection of patients with osteoporosis with a high risk for NV fractures, and may help to choose from available treatments those with a proven efficacy for reduction of NV fracture risk. PMID:17314119

The impact of different aperture distribution models and critical stress criteria on equivalent permeability in fractured rocks

NASA Astrophysics Data System (ADS)

Bisdom, Kevin; Bertotti, Giovanni; Nick, Hamidreza M.

2016-05-01

Predicting equivalent permeability in fractured reservoirs requires an understanding of the fracture network geometry and apertures. There are different methods for defining aperture, based on outcrop observations (power law scaling), fundamental mechanics (sublinear length-aperture scaling), and experiments (Barton-Bandis conductive shearing). Each method predicts heterogeneous apertures, even along single fractures (i.e., intrafracture variations), but most fractured reservoir models imply constant apertures for single fractures. We compare the relative differences in aperture and permeability predicted by three aperture methods, where permeability is modeled in explicit fracture networks with coupled fracture-matrix flow. Aperture varies along single fractures, and geomechanical relations are used to identify which fractures are critically stressed. The aperture models are applied to real-world large-scale fracture networks. (Sub)linear length scaling predicts the largest average aperture and equivalent permeability. Barton-Bandis aperture is smaller, predicting on average a sixfold increase compared to matrix permeability. Application of critical stress criteria results in a decrease in the fraction of open fractures. For the applied stress conditions, Coulomb predicts that 50% of the network is critically stressed, compared to 80% for Barton-Bandis peak shear. The impact of the fracture network on equivalent permeability depends on the matrix hydraulic properties, as in a low-permeable matrix, intrafracture connectivity, i.e., the opening along a single fracture, controls equivalent permeability, whereas for a more permeable matrix, absolute apertures have a larger impact. Quantification of fracture flow regimes using only the ratio of fracture versus matrix permeability is insufficient, as these regimes also depend on aperture variations within fractures.

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.

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.

A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

PubMed Central

Faroug, Radwane; Stirling, Paul; Ali, Farhan

2013-01-01

Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome. PMID:23819090

Optimizing hydraulic fracture design in the diatomite formation, Lost Hills Field

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

Nelson, D.G.; Klins, M.A.; Manrique, J.F.

1996-12-31

Since 1988, over 1.3 billion pounds of proppant have been placed in the Lost Hills Field of Kern County. California in over 2700 hydraulic fracture treatments involving investments of about $150 million. In 1995, systematic reevaluation of the standard, field trial-based fracture design began. Reservoir, geomechanical, and hydraulic fracture characterization; production and fracture modeling; sensitivity analysis; and field test results were integrated to optimize designs with regard to proppant volume, proppant ramps, and perforating strategy. The results support a reduction in proppant volume from 2500 to 1700 lb/ft which will save about $50,000 per well, totalling over $3 million permore » year. Vertical coverage was found to be a key component of fracture quality which could be optimized by eliminating perforations from lower stress intervals, reducing the total number of perforations, and reducing peak slurry loading from 16 to 12 ppa. A relationship between variations in lithology, pore pressure, and stress was observed. Point-source, perforating strategies were investigated and variable multiple fracture behavior was observed. The discussed approach has application in areas where stresses are variable; pay zones are thick; hydraulic fracture design is based primarily on empirical, trial-and-error field test results; and effective, robust predictive models involving real-data feedback have not been incorporated into the design improvement process.« less

Integrated detection of fractures and caves in carbonate fractured-vuggy reservoirs based on seismic data and well data

NASA Astrophysics Data System (ADS)

Cao, Zhanning; Li, Xiangyang; Sun, Shaohan; Liu, Qun; Deng, Guangxiao

2018-04-01

Aiming at the prediction of carbonate fractured-vuggy reservoirs, we put forward an integrated approach based on seismic and well data. We divide a carbonate fracture-cave system into four scales for study: micro-scale fracture, meso-scale fracture, macro-scale fracture and cave. Firstly, we analyze anisotropic attributes of prestack azimuth gathers based on multi-scale rock physics forward modeling. We select the frequency attenuation gradient attribute to calculate azimuth anisotropy intensity, and we constrain the result with Formation MicroScanner image data and trial production data to predict the distribution of both micro-scale and meso-scale fracture sets. Then, poststack seismic attributes, variance, curvature and ant algorithms are used to predict the distribution of macro-scale fractures. We also constrain the results with trial production data for accuracy. Next, the distribution of caves is predicted by the amplitude corresponding to the instantaneous peak frequency of the seismic imaging data. Finally, the meso-scale fracture sets, macro-scale fractures and caves are combined to obtain an integrated result. This integrated approach is applied to a real field in Tarim Basin in western China for the prediction of fracture-cave reservoirs. The results indicate that this approach can well explain the spatial distribution of carbonate reservoirs. It can solve the problem of non-uniqueness and improve fracture prediction accuracy.

A Fracture Decoupling Experiment

NASA Astrophysics Data System (ADS)

Stroujkova, A. F.; Bonner, J. L.; Leidig, M.; Ferris, A. N.; Kim, W.; Carnevale, M.; Rath, T.; Lewkowicz, J.

2012-12-01

Multiple observations made at the Semipalatinsk Test Site suggest that conducting nuclear tests in the fracture zones left by previous explosions results in decreased seismic amplitudes for the second nuclear tests (or "repeat shots"). Decreased seismic amplitudes reduce both the probability of detection and the seismically estimated yield of a "repeat shot". In order to define the physical mechanism responsible for the amplitude reduction and to quantify the degree of the amplitude reduction in fractured rocks, Weston Geophysical Corp., in collaboration with Columbia University's Lamont Doherty Earth Observatory, conducted a multi-phase Fracture Decoupling Experiment (FDE) in central New Hampshire. The FDE involved conducting explosions of various yields in the damage/fracture zones of previously detonated explosions. In order to quantify rock damage after the blasts we performed well logging and seismic cross-hole tomography studies of the source region. Significant seismic velocity reduction was observed around the source regions after the initial explosions. Seismic waves produced by the explosions were recorded at near-source and local seismic networks, as well as several regional stations throughout northern New England. Our analysis confirms frequency dependent seismic amplitude reduction for the repeat shots compared to the explosions in un-fractured rocks. The amplitude reduction is caused by pore closing and/or by frictional losses within the fractured media.

Comparative evaluation of fracture resistance of Ceramic Veneer with three different incisal design preparations - An In-vitro Study.

PubMed

Jankar, Ajit S; Kale, Yogesh; Kangane, Suresh; Ambekar, Anand; Sinha, Manish; Chaware, Sachin

2014-02-01

Ceramic veneer fracture has occurred mainly at the incisal edge of the veneer because of greater stress. This study compares and evaluates the fracture resistance ceramic veneers with three different incisal preparations. 15 human permanent maxillary central incisor extracted were selected which were divided into three groups of 5 each having a different Incial design Preparation. Group 1: No Incisal reduction with facio- incisal bevel, Group 2 : 1 mm incisal reduction with butt joint, Group 3 : 1 mm incisal reduction with 1 mm height of Palatal chamfer. It was found that Group III had greater fracture resistance as compared to Group I and Group II. Group I had least fracture resistance as compared to Group II and III. Group II had greater fracture resistance as compared to Group I but less than Group III. Ceramic veneer with 1mm incisal reduction with 1mm height of palatal chamfer showed highest fracture resistance as compared to 1mm incisal reduction with butt joint and no incisal reduction with facial-incisal bevel, in order to achieve better esthetic and functional results. The palatal chamfer margin results in preservation of some peripheral enamel layer, which eliminates the micro leakage at the palatal margin-restoration interface and also effectively counteracting shear stress. This design provides a definite seat for cementation. How to cite the article: Jankar AS, Kale Y, Kangane S, Ambekar A, Sinha M, Chaware S. Comparative evaluation of fracture resistance of Ceramic Veneer with three different incisal design preparations - An In-vitro Study. J Int Oral Health 2014;6(1):48-54.

[Utility of nickel-titanium shape memory alloys of vertebral body reduction fixator with assisted distraction bar].

PubMed

Man, Yi; Zheng, Yue-huan; Cao, Peng; Chen, Bo; Zheng, Tao; Sun, Chang-hui; Lu, Jiong

2011-06-07

To test the nickel-titanium (Ni-Ti) shape memory alloys of vertebral body reduction fixator with assisted distraction bar for the treatment of traumatic and osteoporotic vertebral body fracture. A Ni-Ti shape memory alloys of vertebral body reduction fixator with assisted distraction bar was implanted into the compressed fracture specimens through vertebral pedicle with the radiographic monitoring to reduce the collapsed endplate as well as distract the compressed vertebral fracture. Radiographic film and computed tomographic reconstruction technique were employed to evaluate the effects of reduction and distraction. A biomechanic test machine was used to measure the fatigue and the stability of deformation of fixation segments. Relying on the effect of temperature shape memory, such an assembly could basically reduce the collapsed endplate as well as distract the compressed vertebral fracture. And when unsatisfied results of reduction and distraction occurred, its super flexibility could provide additional distraction strength. A Ni-Ti shape memory alloys of vertebral body reduction fixator with assisted distraction bar may provide effective endplate reduction, restore the vertebral height and the immediate biomechanic spinal stability. So the above assembly is indicated for the treatment of traumatic and osteoporotic vertebral body fracture.

[Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach].

PubMed

Mai, J G; Gu, C; Lin, X Z; Li, T; Huang, W Q; Wang, H; Tan, X Y; Lin, H; Wang, Y M; Yang, Y Q; Jin, D D; Fan, S C

2017-03-01

Objective: To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach. Methods: From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision. Results: All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month's follow-up, who didn't accept any treatment because the patient didn't feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all patients had achieved bone union. According to the modified Merle D'Aubigné and Postel scoring system, 5 cases were excellent, 2 cases were good, 1 case was fair. Conclusions: Surgical management of complex acetabular fracture via lateral-rectus approach combine with 3D printing personalized acetabular wing-plate can effectively improve reduction quality and fixation effect. It will be truly accurate, personalized and minimally invasive.

Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle.

PubMed

Parry, Joshua A; Barrett, Ian; Schoch, Bradley; Yuan, Brandon; Cass, Joseph; Cross, William

2018-04-01

To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. Retrospective comparative study. Level I trauma center. Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014. CMN fixation. NSA reduction and lag screw cutout. Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), -63% to -18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%-46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%-49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, -56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, -13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, -24% to 44%; P = 1.0). The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

[The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma].

PubMed

Walenkamp, Monique M J; Bentohami, Abdelali; Slaar, Annelie; Beerekamp, M S H Suzan; Maas, Mario; Jager, L C Cara; Sosef, Nico L; van Velde, Romuald; Ultee, Jan M; Steyerberg, Ewout W; Goslings, J C Carel; Schep, Niels W L

2016-01-01

Although only 39% of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma in the Emergency Department (ED) for radiography. This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wrist fractures in patients following wrist trauma; (2) external validation of this model; and (3) design of a clinical decision rule. The study was conducted in the EDs of five Dutch hospitals: one academic hospital (derivation cohort) and four regional hospitals (external validation cohort). We included all adult patients with acute wrist trauma. The main outcome was fracture of the wrist (distal radius, distal ulna or carpal bones) diagnosed on conventional X-rays. A total of 882 patients were analyzed; 487 in the derivation cohort and 395 in the validation cohort. We derived a clinical prediction model with eight variables: age; sex, swelling of the wrist; swelling of the anatomical snuffbox, visible deformation; distal radius tender to palpation; pain on radial deviation and painful axial compression of the thumb. The Area Under the Curve at external validation of this model was 0.81 (95% CI: 0.77-0.85). The sensitivity and specificity of the Amsterdam Wrist Rules (AWR) in the external validation cohort were 98% (95% CI: 95-99%) and 21% (95% CI: 15%-28). The negative predictive value was 90% (95% CI: 81-99%). The Amsterdam Wrist Rules is a clinical prediction rule with a high sensitivity and negative predictive value for fractures of the wrist. Although external validation showed low specificity and 100 % sensitivity could not be achieved, the Amsterdam Wrist Rules can provide physicians in the Emergency Department with a useful screening tool to select patients with acute wrist trauma for radiography. The upcoming implementation study will further reveal the impact of the Amsterdam Wrist Rules on the anticipated reduction of X-rays requested, missed fractures, Emergency Department waiting times and health care costs.

Analysis of patterns and treatment strategies for mandibular condyle fractures: review of 175 condyle fractures with review of literature.

PubMed

Reddy, N Viveka V; Reddy, P Bhaskar; Rajan, Ritesh; Ganti, Srinivas; Jhawar, D K; Potturi, Abhinand; Pradeep

2013-09-01

This study aims to evaluate incidence, patterns and epidemiology of mandibular condylar fractures (MCF) to propose a treatment strategy for managing MCF and analyze the factors which influence the outcome. One hundred and seventy-five MCF's were evaluated over a four year period and their pattern was recorded in terms of displacement, level of fracture, age of incidence and dental occlusion. Of the 2,718 facial bone fractures, MCF incidence was the third most common at 18.39 %. Of 175 MCF 58.8 % were unilateral and 41.12 % were bilateral. 67 % of bilateral fractures and 43.8 % of unilateral fractures were associated with midline symphysis and contralateral parasymphysis fractures respectively. Most of the MCF was seen in the age group of above 16 years and 50 % of them were at subcondylar level (below the neck of the condyle). Majority of MCF sustained due to inter personal violence were undisplaced (72.7 %) and contrary to this majority of MCF sustained during road traffic accident were displaced. 62.9 % of total fractures required open reduction and rigid fixation and 37.1 % were managed with closed reduction. 80 % of MCF managed with closed reduction were in the age group of below 16 years. From this study it can be concluded that the treatment algorithm proposed for managing MCF is reliable and easy to adopt. We observed that absolute indication for open reduction of MCF is inability to achieve satisfactory occlusion by closed method and absolute contraindication for open reduction is condylar head fracture irrespective of the age of the patient.

Second and third NIR optical windows for imaging of bone microfractures

NASA Astrophysics Data System (ADS)

Sordillo, Laura A.; Pu, Yang; Sordillo, Peter P.; Budansky, Yury; Alfano, R. R.

2014-05-01

Microfractures in bone, secondary to repetitive stress, particularly in the lower extremities, are an important problem for military recruits and for athletes. They also may occur in those with brittle bones, such as the elderly, or in patients taking bisphosphonates for osteoporosis. Microfractures can be early predictors of major bone fracture and may be as important as changes in bone density in predicting where and how likely a major fracture will occur. Unlike major bone fractures, microfractures can be difficult to detect by conventional methods. We explored a second NIR spectral window from 1,100 nm to 1,350 nm, and a third spectral window from 1,600 nm to 1,870 nm to image microfractures through tissue media. Due to a reduction in scattering at longer NIR wavelengths, employment of the second and third NIR windows may allow for deeper penetration into tissue and higher contrast images of microfractures underneath the skin.

Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results.

PubMed

Mingo-Robinet, Juan; Torres-Torres, Miguel; Moreno-Barrero, María; Alonso, Juan Antonio; García-González, Sara

2015-01-01

The treatment of subtrochanteric fractures in the elderly remains technically challenging, due to instability and osteoporosis, with high reoperation rates. Even if intramedullary nailing is the most reliable treatment, reduction is difficult and cerclage wiring remains controversial. The purpose of this study was to evaluate 26 consecutive subtrochanteric fractures in elderly patients treated with a minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage wiring. A retrospective analysis was conducted between January 2010 and September 2013. Data obtained from the medical records included patient's age, sex, classification of the fracture, the quality of reduction after surgery, and the presence of postoperative complications, especially fracture displacement and delayed union or nonunion. Twenty-six patients had adequate radiographic and clinical follow-up. Mean age was 84.4 (range 75-96) years. The mean duration of follow-up was 7.6 months (6-14 months). Mean surgical time was 74.42 min (range 45-115 min). Twenty-four (92.3%) showed acceptable varus/valgus alignment, and no sagittal plane malunions were noted. The tip-apex distance was <25 mm in all cases. Distraction at the fracture was <10mm in 21 fractures. Three patients had limb length discrepancy of 1cm. All fractures healed uneventfully. Reducing the fracture before nailing is mandatory to achieve good results. Minimally invasive clamp reduction without cerclage wires, even if challenging, has proven to be a safe, reproducible, and effective surgical technique, with at least the same results as other series. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

Open reduction of nasal bone fractures through an intercartilaginous incision.

PubMed

Kim, Ji Heui; Lee, Jun Ho; Hong, Seok Min; Park, Chan Hum

2013-01-01

Open reduction through an intercartilaginous incision was useful for treating delayed-diagnosed nasal bone fractures because it resulted in a successful outcome with minimal complications. Nasal bone fractures are generally managed with closed reduction, which is usually inadequate and results in airway obstruction with a delayed diagnosis of nasal bone fracture when bone healing and fibrotic adhesions around the bone fragment have progressed. This study investigated the surgical outcome of open reduction through an intercartilaginous incision for delayed-diagnosis nasal bone fractures. The study enrolled 18 patients who underwent open reduction through an intercartilaginous incision to correct delayed-diagnosis nasal bone fractures. Three independent otorhinolaryngologists evaluated the outcomes 4-35 months (average 12.7 months) postoperatively as excellent, fair or poor. The time from injury to surgery was 11-39 days (20-39 days in adults and 11-30 days in children). The 18 cases included 16 primary repairs and two revisions. A Kirschner wire was inserted in six (33.3%) patients who had unstable reduced nasal bones. Postoperatively, l5 (83%) patients had excellent results, two (11%) had fair, and one (6%) had a poor outcome. No patient experienced any complication.

Intra-operative 3D imaging system for robot-assisted fracture manipulation.

PubMed

Dagnino, G; Georgilas, I; Tarassoli, P; Atkins, R; Dogramadzi, S

2015-01-01

Reduction is a crucial step in the treatment of broken bones. Achieving precise anatomical alignment of bone fragments is essential for a good fast healing process. Percutaneous techniques are associated with faster recovery time and lower infection risk. However, deducing intra-operatively the desired reduction position is quite challenging due to the currently available technology. The 2D nature of this technology (i.e. the image intensifier) doesn't provide enough information to the surgeon regarding the fracture alignment and rotation, which is actually a three-dimensional problem. This paper describes the design and development of a 3D imaging system for the intra-operative virtual reduction of joint fractures. The proposed imaging system is able to receive and segment CT scan data of the fracture, to generate the 3D models of the bone fragments, and display them on a GUI. A commercial optical tracker was included into the system to track the actual pose of the bone fragments in the physical space, and generate the corresponding pose relations in the virtual environment of the imaging system. The surgeon virtually reduces the fracture in the 3D virtual environment, and a robotic manipulator connected to the fracture through an orthopedic pin executes the physical reductions accordingly. The system is here evaluated through fracture reduction experiments, demonstrating a reduction accuracy of 1.04 ± 0.69 mm (translational RMSE) and 0.89 ± 0.71 ° (rotational RMSE).

Displaced intra-articular calcaneal fractures.

PubMed

Bajammal, Sohail; Tornetta, Paul; Sanders, David; Bhandari, Mohit

2005-01-01

Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial. Nonoperative treatment options include elevation, ice, early mobilization, and cyclic compression of the plantar arch. Operative treatment options include closed reduction and percutaneous pin fixation, open reduction and internal fixation, and arthrodesis. The effect of operative versus nonoperative treatment has been the focus of several comparative studies. This study was designed to determine the effect of operative treatment compared with nonoperative treatment on the rate of union, complications, and functional outcome after intra-articular calcaneal fracture in adults.

The application of the Risdon approach for mandibular condyle fractures.

PubMed

Nam, Seung Min; Lee, Jang Hyun; Kim, Jun Hyuk

2013-07-06

Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1-2 months. The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.

Analysis of the Postoperative Displacement of Trochanteric Fractures on Lateral View Radiographs.

PubMed

Furui, Atsuo; Terada, Nobuki

2017-08-01

Achieving sufficient support of the anterior cortex of the femoral neck is a fundamental goal of the reduction of trochanteric fractures. However, anterior-cortex support is often lost after the fracture reduction. Our aim was to analyze factors contributing to the postoperative displacement of an acceptably reduced trochanteric fracture. The cases of 40 patients with a post-reduction Ikuta subtype N fracture alignment were reviewed. All fractures were fixed with 135° free-sliding plates. On postoperative day 14, patients were classified into two groups: those with retention of the Ikuta subtype N alignment, and those with progression to Ikuta subtype P alignment. The clinical and radiological factors were evaluated between the groups. In addition, to define one of the factors, i.e., the postoperative rotational displacement between the proximal and distal fragments, the relationship between radiographic findings and computed tomography image measurements was assessed in 15 of the 40 patients. Angulation at the fracture site on lateral view radiographs was defined as postoperative rotational displacement, and unstable trochanteric fractures and postoperative rotational displacement were identified as significant risk factors for the postoperative displacement. Therefore, cautious and careful follow-up is warranted for patients with unstable trochanteric fractures or fractures having rotational displacement.

The application of the Risdon approach for mandibular condyle fractures

PubMed Central

2013-01-01

Background Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. Methods A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. Results All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1–2 months. Conclusions The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized. PMID:23829537

Fluoroscopically guided closed reduction and internal fixation of fractures of the lateral portion of the humeral condyle: prospective clinical study of the technique and results in ten dogs.

PubMed

Cook, J L; Tomlinson, J L; Reed, A L

1999-01-01

To report a technique for fluoroscopically guided closed reduction with internal fixation of fractures of the lateral portion of the humeral condyle (FLHC) and determine the long-term results in 10 clinical cases. Prospective clinical case study. Ten dogs with 11 fractures. Fractures of the lateral portion of the humeral condyle were stabilized with transcondylar screws and Kirschner wires. Closed reduction and implant placement were achieved using intraoperative fluoroscopic guidance. After fracture repair, postoperative radiographs were evaluated for articular alignment and implant placement. Dogs were evaluated after surgery by means of lameness scores, elbow range of motion (ROM), radiographic assessment, and owner evaluation of function. Postoperative reduction was considered anatomic in 6 fractures with all other fractures having <1.5 mm of malreduction. Follow-up was available for 9 patients from 9 to 21 months after surgery. All of the fractures had healed. One minor (wire migration) and one major (implant failure) complication occurred. Mean lameness scores were 0 (n = 6), 0.5 (n = 2), and 1 (n = 1) at the time of final follow-up. No significant differences were found in follow-up ROM values between affected and unaffected elbows. All of the dogs in this study regained 90-100% of full function, based on owner assessment. Fluoroscopic guidance for closed reduction and internal fixation of FLHC in dogs is an effective technique.

[POKING REDUCTION TREATMENT OF DISPLACED SCAPULAR NECK FRACTURE WITH SHOULDER ARTHROSCOPY-ASSISTED SURGERY].

PubMed

Qu, Feng; Yuan, Bangtuo; Qi, Wei; Wang, Junliang; Shen, Xuezhen; Wang, Jiangtao; Zhao, Gang; Liu, Yujie

2014-07-01

To discuss the effectiveness of Poking reduction with shoulder arthroscopy-assisted surgery for displaced scapular neck fracture. Between January 2009 and January 2012, 9 cases of displaced scapular neck fracture underwent shoulder arthroscopy-assisted surgery for Poking reduction treatment. Of 9 cases, 6 were men, and 3 were women, aged 21-54 years (mean, 39 years). The causes were traffic accident injury in 7 cases, falling injury from height in 1 case, and hurt injury in 1 case. The shoulder abduction, flexion, and external rotation were obviously limited. X-ray films showed all cases had obvious displaced scapular neck fracture. Three-dimensional reconstruction of CT showed a grossly displaced of fracture. The time of injury to surgery was 4-27 days (mean, 11 days). Patients obtained healing of incision by first intension, without infection, neurovascular injury, or other surgery-related complications. All patients were followed up 19- 31 months (mean, 23 months). X-ray films showed scapular neck fractures healed from 7 to 11 weeks (mean, 8 weeks). At last follow-up, the shoulder abduction, flexion, and external rotation activity were improved significantly when compared with ones at preoperation (P < 0.05); the shoulder Constant score, American Shoulder and Elbow Surgenos (ASES) score, and Rowe score were significantly better than preoperative scores (P < 0.05). The reduction of displaced scapular neck fracture is necessary, and arthroscopic Poking reduction and fixation for displaced scapular neck fracture can reconstruct the shoulder stability and reduce complications.

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

Tea and flavonoid intake predict osteoporotic fracture risk in elderly Australian women: a prospective study.

PubMed

Myers, Gael; Prince, Richard L; Kerr, Deborah A; Devine, Amanda; Woodman, Richard J; Lewis, Joshua R; Hodgson, Jonathan M

2015-10-01

Observational studies have linked tea drinking, a major source of dietary flavonoids, with higher bone density. However, there is a paucity of prospective studies examining the association of tea drinking and flavonoid intake with fracture risk. The objective of this study was to examine the associations of black tea drinking and flavonoid intake with fracture risk in a prospective cohort of women aged >75 y. A total of 1188 women were assessed for habitual dietary intake with a food-frequency and beverage questionnaire. Incidence of osteoporotic fracture requiring hospitalization was determined through the Western Australian Hospital Morbidity Data system. Multivariable adjusted Cox regression was used to examine the HRs for incident fracture. Over 10 y of follow-up, osteoporotic fractures were identified in 288 (24.2%) women; 212 (17.8%) were identified as a major osteoporotic fracture, and of these, 129 (10.9%) were a hip fracture. In comparison with the lowest tea intake category (≤1 cup/wk), consumption of ≥3 cups/d was associated with a 30% decrease in the risk of any osteoporotic fracture (HR: 0.70; 95% CI: 0.50, 0.96). Compared with women in the lowest tertile of total flavonoid intake (from tea and diet), women in the highest tertile had a lower risk of any osteoporotic fracture (HR: 0.65; 95% CI: 0.47, 0.88), major osteoporotic fracture (HR: 0.66; 95% CI: 0.45, 0.95), and hip fracture (HR: 0.58; 95% CI: 0.36, 0.95). For specific classes of flavonoids, statistically significant reductions in fracture risk were observed for higher intake of flavonols for any osteoporotic fracture and major osteoporotic fracture, as well as flavones for hip fracture (P < 0.05). Higher intake of black tea and particular classes of flavonoids were associated with lower risk of fracture-related hospitalizations in elderly women at high risk of fracture. © 2015 American Society for Nutrition.

Linear Elastic and Cohesive Fracture Analysis to Model Hydraulic Fracture in Brittle and Ductile Rocks

NASA Astrophysics Data System (ADS)

Yao, Yao

2012-05-01

Hydraulic fracturing technology is being widely used within the oil and gas industry for both waste injection and unconventional gas production wells. It is essential to predict the behavior of hydraulic fractures accurately based on understanding the fundamental mechanism(s). The prevailing approach for hydraulic fracture modeling continues to rely on computational methods based on Linear Elastic Fracture Mechanics (LEFM). Generally, these methods give reasonable predictions for hard rock hydraulic fracture processes, but still have inherent limitations, especially when fluid injection is performed in soft rock/sand or other non-conventional formations. These methods typically give very conservative predictions on fracture geometry and inaccurate estimation of required fracture pressure. One of the reasons the LEFM-based methods fail to give accurate predictions for these materials is that the fracture process zone ahead of the crack tip and softening effect should not be neglected in ductile rock fracture analysis. A 3D pore pressure cohesive zone model has been developed and applied to predict hydraulic fracturing under fluid injection. The cohesive zone method is a numerical tool developed to model crack initiation and growth in quasi-brittle materials considering the material softening effect. The pore pressure cohesive zone model has been applied to investigate the hydraulic fracture with different rock properties. The hydraulic fracture predictions of a three-layer water injection case have been compared using the pore pressure cohesive zone model with revised parameters, LEFM-based pseudo 3D model, a Perkins-Kern-Nordgren (PKN) model, and an analytical solution. Based on the size of the fracture process zone and its effect on crack extension in ductile rock, the fundamental mechanical difference of LEFM and cohesive fracture mechanics-based methods is discussed. An effective fracture toughness method has been proposed to consider the fracture process zone effect on the ductile rock fracture.

Correlation of Hip Fracture with Other Fracture Types: Toward a Rational Composite Hip Fracture Endpoint

PubMed Central

Colón-Emeric, Cathleen; Pieper, Carl F.; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W.; Adler, Robert A.

2016-01-01

Purpose With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Methods Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between1999-2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics, were used to describe the correlation between each fracture type and hip fracture within individuals, without regards to the timing of the events. Results 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, p<0.0001), femur (0.15, p<0.0001), and shoulder (0.11, p<0.0001). Conclusions Pelvic, acetabular, femur, and shoulder fractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider use of a composite endpoint to better estimate hip fracture risk. PMID:26151123

Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures.

PubMed

Jones, Clifford B; Cornelius, Jonathan P; Sietsema, Debra L; Ringler, James R; Endres, Terrence J

2009-09-01

To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. Retrospective review of scapular or glenoid fractures. Level 1 teaching trauma center. All treated scapular or glenoid fractures over 7 years (1999-2005) were determined. Of a total of 227 scapular or glenoid fractures, 37 were treated with open reduction internal fixation and formed the basis of study. All patients were followed for a minimum of 1 year until healing or discharge from care. All operatively treated scapular fractures were performed in the lateral position on a radiolucent table. A modified Judet approach was used in all patients. The posterior deltoid was incised off the scapular spine cephalad reaching the lateral scapular border. The interval between the teres minor and infraspinatus was paramount for fracture reduction and implant insertion. The 2.7-mm minifragment plates were applied along the lateral border of the scapula. Radiographic assessment of fracture healing and clinical assessment of shoulder function. The majority of patients were males (31 males, 6 females) who sustained blunt trauma. All scapular fractures maintained fixation and reduction. No wound or muscle dehiscence problems were noted. Average range of motion was 158 degrees (range 90-180 degrees). There were no fixation failures or instances of implant loosening. The modified Judet approach allows for excellent scapular and glenoid fracture visualization and reduction while preserving rotator cuff function. Minifragment fixation along the lateral scapular border provides excellent plate position, screw length, and fracture stability.

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.

Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: derivation and validation of a hybrid system.

PubMed

Leslie, William D; Lix, Lisa M

2011-03-01

The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) computes 10-year probability of major osteoporotic fracture from multiple risk factors, including femoral neck (FN) T-scores. Lumbar spine (LS) measurements are not currently part of the FRAX formulation but are used widely in clinical practice, and this creates confusion when there is spine-hip discordance. Our objective was to develop a hybrid 10-year absolute fracture risk assessment system in which nonvertebral (NV) fracture risk was assessed from the FN and clinical vertebral (V) fracture risk was assessed from the LS. We identified 37,032 women age 45 years and older undergoing baseline FN and LS dual-energy X-ray absorptiometry (DXA; 1990-2005) from a population database that contains all clinical DXA results for the Province of Manitoba, Canada. Results were linked to longitudinal health service records for physician billings and hospitalizations to identify nontrauma vertebral and nonvertebral fracture codes after bone mineral density (BMD) testing. The population was randomly divided into equal-sized derivation and validation cohorts. Using the derivation cohort, three fracture risk prediction systems were created from Cox proportional hazards models (adjusted for age and multiple FRAX risk factors): FN to predict combined all fractures, FN to predict nonvertebral fractures, and LS to predict vertebral (without nonvertebral) fractures. The hybrid system was the sum of nonvertebral risk from the FN model and vertebral risk from the LS model. The FN and hybrid systems were both strongly predictive of overall fracture risk (p < .001). In the validation cohort, ROC analysis showed marginally better performance of the hybrid system versus the FN system for overall fracture prediction (p = .24) and significantly better performance for vertebral fracture prediction (p < .001). In a discordance subgroup with FN and LS T-score differences greater than 1 SD, there was a significant improvement in overall fracture prediction with the hybrid method (p = .025). Risk reclassification under the hybrid system showed better alignment with observed fracture risk, with 6.4% of the women reclassified to a different risk category. In conclusion, a hybrid 10-year absolute fracture risk assessment system based on combining FN and LS information is feasible. The improvement in fracture risk prediction is small but supports clinical interest in a system that integrates LS in fracture risk assessment. Copyright © 2011 American Society for Bone and Mineral Research.

Prediction of Central Burst Defects in Copper Wire Drawing Process

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

Vega, G.; NEXANS France, NMC Nexans Metallurgy Centre, Boulevard du Marais, BP39, F-62301 Lens; Haddi, A.

2011-01-17

In this study, the prediction of chevron cracks (central bursts) in copper wire drawing process is investigated using experimental and numerical approaches. The conditions of the chevron cracks creation along the wire axis depend on (i) the die angle, the friction coefficient between the die and the wire, (ii) the reduction in crosssectional area of the wire, (iii) the material properties and (iv) the drawing velocity or strain rate. Under various drawing conditions, a numerical simulation for the prediction of central burst defects is presented using an axisymmetric finite element model. This model is based on the application of themore » Cockcroft and Latham fracture criterion. This criterion was used as the damage value to estimate if and where defects will occur during the copper wire drawing. The critical damage value of the material is obtained from a uniaxial tensile test. The results show that the die angle and the reduction ratio have a significant effect on the stress distribution and the maximum damage value. The central bursts are expected to occur when the die angle and reduction ratio reach a critical value. Numerical predictions are compared with experimental observations.« less

[Conservative treatment of metacarpal fracture].

PubMed

Prokop, A; Helling, H J; Kulus, S; Rehm, K E

2002-01-01

Conservative treatment of meatacarpale fracture is recommended if there are no joint displacement, rotation failures, displacement over 30 degrees ad axim and shortening over 5 mm. Operative procedures should be done in open fractures and serial of fractures of metacarpale bones. Early functionally treatment should be done in stable, not displaced fractures. Cast can be used only for a short time in full extended position of fingers and flexion in metacarpo-phalangeal joint in 60-90 degrees. Twin-tapes after reduction of edema allowed free range of motion by fixed rotation. Closed reduction of displaced fractures of fifth metacarpal bone (boxer's fracture) isn't successful. Cases with displacement over 30 degrees may be operatively treated by intramedullary stabilization.

A nondestructive technique for predicting the strength remaining in filament wound composites subjected to low-level impact

NASA Technical Reports Server (NTRS)

Madaras, E. I.; Poe, C. C.; Heyman, J. S.

1987-01-01

A model for predicting the fracture strength of homogeneous materials is proposed. Impacted FWC samples were evaluated using ultrasonic testing and an X-ray dye penetration method. The ability of the model to measure fracture strength was also examined. The relation between attenuation and velocity measurements is studied. It is observed that the X-ray method is not useful for predicting fracture strength because the dye could not penetrate the matrix. It is noted that fracture strength predictions derived from the fracture mechanical model and the ultrasonic measurements correlate well with actual measured fracture strengths.

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.

Status of the internal orbit after reduction of zygomaticomaxillary complex fractures.

PubMed

Ellis, Edward; Reddy, Likith

2004-03-01

We sought to determine the status of the internal orbit before and after reduction of zygomaticomaxillary complex (ZMC) fractures when treated without internal orbital reconstruction. We conducted a retrospective study of preoperative and postoperative computed tomography (CT) scans in 65 patients with unilateral ZMC fractures who were treated by reduction of the ZMC complex without internal orbital reconstruction. The size and location of the internal orbital defects, orbital soft tissue displacement, and orbital volume were assessed in the preoperative and postoperative CT scans. Reduction in the ZMC fractures was considered ideal in 58 of the 65 patients. Only minor malpositions occurred in the remaining 7 patients. The size of the internal orbital defects increased slightly with ZMC reduction but the internal orbital fractures were realigned, and few had increases in orbital volume or soft tissue sagging into the sinuses. Examination of follow-up CT scans in several patients taken weeks to months later showed that the residual defects became smaller and that none of these patients had an increase in orbital volume or soft tissue sagging. The preoperative CT scan can be used to assess the amount of internal orbital disruption for purposes of developing a treatment plan in patients with ZMC fractures. When there is minimal or no soft tissue herniation and minimal disruption of the internal orbit, ZMC reduction is adequate treatment.

Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients.

PubMed

Turgut, Ali; Kalenderer, Önder; Karapınar, Levent; Kumbaracı, Mert; Akkan, Hasan Ali; Ağuş, Haluk

2016-05-01

Mechanical complications, such as cut-out of the head-neck fixation device, are the most common causes of morbidity after trochanteric femur fracture treatment. The causes of cut-out complications are well defined in patients who are treated with sliding hip screws and biaxial cephalomedullary nails but there are few reports about the patients who are treated with proximal femoral nail antirotation. The purpose of this study was to evaluate the most important factor about occurance of cutout complication and also to evaluate the risks of the combination of each possible factors. Overally 298 patients were enrolled in the study. Medical records were reviewed for patients' age, fracture type, gender, anesthesia type and occurance of cut-out complication. Postoperatively taken radiographs were reviewed for tip-apex distance, obtained collo-diaphyseal angle, the quadrant of the helical blade and Ikuta reduction subgroup. The most important factor (s) and also predicted probability of cut-out complication was calculated for each combination of factors. Cut-out complication was observed in 14 patients (4.7 %). The most important factor about occurrence of the cut-out complication was found as varus reduction (p: 0.01), the second important factor was found as implantation of the helical blade in the improper quadrant (p: 0.02). Tip-apex distance was found as third important factor (p: 0.10). The predicted probability of cut-out complication was calculated as 45.6 % when whole of the four surgeon dependent factors were improperly obtained. Althought obtaining proper tip-apex distance is important to prevent cutout complication in these fractures, if the fracture is not reduced in varus position and helical blade is inserted in the proper quadrant, possibility of cut-out complication is very low even in the patients with high tip-apex distance.

The contribution of rib fractures to chronic pain and disability.

PubMed

Gordy, Stephanie; Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

2014-05-01

The contribution of rib fractures to chronic pain and disability is not well described. Two hundred three patients with rib fractures were followed for 6 months. Chronic pain was assessed using the McGill Pain Questionnaire Pain Rating Index and Present Pain Intensity (PPI) scales. Disability was defined as a decrease in work or functional status. The prevalence of chronic pain was 22% and disability was 53%. Acute PPI predicted chronic pain. Associated injuries, bilateral rib fractures, injury severity score, and number of rib fractures were not predictive of chronic pain. No acute injury characteristics were predictive of disability. Among 89 patients with isolated rib fractures, the prevalence of chronic pain was 28% and of disability was 40%. No injury characteristics predicted chronic pain. Bilateral rib fractures and acute PPI predicted disability. The contribution of rib fractures to chronic pain and disability is significant but unpredictable with conventional injury descriptors. Copyright © 2014 Elsevier Inc. All rights reserved.

A visual servo-based teleoperation robot system for closed diaphyseal fracture reduction.

PubMed

Li, Changsheng; Wang, Tianmiao; Hu, Lei; Zhang, Lihai; Du, Hailong; Zhao, Lu; Wang, Lifeng; Tang, Peifu

2015-09-01

Common fracture treatments include open reduction and intramedullary nailing technology. However, these methods have disadvantages such as intraoperative X-ray radiation, delayed union or nonunion and postoperative rotation. Robots provide a novel solution to the aforementioned problems while posing new challenges. Against this scientific background, we develop a visual servo-based teleoperation robot system. In this article, we present a robot system, analyze the visual servo-based control system in detail and develop path planning for fracture reduction, inverse kinematics, and output forces of the reduction mechanism. A series of experimental tests is conducted on a bone model and an animal bone. The experimental results demonstrate the feasibility of the robot system. The robot system uses preoperative computed tomography data to realize high precision and perform minimally invasive teleoperation for fracture reduction via the visual servo-based control system while protecting surgeons from radiation. © IMechE 2015.

Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: a series of 10 cases and surgical guidelines.

PubMed

Joshi, Samir; Kshirsagar, Rajesh; Mishra, Akshay; Shah, Rahul

2015-01-01

To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. All cases showed satisfactory bone healing without any growth disturbance. Open reduction and rigid internal fixation (ORIF) with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives.

PubMed

Johannesdottir, Fjola; Allaire, Brett; Bouxsein, Mary L

2018-05-30

This review critiques the ability of CT-based methods to predict incident hip and vertebral fractures. CT-based techniques with concurrent calibration all show strong associations with incident hip and vertebral fracture, predicting hip and vertebral fractures as well as, and sometimes better than, dual-energy X-ray absorptiometry areal biomass density (DXA aBMD). There is growing evidence for use of routine CT scans for bone health assessment. CT-based techniques provide a robust approach for osteoporosis diagnosis and fracture prediction. It remains to be seen if further technical advances will improve fracture prediction compared to DXA aBMD. Future work should include more standardization in CT analyses, establishment of treatment intervention thresholds, and more studies to determine whether routine CT scans can be efficiently used to expand the number of individuals who undergo evaluation for fracture risk.

Development of a Korean Fracture Risk Score (KFRS) for Predicting Osteoporotic Fracture Risk: Analysis of Data from the Korean National Health Insurance Service

PubMed Central

Jang, Eun Jin; Park, ByeongJu; Kim, Tae-Young; Shin, Soon-Ae

2016-01-01

Background Asian-specific prediction models for estimating individual risk of osteoporotic fractures are rare. We developed a Korean fracture risk prediction model using clinical risk factors and assessed validity of the final model. Methods A total of 718,306 Korean men and women aged 50–90 years were followed for 7 years in a national system-based cohort study. In total, 50% of the subjects were assigned randomly to the development dataset and 50% were assigned to the validation dataset. Clinical risk factors for osteoporotic fracture were assessed at the biennial health check. Data on osteoporotic fractures during the follow-up period were identified by ICD-10 codes and the nationwide database of the National Health Insurance Service (NHIS). Results During the follow-up period, 19,840 osteoporotic fractures were reported (4,889 in men and 14,951 in women) in the development dataset. The assessment tool called the Korean Fracture Risk Score (KFRS) is comprised of a set of nine variables, including age, body mass index, recent fragility fracture, current smoking, high alcohol intake, lack of regular exercise, recent use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis. The KFRS predicted osteoporotic fractures over the 7 years. This score was validated using an independent dataset. A close relationship with overall fracture rate was observed when we compared the mean predicted scores after applying the KFRS with the observed risks after 7 years within each 10th of predicted risk. Conclusion We developed a Korean specific prediction model for osteoporotic fractures. The KFRS was able to predict risk of fracture in the primary population without bone mineral density testing and is therefore suitable for use in both clinical setting and self-assessment. The website is available at http://www.nhis.or.kr. PMID:27399597

Development of a Korean Fracture Risk Score (KFRS) for Predicting Osteoporotic Fracture Risk: Analysis of Data from the Korean National Health Insurance Service.

PubMed

Kim, Ha Young; Jang, Eun Jin; Park, ByeongJu; Kim, Tae-Young; Shin, Soon-Ae; Ha, Yong-Chan; Jang, Sunmee

2016-01-01

Asian-specific prediction models for estimating individual risk of osteoporotic fractures are rare. We developed a Korean fracture risk prediction model using clinical risk factors and assessed validity of the final model. A total of 718,306 Korean men and women aged 50-90 years were followed for 7 years in a national system-based cohort study. In total, 50% of the subjects were assigned randomly to the development dataset and 50% were assigned to the validation dataset. Clinical risk factors for osteoporotic fracture were assessed at the biennial health check. Data on osteoporotic fractures during the follow-up period were identified by ICD-10 codes and the nationwide database of the National Health Insurance Service (NHIS). During the follow-up period, 19,840 osteoporotic fractures were reported (4,889 in men and 14,951 in women) in the development dataset. The assessment tool called the Korean Fracture Risk Score (KFRS) is comprised of a set of nine variables, including age, body mass index, recent fragility fracture, current smoking, high alcohol intake, lack of regular exercise, recent use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis. The KFRS predicted osteoporotic fractures over the 7 years. This score was validated using an independent dataset. A close relationship with overall fracture rate was observed when we compared the mean predicted scores after applying the KFRS with the observed risks after 7 years within each 10th of predicted risk. We developed a Korean specific prediction model for osteoporotic fractures. The KFRS was able to predict risk of fracture in the primary population without bone mineral density testing and is therefore suitable for use in both clinical setting and self-assessment. The website is available at http://www.nhis.or.kr.

Arthroscopic fixation of the clavicle shaft fracture.

PubMed

Kim, Yang-Soo; Lee, Hyo-Jin; Kim, Jong-Ick; Yang, Hyo; Jin, Hong-Ki; Patel, Hiren Kirtibhai; Kim, Jong-Ho; Park, In

2017-01-01

This article describes an arthroscopic technique for the fixation of clavicle shaft fractures. A viewing portal is made 2 cm anterior to the fracture site, and a working portal is made 2 cm lateral to the fracture site. The guide wire for a 4.0-mm cannulated screw is inserted through the fracture site to the medial fracture fragment under arthroscopic guidance. Through the medial fragment, the guide wire is delivered through the skin anteriorly. The fracture is reduced, and then, the guide wire is drilled back across the fracture site to the lateral fracture fragment. After confirming the reduction under arthroscopy, the appropriately sized cannulated screw is inserted after reaming. This arthroscopic technique would be useful for the precise reduction and minimal invasive fixation of clavicle shaft fractures. Preliminary results are encouraging, and further studies with long-term follow-up are needed to determine the precise indications and limitations of the procedure.

Fracture prediction and calibration of a Canadian FRAX® tool: a population-based report from CaMos

PubMed Central

Fraser, L.-A.; Langsetmo, L.; Berger, C.; Ioannidis, G.; Goltzman, D.; Adachi, J. D.; Papaioannou, A.; Josse, R.; Kovacs, C. S.; Olszynski, W. P.; Towheed, T.; Hanley, D. A.; Kaiser, S. M.; Prior, J.; Jamal, S.; Kreiger, N.; Brown, J. P.; Johansson, H.; Oden, A.; McCloskey, E.; Kanis, J. A.

2016-01-01

Summary A new Canadian WHO fracture risk assessment (FRAX®) tool to predict 10-year fracture probability was compared with observed 10-year fracture outcomes in a large Canadian population-based study (CaMos). The Canadian FRAX tool showed good calibration and discrimination for both hip and major osteoporotic fractures. Introduction The purpose of this study was to validate a new Canadian WHO fracture risk assessment (FRAX®) tool in a prospective, population-based cohort, the Canadian Multi-centre Osteoporosis Study (CaMos). Methods A FRAX tool calibrated to the Canadian population was developed by the WHO Collaborating Centre for Metabolic Bone Diseases using national hip fracture and mortality data. Ten-year FRAX probabilities with and without bone mineral density (BMD) were derived for CaMos women (N=4,778) and men (N=1,919) and compared with observed fracture outcomes to 10 years (Kaplan–Meier method). Cox proportional hazard models were used to investigate the contribution of individual FRAX variables. Results Mean overall 10-year FRAX probability with BMD for major osteoporotic fractures was not significantly different from the observed value in men [predicted 5.4% vs. observed 6.4% (95%CI 5.2–7.5%)] and only slightly lower in women [predicted 10.8% vs. observed 12.0% (95%CI 11.0–12.9%)]. FRAX was well calibrated for hip fracture assessment in women [predicted 2.7% vs. observed 2.7% (95%CI 2.2–3.2%)] but underestimated risk in men [predicted 1.3% vs. observed 2.4% (95%CI 1.7–3.1%)]. FRAX with BMD showed better fracture discrimination than FRAX without BMD or BMD alone. Age, body mass index, prior fragility fracture and femoral neck BMD were significant independent predictors of major osteoporotic fractures; sex, age, prior fragility fracture and femoral neck BMD were significant independent predictors of hip fractures. Conclusion The Canadian FRAX tool provides predictions consistent with observed fracture rates in Canadian women and men, thereby providing a valuable tool for Canadian clinicians assessing patients at risk of fracture. PMID:21161508

A Technique for Reduction of Edentulous Fractures Using Dentures and SMARTLock Hybrid Fixation System

PubMed Central

Carlson, Anna Rose; Shammas, Ronnie Labib; Allori, Alexander Christopher

2017-01-01

Summary: Establishing anatomic reduction of an edentulous mandible fracture is a frequently acknowledged challenge in craniomaxillofacial trauma surgery. In this study, we report a novel method for the reduction of the edentulous mandible fracture, via fabrication of modified Gunning splints using existing dentures and SMARTLock hybrid arch bars. This technique dramatically simplifies the application of an arch bar to dentures, obviates the need for the fabrication of impressions and custom splints, and eliminates the lag time associated with the creation of splints. Furthermore, this method may be used with or without adjunctive rigid internal fixation. The technique described herein of creating Gunning splints with SMARTLock hybrid arch bars provides surgeons with a simple, rapid, single-stage solution for reduction of mandibular fractures in the edentulous patient. PMID:29062645

Assessment of function-graded materials as fracture fixation bone-plates under combined loading conditions using finite element modelling.

PubMed

Fouad, H

2011-05-01

In previous work by Fouad (Medical Engineering and Physics 2010 [23]), 3D finite element (FE) models for fractured bones with function-graded (FG) bone-plates and traditional bone-plates made of stainless steel (SS) and titanium (Ti) alloy were examined under compressive loading conditions using the ABAQUS Code. In this study, the effects of the presence of the torsional load in addition to the compressive load on the predicted stresses of the fracture fixation bone-plate system are examined at different healing stages. The effects on the stress on the fracture site when using contacted and non-contacted bone-plate systems are also studied. The FE modelling results indicate that the torsional load has significant effects on the resultant stress on the fracture fixation bone-plate system, which should be taken into consideration during the design and the analysis. The results also show that the stress shielding at the fracture site decreases significantly when using FG bone-plates compared to Ti alloy or SS bone-plates. The presence of a gap between the bone and the plate results in a remarkable reduction in bone stress shielding at the fracture site. Therefore, the significant effects of using an FG bone-plate with a gap and the presence of torsional load on the resultant stress on the fracture fixation bone-plate system should be taken into consideration. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

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.

[The randomized controlled trial of the treatment for clavicular fracture by rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation].

PubMed

Bi, Hong-zheng; Yang, Mao-qing; Tan, Yuan-chao; Fu, Song

2008-07-01

To study the curative effect and safety of rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation in treating clavicular fracture. All 201 cases of clavicular fractures were randomly divided into treatment group (101 cases) and control group (100 cases). The treatment group was treated by rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation. The control group was treated by open reduction and internal fixation with Kirschner pin. All cases were followed up for 4 to 21 months (mean 10.6 months). SPSS was used to analyze clinic healing time of fracture and shoulder-joint function in both two groups. After operation, 101 cases of treatment group achieved union of fracture and the clinical healing time was 28 to 49 days (mean 34.5+/-2.7 days). In control group,there were 4 cases with nonunion of fracture,the other 96 cases were union,the clinical healing time was 36 to 92 days (mean 55.3+/-4.8 days). The excellent and good rate of shoulder-joint function was 100% in treatment group and 83% in control group. By t-test and chi2-test, there was significant difference between the two groups in curative effect (P<0.05). Rotatory manual reduction with forceps holder and retrograde pinning transfixation can be used in various kinds of clavicular shaft fracture, with many virtues such as easy operation, reliable fixation, short union time of fracture, good functional recovery of shoulder-joint and no incision scar affecting appearance.

Transient gamma-secretase inhibition accelerates and enhances fracture repair likely via Notch signaling modulation

PubMed Central

Wang, Cuicui; Shen, Jie; Yukata, Kiminori; Inzana, Jason A.; O'Keefe, Regis J.; Awad, Hani A.; Hilton, Matthew J.

2014-01-01

Approximately 10% of skeletal fractures result in healing complications and non-union, while most fractures repair with appropriate stabilization and without pharmacologic intervention. It is the latter injuries that cannot be underestimated as the expenses associated with their treatment and subsequent lost productivity are predicted to increase to over $74 billion by 2015. During fracture repair, local mesenchymal stem/progenitor cells (MSCs) differentiate to form new cartilage and bone, reminiscent of events during skeletal development. We previously demonstrated that permanent loss of gamma-secretase activity and Notch signaling accelerates bone and cartilage formation from MSC progenitors during skeletal development, leading to pathologic acquisition of bone and depletion of bone marrow derived MSCs. Here, we investigated whether transient and systemic gamma-secretase and Notch inhibition is capable of accelerating and enhancing fracture repair by promoting controlled MSC differentiation near the fracture site. Our radiographic, microCT, histological, cell and molecular analyses reveal that single and intermittent gamma-secretase inhibitor (GSI) treatments significantly enhance cartilage and bone callus formation via the promotion of MSC differentiation, resulting in only a moderate reduction of local MSCs. Biomechanical testing further demonstrates that GSI treated fractures exhibit superior strength earlier in the healing process, with single dose GSI treated fractures exhibiting bone strength approaching that of un-fractured tibiae. These data further establish that transient inhibition of gamma-secretase activity and Notch signaling temporarily increases osteoclastogenesis and accelerates bone remodeling, which coupled with the effects on MSCs likely explains the accelerated and enhanced fracture repair. Therefore, we propose that the Notch pathway serves as an important therapeutic target during skeletal fracture repair. PMID:25527421

Experimental and numerical simulation of dissolution and precipitation: implications for fracture sealing at Yucca Mountain, Nevada

NASA Astrophysics Data System (ADS)

Dobson, Patrick F.; Kneafsey, Timothy J.; Sonnenthal, Eric L.; Spycher, Nicolas; Apps, John A.

2003-05-01

Plugging of flow paths caused by mineral precipitation in fractures above the potential repository at Yucca Mountain, Nevada could reduce the probability of water seeping into the repository. As part of an ongoing effort to evaluate thermal-hydrological-chemical (THC) effects on flow in fractured media, we performed a laboratory experiment and numerical simulations to investigate mineral dissolution and precipitation under anticipated temperature and pressure conditions in the repository. To replicate mineral dissolution by vapor condensate in fractured tuff, water was flowed through crushed Yucca Mountain tuff at 94 °C. The resulting steady-state fluid composition had a total dissolved solids content of about 140 mg/l; silica was the dominant dissolved constituent. A portion of the steady-state mineralized water was flowed into a vertically oriented planar fracture in a block of welded Topopah Spring Tuff that was maintained at 80 °C at the top and 130 °C at the bottom. The fracture began to seal with amorphous silica within 5 days. A 1-D plug-flow numerical model was used to simulate mineral dissolution, and a similar model was developed to simulate the flow of mineralized water through a planar fracture, where boiling conditions led to mineral precipitation. Predicted concentrations of the major dissolved constituents for the tuff dissolution were within a factor of 2 of the measured average steady-state compositions. The mineral precipitation simulations predicted the precipitation of amorphous silica at the base of the boiling front, leading to a greater than 50-fold decrease in fracture permeability in 5 days, consistent with the laboratory experiment. These results help validate the use of a numerical model to simulate THC processes at Yucca Mountain. The experiment and simulations indicated that boiling and concomitant precipitation of amorphous silica could cause significant reductions in fracture porosity and permeability on a local scale. However, differences in fluid flow rates and thermal gradients between the experimental setup and anticipated conditions at Yucca Mountain need to be factored into scaling the results of the dissolution/precipitation experiments and associated simulations to THC models for the potential Yucca Mountain repository.

Intra-Articular Entrapment of the Medial Epicondyle following a Traumatic Fracture Dislocation of the Elbow in an Adult

PubMed Central

Hassan, Youssef G.; Joukhadar, Nabih I.

2018-01-01

Medial epicondyle entrapment after an acute fracture dislocation of the elbow is a common finding in the pediatric population, but a rare finding in adults. We present a case of an adult patient diagnosed with a traumatic fracture dislocation of the elbow joint with intra-articular entrapment of the medial epicondyle. After initial evaluation, closed reduction was done. Stability testing after reduction showed an unstable joint; thus, open reduction and internal fixation was decided. PMID:29666736

Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures.

PubMed

Lubowitz, James H; Elson, Wylie S; Guttmann, Dan

2005-01-01

Arthroscopic reduction and internal fixation (ARIF) of tibial intercondylar eminence fractures is the emerging state-of-the-art. ARIF is recommended for displaced type III fractures and should be considered for all cases of displaced type II fractures. Fractures without displacement after closed reduction require careful evaluation to rule out meniscal entrapment. Subjective results of ARIF are uniformly excellent, despite reports of objective anteroposterior laxity. Early range-of-motion exercises are essential to prevent loss of extension. Repair using nonabsorbable suture fixation, when of adequate strength to allow early range-of-motion, has the advantages of eliminating the risks of comminution of the fracture fragment, posterior neurovascular injury, and need for hardware removal, compared with ARIF using screws.

Fall risk: the clinical relevance of falls and how to integrate fall risk with fracture risk.

PubMed

Peeters, G; van Schoor, Natasja M; Lips, Paul

2009-12-01

In old age, 5-10% percent of all falls result in a fracture, and up to 90% of all fractures result from a fall. This article describes the link between fall risk and fracture risk in community-dwelling older persons. Which factors attribute to both the fall risk and the fracture risk? Which falls result in a fracture? Which tools are available to predict falls and fractures? Directions for the use of prediction tools in clinical practice are given. Challenges for future research include further validation of existing prediction tools and evaluation of the cost-effectiveness of treatment after screening.

Percutaneous reduction and fixation of an intra-articular calcaneal fracture using an inflatable bone tamp: description of a novel and safe technique

PubMed Central

2012-01-01

Calcaneal fractures are common injuries involving the hind foot and often a source of significant long-term morbidity. Treatment options have changed throughout the ages from periods of preferred nonoperative management to closed reduction with a mallet, and more recently, open reduction and anatomic internal fixation. The current treatment of choice; however, is often debated, as open management of these fractures carries many risks to include wound breakdown and infection. A less invasive form of surgical management through small incisions, while maintaining the ability to obtain joint congruency, anatomic alignment, and restore calcaneal height and width would be ideal. We propose a novel form of fracture reduction using an inflatable bone tamp and percutaneous fracture fixation. Preoperative planning and experienced fluoroscopy is crucial to successful management using this method. Although we achieved successful radiographic outcome in this case, long-term functional outcome of this technique are yet to be published. PMID:22420710

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.

How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction-internal fixation of proximal humeral fractures.

PubMed

Spross, Christian; Zeledon, Rebeca; Zdravkovic, Vilijam; Jost, Bernhard

2017-09-01

With the introduction of the deltoid tuberosity index (DTI), a simple radiographic tool has become available to measure bone mineral density of the proximal humerus. The aim of this study was to assess the influence of local bone mineral density on the early failure rate after angular stable open reduction-internal fixation of proximal humeral fractures (PHFs). We retrospectively followed up all patients treated with angular stable implants for PHFs from 2007 to 2014. The fractures were classified according to Neer, and the DTI, metaphyseal head extension (MHE), medial hinge displacement, and quality of reduction were assessed. Failures were defined as head screw cutouts. The study included 146 patients (mean age, 66 years; range, 20-94 years). The mean follow-up period was 11 months (range, 3-94 months). Of the fractures, 91% were classified as 2- or 3-part fractures and 9% as 4-part fractures. The mean DTI was 1.44 (range, 1.19-2.11), and the mean MHE was 12 mm (range, 0-48 mm). The reduction result was at least acceptable in 80% of fractures. Screw cutouts were found in 23%. The DTI and MHE were the most significant preoperative predictors for the reduction result. The DTI (P = .036) and age (P = .02) were independent preoperative factors, and a good reduction (P = .001) was the only intraoperative factor influencing cutout. This study proves that good bone quality and a long MHE are helpful for the reduction. Furthermore, good bone quality, a younger age, and a good reduction prevent later cutout. We conclude that local bone quality is a relevant factor in the treatment plan for PHFs. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Application of Fracture Distribution Prediction Model in Xihu Depression of East China Sea

NASA Astrophysics Data System (ADS)

Yan, Weifeng; Duan, Feifei; Zhang, Le; Li, Ming

2018-02-01

There are different responses on each of logging data with the changes of formation characteristics and outliers caused by the existence of fractures. For this reason, the development of fractures in formation can be characterized by the fine analysis of logging curves. The well logs such as resistivity, sonic transit time, density, neutron porosity and gamma ray, which are classified as conventional well logs, are more sensitive to formation fractures. In view of traditional fracture prediction model, using the simple weighted average of different logging data to calculate the comprehensive fracture index, are more susceptible to subjective factors and exist a large deviation, a statistical method is introduced accordingly. Combining with responses of conventional logging data on the development of formation fracture, a prediction model based on membership function is established, and its essence is to analyse logging data with fuzzy mathematics theory. The fracture prediction results in a well formation in NX block of Xihu depression through two models are compared with that of imaging logging, which shows that the accuracy of fracture prediction model based on membership function is better than that of traditional model. Furthermore, the prediction results are highly consistent with imaging logs and can reflect the development of cracks much better. It can provide a reference for engineering practice.

Surgical management of coracoid fractures: technical tricks and clinical experience.

PubMed

Hill, Brian W; Jacobson, Aaron R; Anavian, Jack; Cole, Peter A

2014-05-01

The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures; surgical management may be warranted to avoid functional compromise or impingement. A direct approach through Langer's lines allows for easy exposure and direct visualization for an anatomic reduction of simple fractures through the shaft or base of the coracoid. An anterior approach for fractures that extend into the superior glenoid fossa allows for direct exposure to obtain an anatomic articular reduction and indirect reduction of the coracoid fracture. In cases where a complex glenoid or scapula neck/body fracture is being addressed simultaneously either a posterior Judet approach can be used with an indirect reduction method or a separate anterior approach must be combined to address it if not in continuity with the superior scapular segment. Implant selection, primarily interfragmentary screws or a buttress plate, should be based on the size of the fragment, the degree of comminution, and the degree of articular involvement to ensure adequate stabilization. The purpose of this manuscript was to describe a stepwise approach to the surgical management of displaced coracoid fractures, describe surgical tips and techniques, and to present the clinical outcomes in 22 patients after surgical treatment with this approach.

The posterior two-portal approach for reconstruction of scapula fractures: results of 39 patients.

PubMed

Pizanis, A; Tosounidis, G; Braun, C; Pohlemann, T; Wirbel, R J

2013-11-01

The purpose of this study was to describe the so-called posterior two-portal approach to the scapula in detail and to investigate the clinical outcome of patients with displaced glenoid and scapular neck fractures who were surgically treated using this approach. From February 1992 to August 2008, 39 patients (30 men and nine women; mean age: 53 years) with scapular fractures underwent surgical fixation at our institution. Thirty-three patients had glenoid fractures and six had unstable scapular neck fractures. All patients were treated via the two-portal approach. The reduction was evaluated radiographically, and the clinical results were analysed using the Constant score. The mean follow-up period was 78 months (range: 6-168). In 24 of the 33 glenoid fractures, the reduction was anatomical. The mean Constant score was 82.3 (range: 35-100) points. In one case, an early postoperative wound infection was cured by local revision, and one patient developed posttraumatic osteoarthritis of the acromioclavicular joint after 2 years. Only one patient developed specific glenohumeral degeneration after non-anatomical reduction. The posterior two-portal approach allows for a good visualisation of the posterior scapular neck and the glenoid area, facilitating the reduction and safe internal fixation of dislocated scapular neck and glenoid fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

Extraoral approach to mandibular condylar fractures: our experience with 100 cases.

PubMed

Colletti, Giacomo; Battista, Valeria Marinella Augusta; Allevi, Fabiana; Giovanditto, Federica; Rabbiosi, Dimitri; Biglioli, Federico

2014-07-01

Mandibular condylar fractures are very common. The current literature contains many indications and methods of treatment. Extraoral approaches are complicated by the need to avoid injury to the facial nerve. On the other hand intraoral approaches can make fracture reduction and/or fixation difficult. The mini-retromandibular approach provides an excellent view of the surgical field, minimises the risk of injury to the facial nerve, and allows rapid and easy management of condylar fractures. We have collected and reviewed our first 100 condylar fractures treated by means of a mini-retromandibular approach. Between June 2006 and June 2012, Eighty-seven patients with extracapsular condylar fractures underwent open reduction and rigid fixation for 100 extracapsular condylar fractures via a mini-retromandibular approach. Dental occlusion and anatomic reduction were restored in all 100 condylar fractures. Postoperative infection developed in three patients. There was one sialocele and one case of plate fracture. Four patients experienced transient palsy of the buccal branch of the facial nerve. No permanent deficit of any facial nerve branch was observed. No patient showed condylar head resorption. Our experience with the treatment of the first 100 condylar fractures using the mini-retromandibular approach has demonstrated that this technique has allowed the Authors to safely manage extracapsular condylar fractures at all levels. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Pediatric facial fractures: evolving patterns of treatment.

PubMed

Posnick, J C; Wells, M; Pron, G E

1993-08-01

This study reviews the treatment of facial trauma between October 1986 and December 1990 at a major pediatric referral center. The mechanism of injury, location and pattern of facial fractures, pattern of facial injury, soft tissue injuries, and any associated injuries to other organ systems were recorded, and fracture management and perioperative complications reviewed. The study population consisted of 137 patients who sustained 318 facial fractures. Eighty-one patients (171 fractures) were seen in the acute stage, and 56 patients (147 fractures) were seen for reconstruction of a secondary deformity. Injuries in boys were more prevalent than in girls (63% versus 37%), and the 6- to 12-year cohort made up the largest group (42%). Most fractures resulted from traffic-related accidents (50%), falls (23%), or sports-related injuries (15%). Mandibular (34%) and orbital fractures (23%) predominated; fewer midfacial fractures (7%) were sustained than would be expected in a similar adult population. Three quarters of the patients with acute fractures required operative intervention. Closed reduction techniques with maxillomandibular fixation were frequently chosen for mandibular condyle fractures and open reduction techniques (35%) for other regions of the facial skeleton. When open reduction was indicated, plate-and-screw fixation was the preferred method of stabilization (65%). The long-term effects of the injuries and the treatment given on facial growth remain undetermined. Perioperative complication rates directly related to the surgery were low.

Osteoporosis in men.

PubMed

Binkley, Neil

2006-08-01

Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 40-50% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 25-33% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time.

Discriminative value of FRAX for fracture prediction in a cohort of Chinese postmenopausal women.

PubMed

Cheung, E Y N; Bow, C H; Cheung, C L; Soong, C; Yeung, S; Loong, C; Kung, A

2012-03-01

We followed 2,266 postmenopausal Chinese women for 4.5 years to determine which model best predicts osteoporotic fracture. A model that contains ethnic-specific risk factors, some of which reflect frailty, performed as well as or better than the well-established FRAX model. Clinical risk assessment, with or without T-score, can predict fractures in Chinese postmenopausal women although it is unknown which combination of clinical risk factors is most effective. This prospective study sought to compare the accuracy for fracture prediction using various models including FRAX, our ethnic-specific clinical risk factors (CRF) and other simple models. This study is part of the Hong Kong Osteoporosis Study. A total of 2,266 treatment naïve postmenopausal women underwent clinical risk factor and bone mineral density assessment. Subjects were followed up for outcome of major osteoporotic fracture and receiver operating characteristic (ROC) curves for different models were compared. The percentage of subjects in different quartiles of risk according to various models who actually fractured was also compared. The mean age at baseline was 62.1 ± 8.5 years and mean follow-up time was 4.5 ± 2.8 years. A total of 106 new major osteoporotic fractures were reported, of which 21 were hip fractures. Ethnic-specific CRF with T-score performed better than FRAX with T-score (based on both Chinese normative and National Health and Nutrition Examination Survey (NHANES) databases) in terms of AUC comparison for prediction of major osteoporotic fracture. The two models were similar in hip fracture prediction. The ethnic-specific CRF model had a 10% higher sensitivity than FRAX at a specificity of 0.8 or above. CRF related to frailty and differences in lifestyle between populations are likely to be important in fracture prediction. Further work is required to determine which and how CRF can be applied to develop a fracture prediction model in our population.

Statistical Tools And Artificial Intelligence Approaches To Predict Fracture In Bulk Forming Processes

NASA Astrophysics Data System (ADS)

Di Lorenzo, R.; Ingarao, G.; Fonti, V.

2007-05-01

The crucial task in the prevention of ductile fracture is the availability of a tool for the prediction of such defect occurrence. The technical literature presents a wide investigation on this topic and many contributions have been given by many authors following different approaches. The main class of approaches regards the development of fracture criteria: generally, such criteria are expressed by determining a critical value of a damage function which depends on stress and strain paths: ductile fracture is assumed to occur when such critical value is reached during the analysed process. There is a relevant drawback related to the utilization of ductile fracture criteria; in fact each criterion usually has good performances in the prediction of fracture for particular stress - strain paths, i.e. it works very well for certain processes but may provide no good results for other processes. On the other hand, the approaches based on damage mechanics formulation are very effective from a theoretical point of view but they are very complex and their proper calibration is quite difficult. In this paper, two different approaches are investigated to predict fracture occurrence in cold forming operations. The final aim of the proposed method is the achievement of a tool which has a general reliability i.e. it is able to predict fracture for different forming processes. The proposed approach represents a step forward within a research project focused on the utilization of innovative predictive tools for ductile fracture. The paper presents a comparison between an artificial neural network design procedure and an approach based on statistical tools; both the approaches were aimed to predict fracture occurrence/absence basing on a set of stress and strain paths data. The proposed approach is based on the utilization of experimental data available, for a given material, on fracture occurrence in different processes. More in detail, the approach consists in the analysis of experimental tests in which fracture occurs followed by the numerical simulations of such processes in order to track the stress-strain paths in the workpiece region where fracture is expected. Such data are utilized to build up a proper data set which was utilized both to train an artificial neural network and to perform a statistical analysis aimed to predict fracture occurrence. The developed statistical tool is properly designed and optimized and is able to recognize the fracture occurrence. The reliability and predictive capability of the statistical method were compared with the ones obtained from an artificial neural network developed to predict fracture occurrence. Moreover, the approach is validated also in forming processes characterized by a complex fracture mechanics.

Reconstruction of the pelvic brim and its role in the reduction accuracy of displaced T-shaped acetabular fracture.

PubMed

Harnroongroj, T; Asavamongkolkul, A; Chareancholvanich, K

2000-05-01

Open reduction of the displaced T-shaped acetabular fracture has a problem of accuracy of the fracture reduction. This study was carried out to demonstrate that the reconstruction of the pelvic brim by approaching the pubo-acetabular fragment plays a role in the accuracy of the reduction of displaced T-shaped acetabular fractures. From 1975 to 1990, a retrospective study was carried out of 22 patients who sustained a displaced T-shaped acetabular fracture. The patients were operated on by open reduction and internal fixation of the ischio-acetabular fragment to the posterior column without restoration of the pelvic brim. Radiographs of the pelvis were reviewed. The result showed that there was displacement of the pubo-acetabular fragment including the medial wall in all cases. As the result of this study, a prospective study between 1990 and 1997 was carried out of 15 patients who sustained displaced T-shaped acetabular fractures including 3 cases with medial displacement of the femoral head. The pubo-acetabular fragment was anatomically reduced and fixed to the anterior column of the acetabulumn as the first approach to restore a disrupted pelvic brim. There, patterns of the acetabular fracture were subsequently re-evaluated especially the ischio-acetabular fragment including the position of the femoral head by using an intraoperative portable X-ray technique. The stability of the hip joint was assessed by hip flexion. The intraoperative radiograph appearances of the ischio-acetabular fragment were visually confirmed by a second surgical exposure. The results showed that the intraoperative radiographs gave spontaneous reduction of the ischio-acetabular fragment in all patients except one. There was a reduction of the displaced femoral head into the hip socket in the three patients. The hip joints were stable in all patients. The second surgical exposure showed that there was good spontaneous reduction of the ischio-acetabular fragment to the posterior column by ligamentotaxis in 14 patients. Therefore, it is not necessary to address the ischio-acetabular fragment. In the exceptional case, the ischio-acetabular fragment was displaced as a free bone which could not be reduced by ligamentotaxis. However, reduction and internal fixation of the ischio-acetabular fragment to the posterior column for complete re-application of the hip joint onto the pelvic ring of this case was facilitated. Postoperative 2 year and 5 year follow-up showed that the fracture had healed without heterotrophic ossification or premature osteoarthrosis of the hip joint. The exceptional case had a broken plate at the anterior column of the acetabulum. Hip function was evaluated clinically using Merle D' Aubigne's hip score. All patients had a "very good score". The study showed that reconstruction of the pelvic brim by anatomical reduction and fixation of the pubo-acetabular fragment to the anterior column plays an important role in the accuracy of fracture reduction of a displaced T-shaped acetabular fracture.

A new software for prediction of femoral neck fractures.

PubMed

Testi, Debora; Cappello, Angelo; Sgallari, Fiorella; Rumpf, Martin; Viceconti, Marco

2004-08-01

Femoral neck fractures are an important clinical, social and economic problem. Even if many different attempts have been carried out to improve the accuracy predicting the fracture risk, it was demonstrated in retrospective studies that the standard clinical protocol achieves an accuracy of about 65%. A new procedure was developed including for the prediction not only bone mineral density but also geometric and femoral strength information and achieving an accuracy of about 80% in a previous retrospective study. Aim of the present work was to re-engineer research-based procedures and develop a real-time software for the prediction of the risk for femoral fracture. The result was efficient, repeatable and easy to use software for the evaluation of the femoral neck fracture risk to be inserted in the daily clinical practice providing a useful tool for the improvement of fracture prediction.

Trabecular Bone Strength Predictions of HR-pQCT and Individual Trabeculae Segmentation (ITS)-Based Plate and Rod Finite Element Model Discriminate Postmenopausal Vertebral Fractures

PubMed Central

Liu, X. Sherry; Wang, Ji; Zhou, Bin; Stein, Emily; Shi, Xiutao; Adams, Mark; Shane, Elizabeth; Guo, X. Edward

2013-01-01

While high-resolution peripheral quantitative computed tomography (HR-pQCT) has advanced clinical assessment of trabecular bone microstructure, nonlinear microstructural finite element (μFE) prediction of yield strength by HR-pQCT voxel model is impractical for clinical use due to its prohibitively high computational costs. The goal of this study was to develop an efficient HR-pQCT-based plate and rod (PR) modeling technique to fill the unmet clinical need for fast bone strength estimation. By using individual trabecula segmentation (ITS) technique to segment the trabecular structure into individual plates and rods, a patient-specific PR model was implemented by modeling each trabecular plate with multiple shell elements and each rod with a beam element. To validate this modeling technique, predictions by HR-pQCT PR model were compared with those of the registered high resolution μCT voxel model of 19 trabecular sub-volumes from human cadaveric tibiae samples. Both Young’s modulus and yield strength of HR-pQCT PR models strongly correlated with those of μCT voxel models (r2=0.91 and 0.86). Notably, the HR-pQCT PR models achieved major reductions in element number (>40-fold) and CPU time (>1,200-fold). Then, we applied PR model μFE analysis to HR-pQCT images of 60 postmenopausal women with (n=30) and without (n=30) a history of vertebral fracture. HR-pQCT PR model revealed significantly lower Young’s modulus and yield strength at the radius and tibia in fracture subjects compared to controls. Moreover, these mechanical measurements remained significantly lower in fracture subjects at both sites after adjustment for aBMD T-score at the ultradistal radius or total hip. In conclusion, we validated a novel HR-pQCT PR model of human trabecular bone against μCT voxel models and demonstrated its ability to discriminate vertebral fracture status in postmenopausal women. This accurate nonlinear μFE prediction of HR-pQCT PR model, which requires only seconds of desktop computer time, has tremendous promise for clinical assessment of bone strength. PMID:23456922

Long-term effects of functional impairment on fracture risk and mortality in postmenopausal women.

PubMed

Rikkonen, T; Poole, K; Sirola, J; Sund, R; Honkanen, R; Kröger, H

2018-06-02

Our findings imply that simple functional tests can predict both hip fracture risk and excess mortality in postmenopausal women. Since the tests characterize general functional capacity (one-legged stance, squatting down, and grip strength), these simple measures should have clinical utility in the assessment of women at risk of falls and fragility fracture. Functional impairment is associated with the risk of fall, which is the leading cause of hip fracture. We aimed to determine how clinical assessments of functional impairment predict long-term hip fracture and mortality. A population-based prospective cohort involved 2815 Caucasian women with the average baseline age of 59.1 years. The mean follow-up time in 1994-2014 was 18.3 years. Three functional tests and their combinations assessed at baseline were treated as dichotomous risk factors: (1) inability to squat down and touch the floor (SQ), (2) inability to stand on one leg for 10 s (SOL), and (3) having grip strength (GS) within the lowest quartile (≤ 58 kPa, mean 45.6 kPa). Bone mineral density (BMD) at the proximal femur was measured by DXA. Fractures and deaths were verified from registries. Hazard ratios were determined by using Cox proportional models. Age, body mass index (BMI), and BMD were included as covariates for fracture risk estimates. Age, BMI, and smoking were used for mortality. Altogether, 650 (23.1%) women had 718 follow-up fractures, including 86 hip fractures. The mortality during the follow-up was 16.8% (n = 473). Half of the women (56.8%, n = 1600) had none of the impairments and were regarded as the referent group. Overall, women with any of the three impairments (43.2%, n = 1215) had higher risks of any fracture, hip fracture, and death, with hazard ratios (HR) of 1.3 ((95% CI) 1.0-1.5, p < 0.01), 2.4 (1.5-3.4, p < 0.001), and 1.5 (1.3-1.8, p < 0.001), respectively. The strongest single predictor for hip fracture was failing to achieve a one-leg stand for 10 s (prevalence 7.1%, n = 200), followed by inability to squat down (27.0%, n = 759) and weak grip strength (24.4%, n = 688), with their respective HRs of 4.3 (2.3-8.0, p < 0.001), 3.1 (2.0-5.0, p < 0.001), and 2.0 (1.2-3.4, p < 0.001). In addition, age, lower BMD, BMI, and smoking were significant covariates. These findings suggest that functional tests provide long-term prediction of fracture and death in postmenopausal women. Whether reversal of these impairments is associated with a reduction in adverse outcomes is an area for future trials.

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.

Nonstandard Lumbar Region in Predicting Fracture Risk.

PubMed

Alajlouni, Dima; Bliuc, Dana; Tran, Thach; Pocock, Nicholas; Nguyen, Tuan V; Eisman, John A; Center, Jacqueline R

Femoral neck (FN) bone mineral density (BMD) is the most commonly used skeletal site to estimate fracture risk. The role of lumbar spine (LS) BMD in fracture risk prediction is less clear due to osteophytes that spuriously increase LS BMD, particularly at lower levels. The aim of this study was to compare fracture predictive ability of upper L1-L2 BMD with standard L2-L4 BMD and assess whether the addition of either LS site could improve fracture prediction over FN BMD. This study comprised a prospective cohort of 3016 women and men over 60 yr from the Dubbo Osteoporosis Epidemiology Study followed up for occurrence of minimal trauma fractures from 1989 to 2014. Dual-energy X-ray absorptiometry was used to measure BMD at L1-L2, L2-L4, and FN at baseline. Fracture risks were estimated using Cox proportional hazards models separately for each site. Predictive performances were compared using receiver operating characteristic curve analyses. There were 565 women and 179 men with a minimal trauma fracture during a mean of 11 ± 7 yr. L1-L2 BMD T-score was significantly lower than L2-L4 T-score in both genders (p < 0.0001). L1-L2 and L2-L4 BMD models had a similar fracture predictive ability. LS BMD was better than FN BMD in predicting vertebral fracture risk in women [area under the curve 0.73 (95% confidence interval, 0.68-0.79) vs 0.68 (95% confidence interval, 0.62-0.74), but FN was superior for hip fractures prediction in both women and men. The addition of L1-L2 or L2-L4 to FN BMD in women increased overall and vertebral predictive power compared with FN BMD alone by 1% and 4%, respectively (p < 0.05). In an elderly population, L1-L2 is as good as but not better than L2-L4 site in predicting fracture risk. The addition of LS BMD to FN BMD provided a modest additional benefit in overall fracture risk. Further studies in individuals with spinal degenerative disease are needed. Copyright © 2017 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

A Theoretical Model for Predicting Fracture Strength and Critical Flaw Size of the ZrB2-ZrC Composites at High Temperatures

NASA Astrophysics Data System (ADS)

Wang, Ruzhuan; Li, Xiaobo; Wang, Jing; Jia, Bi; Li, Weiguo

2018-06-01

This work shows a new rational theoretical model for quantitatively predicting fracture strength and critical flaw size of the ZrB2-ZrC composites at different temperatures, which is based on a new proposed temperature dependent fracture surface energy model and the Griffith criterion. The fracture model takes into account the combined effects of temperature and damage terms (surface flaws and internal flaws) with no any fitting parameters. The predictions of fracture strength and critical flaw size of the ZrB2-ZrC composites at high temperatures agree well with experimental data. Then using the theoretical method, the improvement and design of materials are proposed. The proposed model can be used to predict the fracture strength, find the critical flaw and study the effects of microstructures on the fracture mechanism of the ZrB2-ZrC composites at high temperatures, which thus could become a potential convenient, practical and economical technical means for predicting fracture properties and material design.

Surgical treatment for pilon fracture of the ankle-open reduction and internal fixation.

PubMed

Chen, Y W; Huang, P J; Hsu, C Y; Kuo, C H; Cheng, Y M; Lin, S Y; Chen, L H; Chiang, H C

1998-01-01

From 1991 to 1994, 39 ankles of 38 patients underwent surgical open reduction and internal fixation for pilon fractures. These patients included 29 males and 9 females with an average age of 38.6 y/o (range 28 y/o-58 y/o). The follow up and evaluation period averaged 31.7 months (range 22Ms-44Ms), during which time a standing x-ray for arthrosis grading and functional scale was used for clinical evaluation. Complications included 1 case of infection, 1 case of loss reduction, 2 cases of partial skin necrosis and 2 cases of delayed union. Post-traumatic arthritis occurred in 23 ankles (59%) but only 4 ankles of grade 4 arthrosis resulted in poor functional scale and the overall satisfactory rate was 82%. It was found that anatomic reduction, rigid fixation and early motion exercise are important to successful treatment of ankle fractures. Regarding pilon fracture, specifically the severity of fracture pattern and delay of reduction are important problems to overcome to ensure successful results. Therefore, adequate surgical approach for entire view of ankle joint, reduction and fixation of fibula, sufficient bone graft for articular support, intraoperative x-ray check and postoperative immobilization are essential for the achievement of better clinical results.

Causes and treatment of mandibular and condylar fractures in children and adolescents: a review of 104 cases.

PubMed

Shi, Jun; Chen, Zhibiao; Xu, Bing

2014-03-01

There are no uniform treatments, standards, and specifications for conservative and surgical management of mandibular fractures in children and adolescents. To review the management of mandibular fractures in children and adolescents at our institution. The medical records of 104 children and adolescents (60 male and 44 female) treated for mandibular fractures from 2005 to 2012 at the Ninth People's Hospital, Shanghai, China, were retrospectively reviewed. The participants were classified as having deciduous dentition (age ≤6 years), mixed dentition (age >6 but <12 years), and permanent dentition (age ≥12 but ≤16 years). Conservative treatment and surgical management. Helkimo clinical dysfunction and anamnestic indices. Condylar process fractures accounted for 55.7% of the fractures (112 fractures of 201 total fracture sites), and symphysis fractures, parasymphysis fractures, fractures of the body, and fractures of the angle accounted for 20.9%, 11.9%, 7.0%, and 3.5% of the fractures, respectively. A total of 83 cases with 159 fracture sites with complete follow-up data were included in the treatment analysis. In these 83 patients, 77 fractures were dentigerous bone fractures, 46 were intracapsular fractures, and 36 were extracapsular fractures. Dentigerous bone fractures of the mandible were managed by closed or open reduction in children younger than 12 years and were managed more often by open reduction and fixation in those between ages 12 and 16 years. Closed treatment was performed for 22 condylar process fractures (28.6%), and open reduction was carried out for 55 condylar process fractures (71.4%). In patients with intracapsular fractures, there was no significant relationship between dentation age and treatment method (P = .06). Most patients with extracapsular fractures with permanent dentition underwent surgical fixation (73.3%), whereas most with deciduous dentition received conservative treatment (87.5%). In patients with condylar process fractures, there was no significant difference in Ai and Di based on treatment method (P = .49 and P = .76, respectively). The treatment of mandibular fractures in children and adolescents should be determined by clinical factors including age, location, and type of fracture.

Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

PubMed

Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

2017-05-01

This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p < 0.05): open fracture (OR 3.78; 95% CI 2.71-5.27), compartment syndrome (OR 3.53; 95% CI 2.13-5.86), operative time (OR 2.15; 95% CI 1.53-3.02), tobacco use (OR 2.13; 95% CI 1.13-3.99), and external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

[Clinical practice guideline on closed tibial plateau fractures in adulthood].

PubMed

Ocegueda-Sosa, Miguel Ángel; Valenzuela-Flores, Adriana Abigail; Aldaco-García, Víctor Daniel; Flores-Aguilar, Sergio; Manilla-Lezama, Nicolás; Pérez-Hernández, Jorge

2013-01-01

Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture. The mechanism of production of this fracture is through large varus or valgus deformation to which is added a factor of axial load. The trauma may be direct or indirect. The degree of displacement, fragmentation and involvement of soft tissues like ligaments, menisci, vascular and nerve structures are determined by the magnitude of the force exerted. Any intra-articular fracture treatment can lead to an erroneous instability, deformity and limitation of motion with subsequent arthritic changes, leading to joint incongruity, limiting activity and significantly altering the quality of life. Open reduction and internal fixation with anatomic restitution is the method used in this type of fracture. However, the results of numerous publications can be questioned due to the inclusion in the same study of fractures treated with very different methods.

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.

Management of Hip Fractures in Lateral Position without a Fracture Table.

PubMed

Pahlavanhosseini, Hamid; Valizadeh, Sima; Banadaky, Seyyed Hossein Saeed; Karbasi, Mohammad H Akhavan; Abrisham, Seyed Mohammad J; Fallahzadeh, Hossein

2014-09-01

Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe.

Management of Hip Fractures in Lateral Position without a Fracture Table

PubMed Central

Pahlavanhosseini, Hamid; Valizadeh, Sima; Banadaky, Seyyed Hossein Saeed; Karbasi, Mohammad H Akhavan; Abrisham, Seyed Mohammad J; Fallahzadeh, Hossein

2014-01-01

Background: Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. Methods: 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). Results: The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). Conclusions: It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe. PMID:25386577

Treatment of type II odontoid fracture with a novel technique

PubMed Central

Zhu, Ce; Wang, Lei; Liu, Hao; Song, Yueming; Liu, Limin; Li, Tao; Gong, Quan

2017-01-01

Abstract Surgical methods for type II odontoid fracture can be classified into 2 main groups: anterior or posterior approach. A more effective way to achieve bone fusion with the lowest possible surgical risk is needed. Therefore, the aim of our study was to describe and evaluate a novel technique, cable-dragged reduction/cantilever beam internal fixation for the treatment of type II odontoid fracture. This was a retrospective study enrolled 34 patients underwent posterior cable-dragged reduction/cantilever-beam internal fixation surgery. Medical records, rates of reduction, the location of the instrumentation and fracture healing during follow-up were analyzed. Once fracture healing was obtained, instrumentation was removed. Neck pain (scored using a visual analog scale [VAS]), neck stiffness, patient satisfaction, and neck disability index (NDI) were recorded before and after removing the instrumentation during follow-up. The mean duration of follow up was 22.8 ± 5.3 months. There was no iatrogenic damage to nerves or blood vessels. Radiographic evaluation showed complete reduction in the 20 patients with fracture displacement and satisfactory fracture healing in all 34 cases. Titanium cable breakage was observed in 4 patients after fracture healing. After removal of instrumentation, significant improvements were seen in neck-pain VAS score, neck stiffness, patient satisfaction, and NDI (all P < .01). Posterior cable-dragged reduction/cantilever-beam internal fixation was an optimal salvage maneuver to conventional surgical methods such as anterior screw fixation and C1–C2 screw-rod system. The operative difficulty and incidence of nerve and vascular injury were reduced. Its major disadvantage is the exposure and screw-setting at C3, which is left intact in traditional surgery, and it is suitable only for patients with intact C1 posterior arches. PMID:29095313

Complications of Nasal Bone Fractures.

PubMed

Hwang, Kun; Yeom, Seung Han; Hwang, Suk Hyun

2017-05-01

The aim of this study was to perform a systematic review of the treatment of nasal bone fractures. The search terms ("nasal bone fracture" AND complication) and ("nasal bone fracture" AND [anosmia OR olfaction OR olfactory nerve OR smell]) and (anosmia AND ["nasal preparation" OR "nasal antiseptics"]) were used to search PubMed and SCOPUS. Of the 500 titles, 40 full papers were reviewed. One paper was excluded, and 3 mined papers were added. Ultimately, 12 papers were analyzed. The overall deformity rate was 10.4% ± 4.8%. No significant differences were found between patients who underwent closed reduction (14.7% ± 7.3%) and those who underwent open reduction (9.4% ± 4.4%), between those who underwent local anesthesia (5.8% ± 4.5%), and those who underwent general anesthesia (8.8% ± 3.8%), or between those who received timely treatment (5.7%) and those whose treatment was delayed (9.0%). Septal deviation occurred in 10.0% of patients as a sequela of nasal bone fracture. The nasal obstruction rate was 10.5% ± 5.3%. Fewer patients of nasal obstruction occurred in the open reduction patients (6.9% ± 4.4%) than in the closed reduction patients (15.2%). One patient of epiphora and 1 patient of diplopia were reportedAmong the 77 patients with nasal bone fractures, 29 (37.7% ± 11.3%) complained of olfactory disturbances. No significant associations were found between the type of fracture and the presence of olfactory disturbances. It is recommended for providers to explain to patients that approximately one-tenth of nasal bone fractures exhibit deformity, septal deviation, or nasal obstruction after surgery. Surgeons should take considerable care to avoid the olfactory mucosa during reduction surgery.

[New techniques in the operative treatment of calcaneal fractures].

PubMed

Rammelt, S; Amlang, M; Sands, A K; Swords, M

2016-03-01

The ideal treatment of displaced intra-articular calcaneal fractures is still controversially discussed. Because of the variable fracture patterns and the vulnerable soft tissue coverage an individual treatment concept is advisable. In order to minimize wound edge necrosis associated with extended lateral approaches, selected fractures may be treated percutaneously or in a less invasive manner while controlling joint reduction via a sinus tarsi approach. Fixation in these cases is achieved with screws, intramedullary locking nails or modified plates that are slid in subcutaneously. A thorough knowledge of the three dimensional calcaneal anatomy and open reduction maneuvers is a prerequisite for good results with less invasive techniques. Early functional follow-up treatment aims at early rehabilitation independent of the kind of fixation. Peripheral fractures of the talus and calcaneus frequently result from subluxation and dislocation at the subtalar and Chopart joints. They are still regularly overlooked and result in painful arthritis if left untreated. If an exact anatomical reduction of these intra-articular fractures is impossible, resection of small fragments is indicated.

Factors Associated With Narcotic Use After Clavicle Fractures.

PubMed

Weinberg, Douglas S; Napora, Joshua K; West, William H; Grimberg, Dominic C; Vallier, Heather A

2016-09-01

Clavicle fractures are common in adults. Recent studies have shown that operative treatment of clavicle fractures has benefits in many situations. However, there is controversy about the indications. Data on social outcomes are limited. A total of 434 patients with 436 clavicle fractures treated both operatively and nonoperatively at a level 1 trauma center were identified. Narcotic use was recorded 2, 4, 6, 8, 10, 12, 14, and 16 weeks after injury for both treatment groups. Other descriptive data included age, sex, laterality, hand dominance, rib fractures, smoking, alcohol use, employment, long bone or spine fracture, open clavicle fracture, and mechanism of injury. Logistic regression analysis was performed to determine the independent predictors of narcotic use after clavicle fracture. Open reduction and internal fixation was performed in 105 fractures (24%), and 329 fractures were managed nonoperatively. A total of 154 patients (35%) reported some narcotic use 2 weeks after injury, and 15% were still using narcotics 16 weeks after injury. Narcotic use decreased over time in patients treated with open reduction and internal fixation (10% vs 15% after nonoperative management). Patients treated with open reduction and internal fixation reported reduced narcotic use at 16 weeks (odds ratio [OR], 0.454; P=.070). Concurrent rib fracture (OR, 5.668; P<.001), smoking (OR, 3.095; P=.013), unemployment (OR, 5.429; P<.0005), and long bone or spine fracture (OR, 6.761; P<.001) were predictors of narcotic use. Further studies of the social, economic, and financial outcomes of clavicle fracture and osteosynthesis are warranted. [Orthopedics. 2016; 39(5):e917-e923.]. Copyright 2016, SLACK Incorporated.

[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

A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures.

PubMed

Panteliadis, Pavlos; Musbahi, Omar; Muthian, Senthil; Goyal, Shivam; Montgomery, Alexander Sheriff; Ranganathan, Arun

2017-01-01

Management of thoracolumbar fractures remains controversial in the literature. The primary aims of this study were to assess different levels of fixation with respect to radiological outcomes in terms of fracture reduction and future loss of correction. This is a single center, retrospective study. Fifty-five patients presenting with thoracolumbar fractures between January 2012 and December 2015 were analyzed in the study. The levels of fixation were divided in 3 groups, 1 vertebra above and 1 below the fracture (1/1), 2 above and 2 below (2/2), and 2 above and 1 below (2/1). The most common mechanism was high fall injury and the most common vertebra L1. Burst fractures were the ones with the highest incidence. The 2/2 fixation achieved the best reduction of the fracture but with no statistical significance. The correction is maintained better by the 2/2 fixation but there is no statistical difference compared to the other fixations. Insertion of screws at the fracture level did not improve outcomes. The data of this study identified a trend towards better radiological outcomes for fracture reduction and maintenance of the correction in the 2/2 fixations. However these results are not statistically significant. Future multicenter prospective clinical trials are needed in order to agree on the ideal management and method of fixation for thoracolumbar fractures.

Crack Growth Simulation and Residual Strength Prediction in Airplane Fuselages

NASA Technical Reports Server (NTRS)

Chen, Chuin-Shan; Wawrzynek, Paul A.; Ingraffea, Anthony R.

1999-01-01

This is the final report for the NASA funded project entitled "Crack Growth Prediction Methodology for Multi-Site Damage." The primary objective of the project was to create a capability to simulate curvilinear fatigue crack growth and ductile tearing in aircraft fuselages subjected to widespread fatigue damage. The second objective was to validate the capability by way of comparisons to experimental results. Both objectives have been achieved and the results are detailed herein. In the first part of the report, the crack tip opening angle (CTOA) fracture criterion, obtained and correlated from coupon tests to predict fracture behavior and residual strength of built-up aircraft fuselages, is discussed. Geometrically nonlinear, elastic-plastic, thin shell finite element analyses are used to simulate stable crack growth and to predict residual strength. Both measured and predicted results of laboratory flat panel tests and full-scale fuselage panel tests show substantial reduction of residual strength due to the occurrence of multi-site damage (MSD). Detailed comparisons of n stable crack growth history, and residual strength between the predicted and experimental results are used to assess the validity of the analysis methodology. In the second part of the report, issues related to crack trajectory prediction in thin shells; an evolving methodology uses the crack turning phenomenon to improve the structural integrity of aircraft structures are discussed, A directional criterion is developed based on the maximum tangential stress theory, but taking into account the effect of T-stress and fracture toughness orthotropy. Possible extensions of the current crack growth directional criterion to handle geometrically and materially nonlinear problems are discussed. The path independent contour integral method for T-stress evaluation is derived and its accuracy is assessed using a p- and hp-version adaptive finite element method. Curvilinear crack growth is simulated in coupon tests and in full-scale fuselage panel tests. Both T-stress and fracture toughness orthotropy are found to be essential to predict the observed crack paths. The analysis methodology and software program (FRANC3D/STAGS) developed herein allows engineers to maintain aging aircraft economically while insuring continuous airworthiness. Consequently, it will improve the technology to support the safe operation of the current aircraft fleet as well as the design of more damage-tolerant aircraft for the next generation fleet.

Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures.

PubMed

Galante, Vito N; Vicenti, Giovanni; Corina, Gianfranco; Mori, Claudio; Abate, Antonella; Picca, Girolamo; Conserva, Vito; Speciale, Domenico; Scialpi, Lorenzo; Tartaglia, Nicola; Caiaffa, Vincenzo; Moretti, Biagio

2016-10-01

To determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. Retrospective, multicentre study. Adult patients with tibial pilon fractures treated with hybrid external fixation. Fracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator. Fracture union, complications, functional outcome (Mazur Ankle Score). Union was obtained in 159 fractures at an average of 125days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin-track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures. Hybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally-invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications. Level IV Case series. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management of complications of open reduction and internal fixation of ankle fractures.

PubMed

Ng, Alan; Barnes, Esther S

2009-01-01

The management of complications resulting from the open reduction and internal fixation of ankle fractures is discussed in detail. The initial radiographic findings of the most common postsurgical complications of ankle fracture reduction are briefly discussed, namely lateral, medial, and posterior malleolar malunion or nonunion, syndesmotic widening, degenerative changes, and septic arthritis with or without concomitant osteomyelitis. Emphasis is placed on the management of these complications, with a review of the treatment options proposed in the literature, a detailed discussion of the authors' recommendations, and an inclusion of different case presentations.

The influence of open fracture anisotropy on CO2 movement within geological storage complexes

NASA Astrophysics Data System (ADS)

Bond, C. E.; Wightman, R.; Ringrose, P. S.

2012-12-01

Carbon mitigation through the geological storage of carbon dioxide is dependent on the ability of geological formations to store CO2 trapping it within a geological storage complex. Secure long-term containment needs to be demonstrated, due to both political and social drivers, meaning that this containment must be verifiable over periods of 100-105 years. The effectiveness of sub-surface geological storage systems is dependent on trapping CO2 within a volume of rock and is reliant on the integrity of the surrounding rocks, including their chemical and physical properties, to inhibit migration to the surface. Oil and gas reservoir production data, and field evidence show that fracture networks have the potential to act as focused pathways for fluid movement. Fracture networks can allow large volumes of fluid to migrate to the surface within the time scales of interest. In this paper we demonstrate the importance of predicting the effects of fracture networks in storage, using a case study from the In Salah CO2 storage site, and show how the fracture permeability is closely controlled by the stress regime that determines the open fracture network. Our workflow combines well data of imaged fractures, with a discrete fracture network (DFN) model of tectonically induced fractures, within the horizon of interest. The modelled and observed fractures have been compared and combined with present day stress data to predict the open fracture network and its implications for anisotropic movement of CO2 in the sub-surface. The created fracture network model has been used to calculate the 2D permeability tensor for the reservoir for two scenarios: 1) a model in which all fractures are permeable, based on the whole DFN model and 2) those fractures determined to be in dilatational failure under the present day stress regime, a sub-set of the DFN. The resulting permeability anisotropy tensors show distinct anisotropies for the predicted CO2 movement within the reservoir. These predictions have been compared with InSAR imagery of surface uplift, used as an indicator of fluid pressure and movement in the sub-surface, around the CO2 injection wells. The analysis shows that the permeability tensor with the greatest anisotropy, that for the DFN sub-set of open fractures, matches well with the anisotropy in surface uplift imaged by InSAR. We demonstrate that predicting fracture networks alone does not predict fluid movement in the sub-surface, and that fracture permeability is closely controlled by the stress regime that determines the open fracture network. Our results show that a workflow of fracture network prediction combined with present day stress analysis can be used to successfully predict CO2 movement in the sub-surface at an active injection site.

Sliding contact fracture of dental ceramics: Principles and validation

PubMed Central

Ren, Linlin; Zhang, Yu

2014-01-01

Ceramic prostheses are subject to sliding contact under normal and tangential loads. Accurate prediction of the onset of fracture at two contacting surfaces holds the key to greater long-term performance of these prostheses. In this study, building on stress analysis of Hertzian contact and considering fracture criteria for linear elastic materials, a constitutive fracture mechanics relation was developed to incorporate the critical fracture load with the contact geometry, coefficient of friction and material fracture toughness. Critical loads necessary to cause fracture under a sliding indenter were calculated from the constitutive equation, and compared with the loads predicted from elastic stress analysis in conjunction with measured critical load for frictionless normal contact—a semi-empirical approach. The major predictions of the models were calibrated with experimentally determined critical loads of current and future dental ceramics after contact with a rigid spherical slider. Experimental results conform with the trends predicted by the models. PMID:24632538

The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma.

PubMed

Walenkamp, Monique M J; Bentohami, Abdelali; Slaar, Annelie; Beerekamp, M Suzan H; Maas, Mario; Jager, L Cara; Sosef, Nico L; van Velde, Romuald; Ultee, Jan M; Steyerberg, Ewout W; Goslings, J Carel; Schep, Niels W L

2015-12-18

Although only 39 % of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma in the Emergency Department (ED) for radiography. This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wrist fractures in patients following wrist trauma; (2) external validation of this model; and (3) design of a clinical decision rule. The study was conducted in the EDs of five Dutch hospitals: one academic hospital (derivation cohort) and four regional hospitals (external validation cohort). We included all adult patients with acute wrist trauma. The main outcome was fracture of the wrist (distal radius, distal ulna or carpal bones) diagnosed on conventional X-rays. A total of 882 patients were analyzed; 487 in the derivation cohort and 395 in the validation cohort. We derived a clinical prediction model with eight variables: age; sex, swelling of the wrist; swelling of the anatomical snuffbox, visible deformation; distal radius tender to palpation; pain on radial deviation and painful axial compression of the thumb. The Area Under the Curve at external validation of this model was 0.81 (95 % CI: 0.77-0.85). The sensitivity and specificity of the Amsterdam Wrist Rules (AWR) in the external validation cohort were 98 % (95 % CI: 95-99 %) and 21 % (95 % CI: 15 %-28). The negative predictive value was 90 % (95 % CI: 81-99 %). The Amsterdam Wrist Rules is a clinical prediction rule with a high sensitivity and negative predictive value for fractures of the wrist. Although external validation showed low specificity and 100 % sensitivity could not be achieved, the Amsterdam Wrist Rules can provide physicians in the Emergency Department with a useful screening tool to select patients with acute wrist trauma for radiography. The upcoming implementation study will further reveal the impact of the Amsterdam Wrist Rules on the anticipated reduction of X-rays requested, missed fractures, Emergency Department waiting times and health care costs. This study was registered in the Dutch Trial Registry, reference number NTR2544 on October 1(st), 2010.

Predicting grid-size-dependent fracture strains of DP980 with a microstructure-based post-necking model

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

Cheng, G.; Hu, X. H.; Choi, K. S.

Ductile fracture is a local phenomenon, and it is well established that fracture strain levels depend on both stress triaxiality and the resolution (grid size) of strain measurements. Two-dimensional plane strain post-necking models with different representative volume element (RVE) sizes are used to predict the size-dependent fracture strain of a commercial dual-phase steel, DP980. The models are generated from the actual microstructures, and the individual phase flow properties and literature-based individual phase damage parameters for the Johnson-Cook model are used for ferrite and martensite. A monotonic relationship is predicted: the smaller the model size, the higher the fracture strain. Thus,more » a general framework is developed to quantify the size-dependent fracture strains for multiphase materials. In addition to the RVE sizes, the influences of intrinsic microstructure features, i.e., the flow curve and fracture strains of the two constituent phases, on the predicted fracture strains also are examined. Application of the derived fracture strain versus RVE size relationship is demonstrated with large clearance trimming simulations with different element sizes.« less

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.

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

Fractures of the capitellum--a comparison of two fixation methods.

PubMed

Poynton, A R; Kelly, I P; O'Rourke, S K

1998-06-01

Isolated capitellar fractures are rare, accounting for only 1 per cent of all elbow fractures (Bryan and Morrey, The Elbow and its Disorders, 1985). Many different fixation methods have been described but no series has compared these treatment modalities because of the rarity of these fractures. This paper compares the outcome of two types of fixation of type I capitellar fractures. Group one (n = 6) had open reduction and Kirschner wire fixation while group two (n = 6) had open reduction and Herbert screw fixation. Both groups were compared clinically, functionally and radiographically. We found that Herbert screw fixation enabled earlier mobilization and a better functional outcome.

Fractures of the Talus: State of the Art.

PubMed

Vallier, Heather A

2015-09-01

Talus fractures occur rarely but are often associated with complications and functional limitations. Urgent reduction of associated dislocations is recommended with open reduction and internal fixation of displaced fractures when adjacent soft tissue injury permits. Delayed definitive fixation may reduce the risks of wound complications and infections. Restoration of articular and axial alignment is necessary to optimize ankle and hindfoot function. Despite this, posttraumatic arthrosis occurs frequently after talar neck and body fractures, especially with comminution of the talar body. Osteonecrosis is reported in up to half of talar neck fractures, although many of these injuries will revascularize without collapse of the talar dome. Initial fracture displacement and presence of open fractures increase the risk of osteonecrosis. Talar process fractures may be subtle and easily missed on plain radiographs. Advanced imaging will provide detail to facilitate treatment planning. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Hygrothermomechanical fracture stress criteria for fiber composites with sense-parity

NASA Technical Reports Server (NTRS)

Chamis, C. C.; Ginty, C. A.

1983-01-01

Hygrothermomechanical fracture stress criteria are developed and evaluated for unidirectional composites (plies) with sense-parity. These criteria explicity quantify the individual contributions of applied, hygral and thermal stresses as well as couplings among these stresses. The criteria are for maximum stress, maximum strain, internal friction, work-to-fracture and combined-stress fracture. Predicted results obtained indicate that first ply failure will occur at stress levels lower than those predicted using criteria currently available in the literature. Also, the contribution of the various stress couplings (predictable only by fracture criteria with sense-parity) is significant to first ply failure and attendant fracture modes.

Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction.

PubMed

Kim, J H; Nam, D H

2015-10-01

Most surgeons agree that closed treatment provides the best results for condylar fractures in children. Nevertheless, treatment of the paediatric mandibular condyle fracture that is severely displaced or dislocated is controversial. The purpose of this study was to investigate the long-term clinical and radiological outcomes following the treatment of displaced or dislocated condylar fractures in children using threaded Kirschner wire and external rubber traction. This procedure can strengthen the advantage of closed reduction and make up for the shortcomings of open reduction. From March 1, 2005 to December 25, 2011, 11 children aged between 4 and 12 years with displaced or dislocated mandibular condyle fractures were treated using threaded Kirschner wire and external rubber traction under portable C-arm fluoroscopy. All patients had unilateral displaced or dislocated condylar fractures. The follow-up period ranged from 24 to 42 months (mean 29.3 months). Normal occlusion and pain-free function of the temporomandibular joint, without deviation or limitation of jaw opening, was achieved in all patients. This closed reduction technique in displaced or dislocated condylar fractures in children offers a reliable solution in preventing the unfavourable sequelae of closed treatment and the open technique, such as altered morphology, functional disturbances, and facial nerve damage. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Fracture toughness testing of polymer matrix composites

NASA Technical Reports Server (NTRS)

Grady, Joseph E.

1992-01-01

A review of the interlaminar fracture indicates that a standard specimen geometry is needed to obtain consistent fracture toughness measurements in polymer matrix composites. In general, the variability of measured toughness values increases as the toughness of the material increases. This variability could be caused by incorrect sizing of test specimens and/or inconsistent data reduction procedures. A standard data reduction procedure is therefore needed as well, particularly for the tougher materials. Little work has been reported on the effects of fiber orientation, fiber architecture, fiber surface treatment or interlaminar fracture toughness, and the mechanisms by which the fibers increase fracture toughness are not well understood. The little data that is available indicates that woven fiber reinforcement and fiber sizings can significantly increase interlaminar fracture toughness.

Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial

PubMed Central

2014-01-01

Background Fractures of the distal radius are common and account for an estimated 17% of all fractures diagnosed. Two-thirds of these fractures are displaced and require reduction. Although distal radius fractures, especially extra-articular fractures, are considered to be relatively harmless, inadequate treatment may result in impaired function of the wrist. Initial treatment according to Dutch guidelines consists of closed reduction and plaster immobilisation. If fracture redisplacement occurs, surgical treatment is recommended. Recently, the use of volar locking plates has become more popular. The aim of this study is to compare the functional outcome following surgical reduction and fixation with a volar locking plate with the functional outcome following closed reduction and plaster immobilisation in patients with displaced extra-articular distal radius fractures. Design This single blinded randomised controlled trial will randomise between open reduction and internal fixation with a volar locking plate (intervention group) and closed reduction followed by plaster immobilisation (control group). The study population will consist of all consecutive adult patients who are diagnosed with a displaced extra-articular distal radius fracture, which has been adequately reduced at the Emergency Department. The primary outcome (functional outcome) will be assessed by means of the Disability Arm Shoulder Hand Score (DASH). Secondary outcomes comprise the Patient-Rated Wrist Evaluation score (PRWE), quality of life, pain, range of motion, radiological parameters, complications and cross-overs. Since the treatment allocated involves a surgical procedure, randomisation status will not be blinded. However, the researcher assessing the outcome at one year will be unaware of the treatment allocation. In total, 90 patients will be included and this trial will require an estimated time of two years to complete and will be conducted in the Academic Medical Centre Amsterdam and its partners of the regional trauma care network. Dicussion Ideally, patients would be randomised before any kind of treatment has been commenced. However, we deem it not patient-friendly to approach possible participants before adequate reduction has been obtained. Trial registration This study is registered at the Netherlands Trial Register (NTR3113) and was granted permission by the Medical Ethical Review Committee of the Academic Medical Centre on 01-10-2012. PMID:24642190

A prospective study on the effectiveness of cotton versus waterproof cast padding in maintaining the reduction of pediatric distal forearm fractures.

PubMed

Robert, Christopher E; Jiang, Jimmy J; Khoury, Joseph G

2011-03-01

Distal forearm fractures, one of the most common fractures seen in the pediatric population, are regularly treated by closed reduction and casting. Our study investigates the effectiveness of Gore-Tex-lined casting in maintaining the reduction of 100% displaced distal forearm fractures compared with traditional cotton-lined casts. We screened all patients from February 2007 to July 2009 who presented to Children's Hospital in Birmingham, AL with a distal radius fracture. Only patients with 100% displaced distal radius fractures were eligible to be assigned to either the cotton-lined or Gore-Tex-lined cast groups. Power analysis was performed to identify an adequate patient sample size. The mean maximum change between initial post-reduction x-rays and follow-up x-rays for anterior-posterior (AP) angulation, AP displacement, lateral angulation, and lateral displacement of the radius were calculated for both cotton and Gore-Tex groups. The rate of subsequent intervention and/or unacceptable results for each group was also analyzed. Seven hundred and twenty-two patients were treated with distal radius fractures at our hospital with 59 patients eligible for inclusion in our study. Thirty-six of our patients were treated with cotton-lined casts, and 23 patients were treated with Gore-Tex-lined cast. The mean maximum change in AP angulation, AP displacement, lateral angulation, and lateral displacement of the radius after initial reduction was 9.2 degrees, 6.9%, 13.9 degrees, and 13.6%, respectively, for the cotton-lined cast group and 7.7 degrees, 6.1%, 14.6 degrees, and 9.6%, respectively, for the Gore-Tex-lined cast group. There were no statistical differences between the means of the 4 measurements (P=0.33, 0.69, 0.73, and 0.10, respectively). There were also no significant differences between groups for final AP and lateral angulation and displacement. Subgroup analysis showed no significant differences in all measurements between cotton and Gore-Tex groups. Gore-Tex and cotton-lined casts are equally effective in their ability to maintain the reduction of 100% displaced distal forearm fractures. Thus, Gore-Tex-lined casts can be offered to pediatric patients immediately after closed reduction of distal radius fractures of any severity. Therapeutic level II.

Shaft-Condylar Angle for surgical correction in neglected and displaced lateral humeral condyle fracture in children.

PubMed

Mulpruek, Pornchai; Angsanuntsukh, Chanika; Woratanarat, Patarawan; Sa-Ngasoongsong, Paphon; Tawonsawatruk, Tulyapruek; Chanplakorn, Pongsthorn

2015-09-01

To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA<30°, >50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study

PubMed Central

Cohen-Stavi, Chandra; Leventer-Roberts, Maya; Balicer, Ran D

2017-01-01

Objective To directly compare the performance and externally validate the three most studied prediction tools for osteoporotic fractures—QFracture, FRAX, and Garvan—using data from electronic health records. Design Retrospective cohort study. Setting Payer provider healthcare organisation in Israel. Participants 1 054 815 members aged 50 to 90 years for comparison between tools and cohorts of different age ranges, corresponding to those in each tools’ development study, for tool specific external validation. Main outcome measure First diagnosis of a major osteoporotic fracture (for QFracture and FRAX tools) and hip fractures (for all three tools) recorded in electronic health records from 2010 to 2014. Observed fracture rates were compared to probabilities predicted retrospectively as of 2010. Results The observed five year hip fracture rate was 2.7% and the rate for major osteoporotic fractures was 7.7%. The areas under the receiver operating curve (AUC) for hip fracture prediction were 82.7% for QFracture, 81.5% for FRAX, and 77.8% for Garvan. For major osteoporotic fractures, AUCs were 71.2% for QFracture and 71.4% for FRAX. All the tools underestimated the fracture risk, but the average observed to predicted ratios and the calibration slopes of FRAX were closest to 1. Tool specific validation analyses yielded hip fracture prediction AUCs of 88.0% for QFracture (among those aged 30-100 years), 81.5% for FRAX (50-90 years), and 71.2% for Garvan (60-95 years). Conclusions Both QFracture and FRAX had high discriminatory power for hip fracture prediction, with QFracture performing slightly better. This performance gap was more pronounced in previous studies, likely because of broader age inclusion criteria for QFracture validations. The simpler FRAX performed almost as well as QFracture for hip fracture prediction, and may have advantages if some of the input data required for QFracture are not available. However, both tools require calibration before implementation. PMID:28104610

[Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures: a report of 56 patients].

PubMed

Liu, Yin-Wen; Kuang, Yong; Gu, Xin-Feng; Zheng, Yu-Xin; Li, Zhi-Qiang; Wei, Xiao-En; Zhang, Ming-Cai; Zhan, Hong-Sheng; Shi, Yin-yu

2013-03-01

To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis (MIPPO) for proximal and distal tibial fractures. From March 2007 to December 2010, 56 patients with proximal and distal tibial fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females,aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right fracture was in 31 cases; proximal tibial fracture was in 15 cases and distal tibial fractures was in 41 cases; 34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated. The mean operative time was 46 min in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complication with delayed union,and after auto grafting with ilium bone,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixation failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of Johner-Wruhs score,46 cases obtained excellent results,9 good and 2 fair. Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue,simplify operative procedure and decrease wound, but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages of less soft tissue injury, less blood loss, reliable fixation, which is effective method in treating proximal and distal tibial fractures and corresponds with the standpoint of biological fixation.

Clean Cast Steel Technology: Effect of Micro-porosity on Tensile and Charpy Properties of Four Cast Steels

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

Griffin, John, A.; Bates, Charles, E.

2005-09-19

The effect of these large shrink cavities on mechanical properties could be easily calculated using well established engineering formulas. Over the years, increases in computational and metallurgical resources have allowed the modeler to improve accuracy and increase the complexity of numerical predictors. An accurate prediction of micro-porosity, not observable using conventional radiographic techniques, and an engineering understanding of the effect on mechanical properties would give a designer confidence in using a more efficient casting design and a lower safety factor. This will give castings an additional design advantage. The goal of this project is to provide current and future modelers/designersmore » with a tensile and Charpy property dataset for validation of micro-porosity predictors. The response of ultimate strength, elongation, and reduction in area to micro-porosity was very similar in all four alloys. Ultimate strength was largely unaffected by tensile fracture surface porosity until values of about 25% were reached and decreased linearly with increasing values. Elongation and reduction in area decreased sharply after less than 5% fracture surface porosity. Niyama values of about 0.7 were produced sound material and acceptable tensile properties. Ultrasonic velocities of 0.233 in/usec and higher produced acceptable tensile properties. Metallographic examination revealed a ratio of 4-6 to 1 in fracture surface porosity to metallographic porosity. Charpy impact properties were largely unaffected by the microporosity concentrations examined in this study and did not correlate to either Niyama values, fracture surface porosity, or metallographic porosity.« less

Transoral Open Reduction for Subcondylar Fractures of the Mandible Using an Angulated Screwdriver System.

PubMed

Nam, Seung Min; Kim, Yong Bae; Cha, Han Gyu; Wee, Syeo Young; Choi, Chang Yong

2015-09-01

The management of subcondylar mandibular fractures has been a matter of controversy. Although closed reduction is the most useful method, it can be difficult to achieve anatomical reduction with this technique compared with open reduction and internal fixation (ORIF). Most surgeons prefer to treat subcondylar fractures by extraoral approaches rather than intraoral approaches because extraoral approaches provide good visualization of the operative field. The retromandibular, submandibular, and perilobular approaches are commonly performed in the treatment of displaced condylar or subcondylar fractures and that the functional results of these treatments are good. However, extraoral approaches have a high rate of surgical complications such as salivary fistula formation, visible scarring, and facial nerve injury, compared with intraoral approaches. Therefore, this clinical study evaluated the clinical results of ORIF for mandibular subcondylar fractures through a transoral approach using an angulated screwdriver system without endoscopic assistance. A study was conducted between March 2011 and October 2012. Eleven patients with subcondylar fractures of the mandible were treated through a transoral approach using an angulated screwdriver. There were 10 male patients and 1 female patient aged 21 to 72 years (mean, 38 years). Nine patients had a symphyseal or parasymphyseal fracture, and 2 patients had isolated subcondylar fractures of the mandible. Eleven patients with subcondylar fractures of the mandible were treated with a transoral approach using an angulated screwdriver. The subcondylar fracture was on the left side in 6 patients and on the right in 5. All patients achieved satisfactory ranges of temporomandibular joint movement with an interincisal distance of more than 40 mm without deviation and stable individual centric occlusion. The maximum operation duration was 165 minutes, and the average duration of ORIF was 97 minutes. The association between the operation duration and the number of operations was statistically significant. Our clinical study shows that subcondylar fractures of the mandible can be treated using an angulated screwdriver system through a transoral approach and that this technique provides reliable, satisfactory, and safe clinical outcomes.

Clinical prediction rule for suspected scaphoid fractures: A prospective cohort study.

PubMed

Rhemrev, S J; Beeres, F J P; van Leerdam, R H; Hogervorst, M; Ring, D

2010-10-01

The low prevalence of true fractures amongst suspected fractures magnifies the shortcomings of the diagnostic tests used to triage suspected scaphoid fractures. The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a scaphoid fracture than others who lacked the subset criteria. Seventy-eight consecutive patients diagnosed with a suspected scaphoid fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. Analysis revealed three significant independent predictors: extension <50%, supination strength ≤ 10% and the presence of a previous fracture. Clinical prediction rules have the potential to increase the prevalence of true fractures amongst patients with suspected scaphoid fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage. 2010 Elsevier Ltd. All rights reserved.

Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children.

PubMed

Park, Hoon; Park, Kwang Won; Park, Kun Bo; Kim, Hyun Woo; Eom, Nam Kyu; Lee, Dong Hoon

2017-07-01

The aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture. We retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores. Five patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up. Open reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity. © Copyright: Yonsei University College of Medicine 2017

High serum total cholesterol is a long-term cause of osteoporotic fracture.

PubMed

Trimpou, P; Odén, A; Simonsson, T; Wilhelmsen, L; Landin-Wilhelmsen, K

2011-05-01

Risk factors for osteoporotic fractures were evaluated in 1,396 men and women for a period of 20 years. Serum total cholesterol was found to be an independent osteoporotic fracture risk factor whose predictive power improves with time. The purpose of this study was to evaluate long-term risk factors for osteoporotic fracture. A population random sample of men and women aged 25-64 years (the Gothenburg WHO MONICA project, N = 1,396, 53% women) was studied prospectively. The 1985 baseline examination recorded physical activity at work and during leisure time, psychological stress, smoking habits, coffee consumption, BMI, waist/hip ratio, blood pressure, total, HDL and LDL cholesterol, triglycerides, and fibrinogen. Osteoporotic fractures over a period of 20 years were retrieved from the Gothenburg hospital registers. Poisson regression was used to analyze the predictive power for osteoporotic fracture of each risk factor. A total number of 258 osteoporotic fractures occurred in 143 participants (10.2%). As expected, we found that previous fracture, smoking, coffee consumption, and lower BMI each increase the risk for osteoporotic fracture independently of age and sex. More unexpectedly, we found that the gradient of risk of serum total cholesterol to predict osteoporotic fracture significantly increases over time (p = 0.0377). Serum total cholesterol is an independent osteoporotic fracture risk factor whose predictive power improves with time. High serum total cholesterol is a long-term cause of osteoporotic fracture.

Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women.

PubMed

Azagra, Rafael; Zwart, Marta; Encabo, Gloria; Aguyé, Amada; Martin-Sánchez, Juan Carlos; Puchol-Ruiz, Nuria; Gabriel-Escoda, Paula; Ortiz-Alinque, Sergio; Gené, Emilio; Iglesias, Milagros; Moriña, David; Diaz-Herrera, Miguel Angel; Utzet, Mireia; Manresa, Josep Maria

2016-06-17

The FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007. The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities. The discriminatory ability of the FRAX was assessed using the 'area under curve' of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period. One thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630-0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661-0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652-0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827-0.938), 0.857 (95 % CI 0.773-0.941), and 0.814 (95 % CI 0.712-0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively. The FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool's predictive capability.

Reliability Estimation for Single-unit Ceramic Crown Restorations

PubMed Central

Lekesiz, H.

2014-01-01

The objective of this study was to evaluate the potential of a survival prediction method for the assessment of ceramic dental restorations. For this purpose, fast-fracture and fatigue reliabilities for 2 bilayer (metal ceramic alloy core veneered with fluorapatite leucite glass-ceramic, d.Sign/d.Sign-67, by Ivoclar; glass-infiltrated alumina core veneered with feldspathic porcelain, VM7/In-Ceram Alumina, by Vita) and 3 monolithic (leucite-reinforced glass-ceramic, Empress, and ProCAD, by Ivoclar; lithium-disilicate glass-ceramic, Empress 2, by Ivoclar) single posterior crown restorations were predicted, and fatigue predictions were compared with the long-term clinical data presented in the literature. Both perfectly bonded and completely debonded cases were analyzed for evaluation of the influence of the adhesive/restoration bonding quality on estimations. Material constants and stress distributions required for predictions were calculated from biaxial tests and finite element analysis, respectively. Based on the predictions, In-Ceram Alumina presents the best fast-fracture resistance, and ProCAD presents a comparable resistance for perfect bonding; however, ProCAD shows a significant reduction of resistance in case of complete debonding. Nevertheless, it is still better than Empress and comparable with Empress 2. In-Ceram Alumina and d.Sign have the highest long-term reliability, with almost 100% survivability even after 10 years. When compared with clinical failure rates reported in the literature, predictions show a promising match with clinical data, and this indicates the soundness of the settings used in the proposed predictions. PMID:25048249

A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat.

PubMed

Oxley, Bill

2018-04-01

To report the use of a 3-dimensional (3D)-printed patient-specific reduction guide system to facilitate minimally invasive plate osteosynthesis (MIPO) of a humeral fracture in a cat. Case report. A 9-year-old male neutered domestic short hair cat weighing 4.4 kg. A 9-year-old male domestic short hair cat was presented with a comminuted, mid-diaphyseal left humeral fracture. Computed tomographic data were processed to yield 3D mesh representations of both humeri and subsequently manipulated in computer-aided design software. The mirrored, intact humerus was used as a template for appropriate spatial orientation of the major proximal and distal fracture fragments. Patient-specific Ellis pin orientation guides and a reduction guide were designed and 3D printed. The guide system was used intraoperatively to align the major fracture fragments before application of locking internal fixation via standard MIPO surgical portals. Internal fixation of the fracture resulted in appropriate bone alignment. Recovery was uncomplicated, with early return to normal limb function and radiographic evidence of advanced fracture healing after 4 months. A 3D-printed patient-specific reduction guide system facilitated accurate alignment of a comminuted humeral fracture during MIPO without intraoperative imaging. © 2018 The American College of Veterinary Surgeons.

Small Crack Growth and Its Influence in Near Alpha-Titanium Alloys

DTIC Science & Technology

1989-06-01

geometries via finite element and boundary-collocation analysis 8 , 9 . Elastic plastic fracture mechanics ( EPFM ) 1 0 , 1 1 and local crack tip field...correlation was found between experimental and predicted data, general application of the model is not possible as both 0 and rp are sensitive to changes in...cracks at low AK the load reduction schemes should be altered to remove the residual deformations, perhaps via machining or the application of large

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.

Damage Tolerant Analysis of Cracked Al 2024-T3 Panels repaired with Single Boron/Epoxy Patch

NASA Astrophysics Data System (ADS)

Mahajan, Akshay D.; Murthy, A. Ramachandra; Nanda Kumar, M. R.; Gopinath, Smitha

2018-06-01

It is known that damage tolerant analysis has two objectives, namely, remaining life prediction and residual strength evaluation. To achieve the these objectives, determination of accurate and reliable fracture parameter is very important. XFEM methodologies for fatigue and fracture analysis of cracked aluminium panels repaired with different patch shapes made of single boron/epoxy have been developed. Heaviside and asymptotic crack tip enrichment functions are employed to model the crack. XFEM formulations such as displacement field formulation and element stiffness matrix formulation are presented. Domain form of interaction integral is employed to determine Stress Intensity Factor of repaired cracked panels. Computed SIFs are incorporated in Paris crack growth model to predict the remaining fatigue life. The residual strength has been computed by using the remaining life approach, which accounts for both crack growth constants and no. of cycles to failure. From the various studies conducted, it is observed that repaired panels have significant effect on reduction of the SIF at the crack tip and hence residual strength as well as remaining life of the patched cracked panels are improved significantly. The predicted remaining life and residual strength will be useful for design of structures/components under fatigue loading.

Reduction of Zygomatic Fractures Using the Carroll-Girard T-bar Screw.

PubMed

Baek, Ji Eun; Chung, Chan Min; Hong, In Pyo

2012-09-01

Zygomatic fractures are the second most common facial bone fractures encountered and treated by plastic surgeons. Stable fixation of fractured fragments after adequate exposure is critical for ensuring three-dimensional anatomic reduction. Between January 2008 and December 2010, 17 patients with zygomatic fractures were admitted to our hospital; there were 15 male and 2 female patients. The average age of the patients was 41 years (range, 19 to 75 years). We exposed the inferior orbital rim and zygomatic complex through a lateral brow, intraoral, and subciliary incisions, which allowed for visualization of the bone, and then the fractured parts were corrected using the Carroll-Girard T-bar screw. Postoperative complications such as malar asymmetry, diplopia, enophthalmos, and postoperative infection were not observed. Lower eyelid retraction and temporary ectropion occurred in 1 of the 17 patients. Functional and cosmetic results were excellent in nearly all of the cases. In this report, we describe using the Carroll-Girard T-bar screw for the reduction of zygomatic fractures. Because this instrument is easy to use and can rotate to any direction and vector, it can be used to correct displaced zygomatic bone more accurately and safely than other devices, without leaving facial scars.

A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India

PubMed Central

Bali, Rishi; Sharma, Parveen; Garg, Amandeep; Dhillon, Guneet

2013-01-01

Abstract: Background: The Department of Oral and Maxillofacial Surgery, D.A.V [C] Dental College and Hospital, Yamuna Nagar, Haryana, India conducted a study on patients with maxillofacial fractures in a time span of seven years (2003-2010). The purpose of this study was to evaluate their aetiology, incidence, patterns and different modalities employed for management. Methods: In this study, 740 patients with 1054 fractures were evaluated clinically and radiographically, based on which closed reduction and open reduction was undertaken. Review of patient records included: Age, sex, time, mechanism and etiology of injury, history of bleeding, unconsciousness and prior first aid, type of vehicle and use of preventive measures, type of fracture and treatment modalities. Results: Road traffic accidents accounted for highest number of fractures predominantly occurring in the age group of 21-30 years (38.3%)1,2. Males incurred more fractures with a male female ratio of 4.2: 1.Mandible was the most commonly fractured bone with parasymphysis being the commonest affected site.76.66% patients had associated head injury and 15.68 % had history of unconsciousness. Open reduction and internal fixation was the preferred modality for mandible whereas the mid face fractures were treated more often by closed methods. Conclusions: Injuries occurred more commonly in 20 – 40 age range with road traffic accident being the major etiological factor. Majority of the patients were driving two wheelers and most were under the effect of alcohol. Most of the injuries occurred during night and road traffic accidents (71.89%) were found to be the major etiological factor. Out of 532 road traffic accidents, 490 patients (66.2%) were on two wheelers, among whom 49(10%) were wearing helmet. In the mandible, fractures occurred most commonly in the parasymphyseal region (224, 30.2%), and out of the 314 fractures of the middle third showed, 155 (49.4%) ZMC. OPG was the most commonly advised X-ray. With regard to treatment modalities, 36.8% of all the mandibular fractures (740) were treated by closed reduction, 62.6% were treated using open reduction and 0.5% was under observation only. PMID:23594725

Management of maxillofacial injuries in Iraq.

PubMed

Kummoona, Raja

2011-09-01

These clinical studies reflect the experience of the author in managing 673 patients treated during the last 8 years. All patients were treated in the Maxillofacial Unit, Surgical Specialties Hospital, Medical City, Baghdad, and in the author's private clinic. Included patients were 530 males and 143 females; patients' age ranged between 1 year and 75 years (mean, 38 y). Distribution of injuries was as follows: fracture of the mandible, 287 (42.64%); middle third injuries, 39 (5.79%); orbital injuries, 236 (35.07%; including 12 cases with cranioorbital injuries); injuries in children, 27 (4.0%); fracture of the zygoma, 52 (7.73%); and fracture of the nose, 40 (5.94%).Maxillofacial injuries in this study were classified as follows: (1) craniomaxillofacial with head injuries and cerebrospinal fluid leak; (2) fracture of the middle third including Le Fort I, II, and III and midline split in the face; (3) fracture of the mandible as an isolated injury or as part of a facial skeleton injury; and (4) isolated complex injuries of the zygoma, the orbital skeleton, and the nasoethmoidal region.The technique used for treating middle third injuries was external fixation either by halo frame (with vertical rods and cheek wires) or by box frame (using 4 external pins connected by rods) or internal fixation by suspending the middle third with internal wires (0.5 mm stainless steel) from the zygomatic process of the frontal bone beneath the zygomatic arch down the lower arch bar. Fractures of the mandible were treated by gunning splint with intermaxillary fixation (IMF) or with open reduction and fixation by stainless steel wire with IMF or by IMF screw or by an arch bar and IMF. Other fractures such as fracture of the orbit were treated by bone graft, sialastic, or lyophilized dura with open reduction. Fractures of the zygoma were treated by open reduction and fixation with stainless steel wire and bone graft or by reduction without fixation. Fractures of the nose were treated by reduction with straightening of the septum with a splint (lead splint or polythene) or by external splint with plaster of Paris. With the techniques used, results from managing these cases were satisfactory.

DEMONSTRATION BULLETIN: HYDRAULIC FRACTURING OF CONTAMINATED SOIL

EPA Science Inventory

Hydraulic fracturing is a physical process that creates fractures in silty clay soil to enhance its permeability. The technology, developed by the Risk Reduction Engineering Laboratory (RREL) and the University of Cincinnati, creates sand-filled horizontal fractures up to 1 in. i...

Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes.

PubMed

Helminen, Heli; Luukkaala, Tiina; Saarnio, Juha; Nuotio, Maria

2017-04-01

Malnutrition is common among older hip fracture patients and associated with adverse outcomes. We examined Mini Nutritional Assessment short (MNA-SF) and long form (MNA-LF) and serum albumin as prognostic indicators of mobility, living arrangements and mortality after hip fracture. Population-based prospective data were collected on 594 hip fracture patients aged 65 and over. MNA-SF, MNA-LF and serum albumin were assessed on admission. Outcomes were poorer mobility; transfer to more assisted living accommodation and mortality one month, four months and one year post fracture. Logistic regression analyses for mobility and living arrangements with odds ratios (OR) and Cox proportional hazards model for mortality with hazard ratios (HR) and 95% confidence intervals (CI) were used, adjusted for age, gender, ASA grade and fracture type. All measures predicted mortality at all time-points. Risk of malnutrition and malnutrition measured by MNA-LF predicted mobility and living arrangements within four months of hip fracture. At one year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements, when measured by MNA-LF. Malnutrition, but not risk thereof, measured by MNA-SF predicted living arrangements at all time-points. None of the measures predicted one-month mobility. All measures were strong indicators of short- and long-term mortality after hip fracture. MNA-LF was superior in predicting mobility and living arrangements, particularly at four months. All measures were relatively poor in predicting short-term outcomes of mobility and living arrangements. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

Oral-motor and electromyographic characterization of patients submitted to open a nd closed reductions of mandibular condyle fracture.

PubMed

Silva, Amanda Pagliotto da; Sassi, Fernanda Chiarion; Andrade, Claudia Regina Furquim de

To characterize the oral-motor system of adults with mandibular condyle facture comparing the performance of individuals submitted to open reduction with internal fixation (ORIF) and closed reduction with mandibulomaxillary fixation (CRMMF). Study participants were 26 adults divided into three groups: G1 - eight individuals submitted to ORIF for correction of condyle fracture; G2 - nine individuals submitted to CRMMF for correction of condyle fracture; CG - nine healthy volunteers with no alterations of the orofacial myofunctional system. All participants underwent the same clinical protocol: assessment of the orofacial myofunctional system; evaluation of the mandibular range of motion; and surface electromyography (sEMG) of the masticatory muscles. Results indicated that patients with condyle fractures from both groups presented significant differences compared with those from the control group in terms of mobility of the oral-motor organs, mastication, and deglutition. Regarding the measures obtained for mandibular movements, participants with facial fractures from both groups showed significant differences compared with those from the control group, indicating greater restrictions in mandibular motion. As for the analysis of sEMG results, G1 patients presented more symmetrical masseter activation during the task of maximal voluntary teeth clenching. Patients with mandibular condyle fractures present significant deficits in posture, mobility, and function of the oral-motor system. The type of medical treatment does not influence the results of muscle function during the first six months after fracture reduction. Individuals submitted to ORIF of the condyle fracture present more symmetrical activation of the masseter muscle.

Treatment of Mandibular Condyle Fractures Using a Modified Transparotid Approach via the Parotid Mini-Incision: Experience with 31 Cases

PubMed Central

Shi, Jun; Yuan, Hao; Xu, Bing

2013-01-01

Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm). No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes. PMID:24386221

[Treatment of linguiform calcaneus fracture by close nail-pry reduction and internal fixation with hollow screws].

PubMed

Tu, Shu-Qiang; Huang, Ke-Di; Shuai, Yong-Ming; Xu, Nan-Yun; Yuan, Qiu-Wen; Guo, Jian

2012-06-01

To study the curative effects of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture. From May 2006 to October 2009,32 patients (35 feet) with linguiform calcaneus fracture were treated by close nail-pry reduction and internal fixation with hollow screws, including 23 males and 9 females ranging in age from 25 to 46 years, with a mean of 37.6 years. According to Paley classification, 3 cases were Paley II a, and 29 cases were Paley II b. All cases were close fractures. The time from injury to operation was 3 to 10 days after most swelling subsided. Böhler angle and Gissane angle were measured by X-ray before and after operation. The therapeutic effect was assessed according to ZHANG Tie-liang's foot score. All the patients were followed-up for 6 to 18 months, with a mean of 12 months. All fractures gained bone healing. The time of fracture healing averaged 12 months. The fractures healed completely and no infection occurred. According to ZHANG Tie-liang's foot scale, the postoperative function was excellent in 18 feet, good in 10 feet, moderate in 5 feet and poor in 2 feet. The Böhler angle and Gissane angle were significant improved after treatment (P < 0.01). The surgical method of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture can regain the foot function, with minimal injury, fewer complications, earlier recovery and lower costs.

The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures

PubMed Central

Ma, Junli; Ma, Limin; Wang, Zhifa; Zhu, Xiongjie; Wang, Weijian

2017-01-01

Abstract Rationale: Precise bony reduction and reconstruction of optimal contour in treating comminuted mandibular fractures is very difficult using traditional techniques and devices. The aim of this report is to introduce our experiences in using virtual surgery and three-dimensional (3D) printing technique in treating this clinical challenge. Patient concerns: A 26-year-old man presented with severe trauma in the maxillofacial area due to fall from height. Diagnosis: Computed tomography images revealed middle face fractures and comminuted mandibular fracture including bilateral condyles. Interventions and outcomes: The computed tomography data was used to construct the 3D cranio-maxillofacial models; then the displaced bone fragments were virtually reduced. On the basis of the finalized model, a customized titanium mesh tray was designed and fabricated using selective laser melting technology. During the surgery, a submandibular approach was adopted to repair the mandibular fracture. The reduction and fixation were performed according to preoperative plan, the bone defects in the mental area were reconstructed with iliac bone graft. The 3D-printed mesh tray served as an intraoperative template and carrier of bone graft. The healing process was uneventful, and the patient was satisfied with the mandible contour. Lessons: Virtual surgical planning combined with 3D printing technology enables surgeon to visualize the reduction process preoperatively and guide intraoperative reduction, making the reduction less time consuming and more precise. 3D-printed titanium mesh tray can provide more satisfactory esthetic outcomes in treating complex comminuted mandibular fractures. PMID:28682875

Structural behavior of composites with progressive fracture

NASA Technical Reports Server (NTRS)

Minnetyan, L.; Murthy, P. L. N.; Chamis, C. C.

1989-01-01

The objective of the study is to unify several computational tools developed for the prediction of progressive damage and fracture with efforts for the prediction of the overall response of damaged composite structures. In particular, a computational finite element model for the damaged structure is developed using a computer program as a byproduct of the analysis of progressive damage and fracture. Thus, a single computational investigation can predict progressive fracture and the resulting variation in structural properties of angleplied composites.

Effect of hydrogen on void initiation in tensile test of carbon steel JIS-S25C

NASA Astrophysics Data System (ADS)

Sugawa, S.; Tsutsumi, N.; Oda, K.

2018-06-01

In order to investigate the effect of hydrogen on tensile fracture mechanism of a carbon steel, tensile tests were conducted. Pre-strain specimens (0%, 5% and 10%) were used to study the effect of hydrogen content, since saturated hydrogen content in specimens increases in increasing dislocation density. The tensile strength and the yield stress of hydrogen specimens were almost the same as uncharged. In contrast, the reduction of area of hydrogen charged specimens was smaller than that of uncharged. To reveal the reasons of decrease of the reduction of area, the fracture surface and longitudinal cross section near the fracture surface were observed. On the fracture surface of uncharged specimens, only dimples were observed. On the other hand, dimples and flat fracture surface were observed on the fracture surface of hydrogen charged. On the longitudinal cross section of hydrogen charged specimens, many voids were observed compared to uncharged. From these observations, it is showed that hydrogen gives a rise to the increase of voids and the hydrogen charged specimens break without sufficient necking, thus hydrogen makes the reduction of area smaller.

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.

Predicting grid-size-dependent fracture strains of DP980 with a microstructure-based post-necking model

DOE PAGES

Cheng, G.; Hu, X. H.; Choi, K. S.; ...

2017-07-08

Ductile fracture is a local phenomenon, and it is well established that fracture strain levels depend on both stress triaxiality and the resolution (grid size) of strain measurements. Two-dimensional plane strain post-necking models with different model sizes are used in this paper to predict the grid-size-dependent fracture strain of a commercial dual-phase steel, DP980. The models are generated from the actual microstructures, and the individual phase flow properties and literature-based individual phase damage parameters for the Johnson–Cook model are used for ferrite and martensite. A monotonic relationship is predicted: the smaller the model size, the higher the fracture strain. Thus,more » a general framework is developed to quantify the grid-size-dependent fracture strains for multiphase materials. In addition to the grid-size dependency, the influences of intrinsic microstructure features, i.e., the flow curve and fracture strains of the two constituent phases, on the predicted fracture strains also are examined. Finally, application of the derived fracture strain versus model size relationship is demonstrated with large clearance trimming simulations with different element sizes.« less

Predicting grid-size-dependent fracture strains of DP980 with a microstructure-based post-necking model

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

Cheng, G.; Hu, X. H.; Choi, K. S.

Ductile fracture is a local phenomenon, and it is well established that fracture strain levels depend on both stress triaxiality and the resolution (grid size) of strain measurements. Two-dimensional plane strain post-necking models with different model sizes are used in this paper to predict the grid-size-dependent fracture strain of a commercial dual-phase steel, DP980. The models are generated from the actual microstructures, and the individual phase flow properties and literature-based individual phase damage parameters for the Johnson–Cook model are used for ferrite and martensite. A monotonic relationship is predicted: the smaller the model size, the higher the fracture strain. Thus,more » a general framework is developed to quantify the grid-size-dependent fracture strains for multiphase materials. In addition to the grid-size dependency, the influences of intrinsic microstructure features, i.e., the flow curve and fracture strains of the two constituent phases, on the predicted fracture strains also are examined. Finally, application of the derived fracture strain versus model size relationship is demonstrated with large clearance trimming simulations with different element sizes.« less

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis.

PubMed

Chartier, Lucas B; Bosco, Laura; Lapointe-Shaw, Lauren; Chenkin, Jordan

2017-03-01

Long bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs. Data source MEDLINE and EMBASE databases were searched through July 19, 2015. Study selection We included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data extraction Thirty studies met inclusion criteria (n=3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%-100%, specificity 79.2%-100%, positive likelihood ratio (LR) 3.11-infinity, and negative LR zero-0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%-100% and 56%-100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%-96.4%) and specificity of 92.9% (95% CI, 86.6%-96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%-95.6%) and specificity of 94.2% (95% CI, 86.1%-97.7%). PoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs.

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

PubMed Central

Akbar, Saleem; Dhar, Shabir A.

2008-01-01

To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The post-operative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit. PMID:18193300

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.

The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study.

PubMed

Dufour, A B; Roberts, B; Broe, K E; Kiel, D P; Bouxsein, M L; Hannan, M T

2012-02-01

We examined the relation between a biomechanical measure, factor-of-risk, and hip fracture risk in 1,100 men and women from the Framingham Study and found that it predicted hip fracture (men, ORs of 1.8; women, 1.2-1.4). Alternative methods of predicting hip fracture are needed since 50% of adults who fracture do not have osteoporosis by bone mineral density (BMD) measurements. One method, factor-of-risk (Φ), computes the ratio of force on the hip in a fall to femoral strength. We examined the relation between Φ and hip fracture in 1,100 subjects from the Framingham Study with measured hip BMD, along with weight, height, and age, collected in 1988-1989. We estimated both peak and attenuated force applied to the hip in a sideways fall from standing height, where attenuated force incorporated cushioning effects of trochanteric soft tissue. Femoral strength was estimated from femoral neck BMD, using cadaveric femoral strength data. Sex-specific, age-adjusted survival models were used to calculate hazard ratios (HR) and 95% confidence intervals for the relation between Φ (peak), Φ (attenuated), and their components with hip fracture. In 425 men and 675 women (mean age, 76 years), 136 hip fractures occurred over median follow-up of 11.3 years. Factor-of-risk, Φ, was associated with increased age-adjusted risk for hip fracture. One standard deviation increase in Φ (peak) and Φ (attenuated) was associated with HR of 1.88 and 1.78 in men and 1.23 and 1.41 in women, respectively. Examining components of Φ, in women, we found fall force and soft tissue thickness were predictive of hip fracture independent of femoral strength (was estimated from BMD). Thus, both Φ (peak) and Φ (attenuated) predict hip fracture in men and women. These findings suggest additional studies of Φ predicting hip fracture using direct measurements of trochanteric soft tissue.

Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures.

PubMed

Siebenrock, K A; Müller, U; Ganz, R

1998-01-01

Subtrochanteric fractures frequently occur as high energy trauma usually in younger patients and may lead to severe comminution of the medial cortex. The medial cortex of the proximal femur is exposed to high compressive forces which make fracture stabilization a difficult problem. Bone healing may be seriously compromised due to extensive comminution and fragment devitalization. This requires reduction techniques which do not cause additional damage to the vitality of the bone. With indirect reduction techniques and the use of a condylar blade plate the results have been significantly improved in these fracture types in our department (1). In this report the essential aspects of indirect reduction for subtrochanteric fractures using a condylar blade plate and the treatment results from our department from earlier years (1) and from the last 2 1/2 years will be presented. In the latter period, fifteen patients with a mean age of 49 years (19-87 years) were treated with this method. Fractures resulted from traffic incidents or falls from a great height in 11 cases (73%). Union was achieved in 14 cases (93%) with full weight-bearing after a mean of 3 months (1-4 1/2 months). Malunion was seen in two cases (13%) without the need for further surgery. Non union occurred in one patient (7%) with a III B open injury due to early infection. After repeated debridements, bone grafting and decortication, the fracture was stabilized with a replacement condylar blade plate and healed uneventfully.

Transoral open reduction and fixation of mandibular condylar base and neck fractures in children and young teenagers--a beneficial treatment option?

PubMed

Schiel, Sebastian; Mayer, Peter; Probst, Florian; Otto, Sven; Cornelius, Carl-Peter

2013-07-01

To evaluate the possible benefits of open surgery, endoscopically assisted reduction and fixation using a transoral route was used in a selected series of pediatric patients with displaced condylar base and neck fractures. A cohort of 6 patients (1 male and 5 female; age range, 7 to 15 yr; mean, 13.4 yr) with displaced condylar base and neck fractures (n = 9) were included. Inclusion criteria were age younger than 16 years, fracture of the condylar base or neck, and displacement of the fracture by at least 45°. Fractures were classified using conventional radiography, cone-beam computed tomography, or computed tomography. Patients underwent transoral endoscopically assisted open reduction and fixation using miniplate osteosynthesis. Postoperatively, patients were followed clinically and radiographically for 18 months. Complete follow-up varied from 18 to 35 months (median, 24.5 months). All patients showed normal occlusion and pain-free unrestricted function of the temporomandibular joint at 3, 6, 12, and 18 months postoperatively. There were no signs of incomplete remodeling or deformation of the condyles. Transoral endoscopically assisted surgical treatment of severely displaced condylar base and neck fractures in children and young teenagers offers a reliable solution to preclude the sequelae of closed treatment, such as altered morphology and functional disturbances, eliminates visible scars, and lowers the risk of facial nerve damage compared with open reduction using an extraoral approach. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures.

PubMed

Li, Guowei; Thabane, Lehana; Papaioannou, Alexandra; Adachi, Jonathan D

2015-08-01

A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that measures of frailty status may aid in fracture risk assessment and fracture prevention in the elderly. Further evidence from randomized controlled trials of osteoporosis medication interventions is needed to support the FI and FRAX as validated measures of fracture risk. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures

PubMed Central

Li, Guowei; Thabane, Lehana; Papaioannou, Alexandra; Adachi, Jonathan D.

2016-01-01

A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02–1.05) and 1.02 (95% CI: 1.01–1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19–1.58) and 1.26 (95% CI: 1.12–1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36–3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82–1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09–3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48–4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18 months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that measures of frailty status may aid in fracture risk assessment and fracture prevention in the elderly. Further evidence from randomized controlled trials of osteoporosis medication interventions is needed to support the FI and FRAX as validated measures of fracture risk. PMID:25916552

Bone mineral content and areal density, but not bone area, predict an incident fracture risk: a comparative study in a UK prospective cohort.

PubMed

Curtis, E M; Harvey, N C; D'Angelo, S; Cooper, C S; Ward, K A; Taylor, P; Pearson, G; Cooper, C

2016-12-01

We studied a prospective UK cohort of women aged 20 to 80 years, assessed by dual-energy X-ray absorptiometry (DXA) at baseline. Bone mineral content (BMC) and areal bone mineral density (aBMD), but not bone area (BA), at femoral neck, lumbar spine and the whole body sites were similarly predictive of incident fractures. Low aBMD, measured by DXA, is a well-established risk factor for future fracture, but little is known about the performance characteristics of other DXA measures such as BA and BMC in fracture prediction. We therefore investigated the predictive value of BA, BMC and aBMD for incident fracture in a prospective cohort of UK women. In this study, 674 women aged 20-80 years, recruited from four GP practices in Southampton, underwent DXA assessment (proximal femur, lumbar spine, total body) between 1991 and 1993. All women were contacted in 1998-1999 with a validated postal questionnaire to collect information on incident fractures and potential confounding factors including medication use. Four hundred forty-three women responded, and all fractures were confirmed by the assessment of images and radiology reports by a research nurse. Cox proportional hazard models were used to explore the risk of incident fracture, and the results are expressed as hazard ratio (HR) per 1 SD decrease in the predictor and 95% CI. Associations were adjusted for age, BMI, alcohol consumption, smoking, HRT, medications and history of fracture. Fifty-five women (12%) reported a fracture. In fully adjusted models, femoral neck BMC and aBMD were similarly predictive of incident fracture. Femoral neck BMC: HR/SD = 1.64 (95%CI: 1.19, 2.26; p = 0.002); femoral neck aBMD: HR/SD = 1.76 (95%CI: 1.19, 2.60; p = 0.005). In contrast, femoral neck BA was not associated with incident fracture, HR/SD = 1.15 (95%CI: 0.88, 1.50; p = 0.32). Similar results were found with bone indices at the lumbar spine and the whole body. In conclusion, BMC and aBMD appear to predict incident fracture with similar HR/SD, even after adjustment for body size. In contrast, BA only weakly predicted the future fracture. These findings support the use of DXA aBMD in fracture risk assessment, but also suggest that factors which specifically influence BMC will have a relevance to the risk of the incident fracture.

Comparative study of the prognosis of an extracorporeal reduction and a closed treatment in mandibular condyle head and/or neck fractures.

PubMed

Park, Jung-Min; Jang, Yong-Wook; Kim, Seong-Gon; Park, Young-Wook; Rotaru, Horatiu; Baciut, Grigore; Hurubeanu, Lucia

2010-12-01

The objective of this study was a comparison of the prognosis between an extracorporeal reduction technique and closed treatment of a mandibular condyle fracture. The relationship between condylar resorption and several clinical variables was also studied. Seventy-one patients who had a mandibular condyle fracture took part in this study. Thirty-five patients (female: 7, male: 28, age: 30.46 ± 14.27 years) were treated by extracorporeal reduction, and 36 patients (male: 24, female: 12, age: 24.28 ± 9.99 years) were treated using a closed treatment. The presence of complications such as condylar resorption, malocclusion, nerve disorder, and disc displacement was evaluated with panoramic radiographs and clinical examinations 12 months after treatment. The relationships between the complications and other clinical variables were evaluated statistically. The anatomic site and fracture type were closely related to condyle resorption in the bivariate analysis. Condylar head fractures showed significantly higher condyle resorption than condylar neck fractures (P = .023). A complex or compound fracture showed significantly higher condyle resorption compared with a simple fracture (P = .006). Patients who had a complex/compound fracture were 34.366 times more likely to have condyle resorption compared with those who had a simple fracture (P = .002). The patient's age and treatment method were also significant predictors for condyle resorption. Fracture type was the strongest predictor of condylar resorption. Because treatment method and patient age were also related to the prognosis, the optimal treatment for mandibular condylar head and/or neck fractures should be individualized according to the patient's condition. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Does formal education and training of staff reduce the operation rate for fractures of the distal radius?

PubMed

McDonald, Kyle; Murphy, Lynn; Gallagher, Brendan; Eames, Niall

2013-12-01

Fractures of the distal radius are one of the most common extremity fractures, and operation rates are increasing. Staff within our unit felt that formal teaching, particularly of new medical staff, with regards to fracture reduction and appropriate cast application could result in a reduction in operation rates. Retrospective data was extracted from FORD (Fracture Outcome and Research Database), including: number of fractures, number of fractures undergoing ORIF, fracture configuration, patient demographics, and mechanism of injury. All patients undergoing ORIF had their radiographs assessed by two separate reviewers. Information regarding adequate fracture reduction, adequate cast application (using Gap Index), and appropriate plaster cast moulding was recorded. Formal teaching was then given to the next group of medical staff rotating through the unit, and the same data was collected prospectively for that six-month period. Exclusion criteria included bilateral injuries, and polytrauma patients. A total of 1623 distal radial fractures were treated in our unit over the 12-month period, with 71 undergoing ORIF in the first 6 months and 39 in the second 6 months, this was statistically significant (p = 0.0009). Our study found that formal teaching and education significantly reduced the operation rate for distal radial fractures. This effect was most significant for extra-articular, dorsally angulated fractures of the distal radius. Our study proves that just 1 h of basic training at the beginning of an attachment can have significant benefits to both the unit and, more importantly, the patients. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

A novel computer algorithm for modeling and treating mandibular fractures: A pilot study.

PubMed

Rizzi, Christopher J; Ortlip, Timothy; Greywoode, Jewel D; Vakharia, Kavita T; Vakharia, Kalpesh T

2017-02-01

To describe a novel computer algorithm that can model mandibular fracture repair. To evaluate the algorithm as a tool to model mandibular fracture reduction and hardware selection. Retrospective pilot study combined with cross-sectional survey. A computer algorithm utilizing Aquarius Net (TeraRecon, Inc, Foster City, CA) and Adobe Photoshop CS6 (Adobe Systems, Inc, San Jose, CA) was developed to model mandibular fracture repair. Ten different fracture patterns were selected from nine patients who had already undergone mandibular fracture repair. The preoperative computed tomography (CT) images were processed with the computer algorithm to create virtual images that matched the actual postoperative three-dimensional CT images. A survey comparing the true postoperative image with the virtual postoperative images was created and administered to otolaryngology resident and attending physicians. They were asked to rate on a scale from 0 to 10 (0 = completely different; 10 = identical) the similarity between the two images in terms of the fracture reduction and fixation hardware. Ten mandible fracture cases were analyzed and processed. There were 15 survey respondents. The mean score for overall similarity between the images was 8.41 ± 0.91; the mean score for similarity of fracture reduction was 8.61 ± 0.98; and the mean score for hardware appearance was 8.27 ± 0.97. There were no significant differences between attending and resident responses. There were no significant differences based on fracture location. This computer algorithm can accurately model mandibular fracture repair. Images created by the algorithm are highly similar to true postoperative images. The algorithm can potentially assist a surgeon planning mandibular fracture repair. 4. Laryngoscope, 2016 127:331-336, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

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.

Nuclear Graphite - Fracture Behavior and Modeling

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

Burchell, Timothy D; Battiste, Rick; Strizak, Joe P

2011-01-01

Evidence for the graphite fracture mechanism is reviewed and discussed. The roles of certain microstructural features in the graphite fracture process are reported. The Burchell fracture model is described and its derivation reported. The successful application of the fracture model to uniaxial tensile data from several graphites with widely ranging structure and texture is reported. The extension of the model to multiaxial loading scenarios using two criteria is discussed. Initially, multiaxial strength data for H-451 graphite were modeled using the fracture model and the Principle of Independent Action. The predicted 4th stress quadrant failure envelope was satisfactory but the 1stmore » quadrant predictions were not conservative and thus were unsatisfactory. Multiaxial strength data from the 1st and 4th stress quadrant for NBG-18 graphite are reported. To improve the conservatism of the predicted 1st quadrant failure envelope for NBG-18 the Shetty criterion has been applied to obtain the equivalent critical stress intensity factor, KIc (Equi), for each applied biaxial stress ratio. The equivalent KIc value is used in the Burchell fracture model to predict the failure envelope. The predicted 1st stress quadrant failure envelope is conservative and thus more satisfactory than achieved previously using the fracture model combined with the Principle of Independent Action.« less

Percutaneous Dorsal Instrumentation of Vertebral Burst Fractures: Value of Additional Percutaneous Intravertebral Reposition—Cadaver Study

PubMed Central

Krüger, Antonio; Schmuck, Maya; Noriega, David C.; Ruchholtz, Steffen; Baroud, Gamal; Oberkircher, Ludwig

2015-01-01

Purpose. The treatment of vertebral burst fractures is still controversial. The aim of the study is to evaluate the purpose of additional percutaneous intravertebral reduction when combined with dorsal instrumentation. Methods. In this biomechanical cadaver study twenty-eight spine segments (T11-L3) were used (male donors, mean age 64.9 ± 6.5 years). Burst fractures of L1 were generated using a standardised protocol. After fracture all spines were allocated to four similar groups and randomised according to surgical techniques (posterior instrumentation; posterior instrumentation + intravertebral reduction device + cement augmentation; posterior instrumentation + intravertebral reduction device without cement; and intravertebral reduction device + cement augmentation). After treatment, 100000 cycles (100–600 N, 3 Hz) were applied using a servohydraulic loading frame. Results. Overall anatomical restoration was better in all groups where the intravertebral reduction device was used (p < 0.05). In particular, it was possible to restore central endplates (p > 0.05). All techniques decreased narrowing of the spinal canal. After loading, clearance could be maintained in all groups fitted with the intravertebral reduction device. Narrowing increased in the group treated with dorsal instrumentation. Conclusions. For height and anatomical restoration, the combination of an intravertebral reduction device with dorsal instrumentation showed significantly better results than sole dorsal instrumentation. PMID:26137481

Management of fractures of the mandibular body and symphysis.

PubMed

Goodday, Reginald H B

2013-11-01

Mandibular fracture, specifically in the symphysis and body regions combined, is the most common facial fracture requiring hospitalization in North America. The primary treatment objective is to restore form and function by achieving anatomic reduction and placing fixation that eliminates mobility of the bone fragments. Several treatment options and surgical techniques are available for performing closed or open reduction. Special considerations are necessary when treating pediatric patients and fractures of the edentulous mandible. Complications relating to the tooth and denture-bearing regions of the mandible include infection, nonunion, and neurosensory changes. Copyright © 2013 Elsevier Inc. All rights reserved.

[APPLICATION OF COMPUTER-ASSISTED SURGICAL PLANNING IN SURGICAL TREATMENT OF ANKLE FRACTURES].

PubMed

Xia, Shengli; Wang, Xiuhui; Fu, Beigang; Lu, Yaogang; Wang, Minghui

2015-12-01

To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type III. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. The mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. Computer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.

Independent external validation of nomograms for predicting risk of low-trauma fracture and hip fracture

PubMed Central

Langsetmo, Lisa; Nguyen, Tuan V.; Nguyen, Nguyen D.; Kovacs, Christopher S.; Prior, Jerilynn C.; Center, Jacqueline R.; Morin, Suzanne; Josse, Robert G.; Adachi, Jonathan D.; Hanley, David A.; Eisman, John A.

2011-01-01

Background A set of nomograms based on the Dubbo Osteoporosis Epidemiology Study predicts the five- and ten-year absolute risk of fracture using age, bone mineral density and history of falls and low-trauma fracture. We assessed the discrimination and calibration of these nomograms among participants in the Canadian Multicentre Osteoporosis Study. Methods We included participants aged 55–95 years for whom bone mineral density measurement data and at least one year of follow-up data were available. Self-reported incident fractures were identified by yearly postal questionnaire or interview (years 3, 5 and 10). We included low-trauma fractures before year 10, except those of the skull, face, hands, ankles and feet. We used a Cox proportional hazards model. Results Among 4152 women, there were 583 fractures, with a mean follow-up time of 8.6 years. Among 1606 men, there were 116 fractures, with a mean follow-up time of 8.3 years. Increasing age, lower bone mineral density, prior fracture and prior falls were associated with increased risk of fracture. For low-trauma fractures, the concordance between predicted risk and fracture events (Harrell C) was 0.69 among women and 0.70 among men. For hip fractures, the concordance was 0.80 among women and 0.85 among men. The observed fracture risk was similar to the predicted risk in all quintiles of risk except the highest quintile of women, where it was lower. The net reclassification index (19.2%, 95% confidence interval [CI] 6.3% to 32.2%), favours the Dubbo nomogram over the current Canadian guidelines for men. Interpretation The published nomograms provide good fracture-risk discrimination in a representative sample of the Canadian population. PMID:21173069

Adjustable patella grapple versus cannulated screw and cable technique for treatment of transverse patellar fractures.

PubMed

Yan, Ning; Yang, Anli; Liu, Xiaodong; Cai, Feng; Liu, Liang; Chang, Shimin

2014-03-01

Although the cannulated screw and cable (CSC) tension band technique is an effective method for fixation of transverse patellar fractures, it has shortcomings, such as extensive soft tissue damage, osseous substance damage, and complex manipulation. We conducted a retrospective comparison of the adjustable patella grapple (APG) technique and the CSC tension band technique. We retrospectively reviewed 78 patients with transverse patellar fractures (45 in the APG group and 33 in the CSC group). Follow-up was 18 months. Comparison criteria were operation time, fracture reduction, fracture healing time, the knee injury and osteoarthritis outcome score for knee function, and complications. The APG group showed shorter operation time and equal fracture reduction, fracture healing time, and knee function compared with the CSC group. Eleven patients in the APG group experienced skin irritation generated by implants. There was no complication in the CSC group. The APG technique should be considered as an alternative method for treatment of transverse patellar fractures.

Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation

PubMed Central

Nunez, Fiesky A.; Luo, T. David; Jupiter, Jesse B.; Nunez, Fiesky A.

2016-01-01

Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity. PMID:28344539

Treatment of displaced mandibular condylar fracture with botulinum toxin A.

PubMed

Akbay, Ercan; Cevik, Cengiz; Damlar, Ibrahim; Altan, Ahmet

2014-04-01

The aim of this case report is to discuss the effect on condylar reduction of botulinum toxin A treatment used in a child with displaced fracture at condylar neck of mandible. A 3-years old boy was admitted to our clinic for incomplete fracture of mandibular symphysis and displaced condylar fracture at the left side. An asymmetrical occlusal splint with intermaxillary fixation was used instead of open reduction and internal fixation because of incomplete fracture of symphysis and possible complications of condyle surgery. However, it was observed that condylar angulation persisted despite this procedure. Thus, botulinum toxin A was administered to masseter, temporalis and pterygoideus medialis muscles. At the end of first month, it was seen that mandibular condyle was almost completely recovered and that fusion was achieved. In conclusion, Botulinum A toxin injection aiming the suppression of masticatory muscle strength facilitates the reduction in the conservative management of displaced condyle in pediatric patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Ottawa Ankle Rules and Subjective Surgeon Perception to Evaluate Radiograph Necessity Following Foot and Ankle Sprain

PubMed Central

Pires, RES; Pereira, AA; Abreu-e-Silva, GM; Labronici, PJ; Figueiredo, LB; Godoy-Santos, AL; Kfuri, M

2014-01-01

Background: Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes. Aim: The present study aims to evaluate the reliability of the Ottawa ankle rules and the orthopedic surgeon subjective perception to assess foot and ankle fractures after sprains. Subjects and Methods: A cross-sectional study was conducted from July 2012 to December 2012. Ethical approval was granted. Two hundred seventy-four adult patients admitted to the emergency department with foot and/or ankle sprain were evaluated by an orthopedic surgeon who completed a questionnaire prior to radiographic assessment. The Ottawa ankle rules and subjective perception of foot and/or ankle fractures were evaluated on the questionnaire. Results: Thirteen percent (36/274) patients presented fracture. Orthopedic surgeon subjective analysis showed 55.6% sensitivity, 90.1% specificity, 46.5% positive predictive value and 92.9% negative predictive value. The general orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% negative predictive value and 19.9% accuracy respectively. Weight-bearing inability was the Ottawa ankle rule item that presented the highest reliability, 69.4% sensitivity, 61.6% specificity, 63.1% accuracy, 21.9% positive predictive value and 93% negative predictive value respectively. Conclusion: The Ottawa ankle rules showed high reliability for deciding when to take radiographs in foot and/or ankle sprains. Weight-bearing inability was the most important isolated item to predict fracture presence. Orthopedic surgeon subjective analysis to predict fracture possibility showed a high specificity rate, representing a confident method to exclude unnecessary radiographic exams. PMID:24971221

OC30 - Fracture reduction with nitrous oxide at the children's emergency department shortens the length of stay and reduces the use of full anaesthesia in the operating department.

PubMed

Lang, Sigrid; Wentzel, Anna-Pia; Ekstrom, Malin

2016-05-09

Theme: Accreditation and quality improvement. Dislocated fractures are common in the children's emergency department (ER). All forms of fracture reduction are very painful requiring nitrous oxide. The purpose is to shorten the length of stay in the hospital as well as sustain a high quality of care. All nurses received theoretical and practical training in the use of nitrous oxide. Evaluations with the families were made by telephone. A total of 40 enclosed fracture reductions were made at the ER, leading to a reduction of 33 patients in the operating department and the length of stay was shortened - this compared to the same time in 2014. No adverse event was reported and no patient felt any increase in pain during the treatment. All patients would repeat the procedure if necessary. The treatment has reduced the length of stay in the hospital without affecting the other patients in the ER or the quality of care.

Balloon osteoplasty--a new technique for reduction and stabilisation of impression fractures in the tibial plateau: a cadaver study and first clinical application.

PubMed

Ahrens, Philipp; Sandmann, Gunther; Bauer, Jan; König, Benjamin; Martetschläger, Frank; Müller, Dirk; Siebenlist, Sebastian; Kirchhoff, Chlodwig; Neumaier, Markus; Biberthaler, Peter; Stöckle, Ulrich; Freude, Thomas

2012-09-01

Fractures of the tibial plateau are among the most severe injuries of the knee joint and lead to advanced gonarthrosis if the reduction does not restore perfect joint congruency. Many different reduction techniques focusing on open surgical procedures have been described in the past. In this context we would like to introduce a novel technique which was first tested in a cadaver setup and has undergone its successful first clinical application. Since kyphoplasty demonstrated effective ways of anatomical correction in spine fractures, we adapted the inflatable instruments and used the balloon technique to reduce depressed fragments of the tibial plateau. The technique enabled us to restore a congruent cartilage surface and bone reduction. In this technique we see a useful new method to reduce depressed fractures of the tibial plateau with the advantages of low collateral damage as it is known from minimally invasive procedures.

Prediction of fracture initiation in square cup drawing of DP980 using an anisotropic ductile fracture criterion

NASA Astrophysics Data System (ADS)

Park, N.; Huh, H.; Yoon, J. W.

2017-09-01

This paper deals with the prediction of fracture initiation in square cup drawing of DP980 steel sheet with the thickness of 1.2 mm. In an attempt to consider the influence of material anisotropy on the fracture initiation, an uncoupled anisotropic ductile fracture criterion is developed based on the Lou—Huh ductile fracture criterion. Tensile tests are carried out at different loading directions of 0°, 45°, and 90° to the rolling direction of the sheet using various specimen geometries including pure shear, dog-bone, and flat grooved specimens so as to calibrate the parameters of the proposed fracture criterion. Equivalent plastic strain distribution on the specimen surface is computed using Digital Image Correlation (DIC) method until surface crack initiates. The proposed fracture criterion is implemented into the commercial finite element code ABAQUS/Explicit by developing the Vectorized User-defined MATerial (VUMAT) subroutine which features the non-associated flow rule. Simulation results of the square cup drawing test clearly show that the proposed fracture criterion is capable of predicting the fracture initiation with sufficient accuracy considering the material anisotropy.

Clavicle Shaft Fractures in Adolescents.

PubMed

Yang, Scott; Andras, Lindsay

2017-01-01

Midshaft clavicle fractures in adolescents are common. Recent literature in adults fractures favors open reduction and plate fixation for significantly displaced and/or shortened midshaft clavicle fractures, although whether this applies to adolescents remains debatable. This article reviews the current literature and controversy in the management of displaced adolescent clavicle fractures. Copyright © 2016 Elsevier Inc. All rights reserved.

Predicting the 10-year risk of hip and major osteoporotic fracture in rheumatoid arthritis and in the general population: an independent validation and update of UK FRAX without bone mineral density

PubMed Central

Klop, Corinne; de Vries, Frank; Bijlsma, Johannes W J; Leufkens, Hubert G M; Welsing, Paco M J

2016-01-01

Objectives FRAX incorporates rheumatoid arthritis (RA) as a dichotomous predictor for predicting the 10-year risk of hip and major osteoporotic fracture (MOF). However, fracture risk may deviate with disease severity, duration or treatment. Aims were to validate, and if needed to update, UK FRAX for patients with RA and to compare predictive performance with the general population (GP). Methods Cohort study within UK Clinical Practice Research Datalink (CPRD) (RA: n=11 582, GP: n=38 755), also linked to hospital admissions for hip fracture (CPRD-Hospital Episode Statistics, HES) (RA: n=7221, GP: n=24 227). Predictive performance of UK FRAX without bone mineral density was assessed by discrimination and calibration. Updating methods included recalibration and extension. Differences in predictive performance were assessed by the C-statistic and Net Reclassification Improvement (NRI) using the UK National Osteoporosis Guideline Group intervention thresholds. Results UK FRAX significantly overestimated fracture risk in patients with RA, both for MOF (mean predicted vs observed 10-year risk: 13.3% vs 8.4%) and hip fracture (CPRD: 5.5% vs 3.1%, CPRD-HES: 5.5% vs 4.1%). Calibration was good for hip fracture in the GP (CPRD-HES: 2.7% vs 2.4%). Discrimination was good for hip fracture (RA: 0.78, GP: 0.83) and moderate for MOF (RA: 0.69, GP: 0.71). Extension of the recalibrated UK FRAX using CPRD-HES with duration of RA disease, glucocorticoids (>7.5 mg/day) and secondary osteoporosis did not improve the NRI (0.01, 95% CI −0.04 to 0.05) or C-statistic (0.78). Conclusions UK FRAX overestimated fracture risk in RA, but performed well for hip fracture in the GP after linkage to hospitalisations. Extension of the recalibrated UK FRAX did not improve predictive performance. PMID:26984006

Whom to treat? The contribution of vertebral X-rays to risk-based algorithms for fracture prediction. Results from the European Prospective Osteoporosis Study.

PubMed

Kaptoge, S; Armbrecht, G; Felsenberg, D; Lunt, M; Weber, K; Boonen, S; Jajic, I; Stepan, J J; Banzer, D; Reisinger, W; Janott, J; Kragl, G; Scheidt-Nave, C; Felsch, B; Matthis, C; Raspe, H H; Lyritis, G; Póor, G; Nuti, R; Miazgowski, T; Hoszowski, K; Armas, J Bruges; Vaz, A Lopes; Benevolenskaya, L I; Masaryk, P; Cannata, J B; Johnell, O; Reid, D M; Bhalla, A; Woolf, A D; Todd, C J; Cooper, C; Eastell, R; Kanis, J A; O'Neill, T W; Silman, A J; Reeve, J

2006-01-01

Vertebral fracture is a strong risk factor for future spine and hip fractures; yet recent data suggest that only 5-20% of subjects with a spine fracture are identified in primary care. We aimed to develop easily applicable algorithms predicting a high risk of future spine fracture in men and women over 50 years of age. Data was analysed from 5,561 men and women aged 50+ years participating in the European Prospective Osteoporosis Study (EPOS). Lateral thoracic and lumbar spine radiographs were taken at baseline and at an average of 3.8 years later. These were evaluated by an experienced radiologist. The risk of a new (incident) vertebral fracture was modelled as a function of age, number of prevalent vertebral fractures, height loss, sex and other fracture history reported by the subject, including limb fractures occurring between X-rays. Receiver Operating Characteristic (ROC) curves were used to compare the predictive ability of models. In a negative binomial regression model without baseline X-ray data, the risk of incident vertebral fracture significantly increased with age [RR 1.74, 95% CI (1.44, 2.10) per decade], height loss [1.08 (1.04, 1.12) per cm decrease], female sex [1.48 (1.05, 2.09)], and recalled fracture history; [1.65 (1.15, 2.38) to 3.03 (1.66, 5.54)] according to fracture site. Baseline radiological assessment of prevalent vertebral fracture significantly improved the areas subtended by ROC curves from 0.71 (0.67, 0.74) to 0.74 (0.70, 0.77) P=0.013 for predicting 1+ incident fracture; and from 0.74 (0.67, 0.81) to 0.83 (0.76, 0.90) P=0.001 for 2+ incident fractures. Age, sex and height loss remained independently predictive. The relative risk of a new vertebral fracture increased with the number of prevalent vertebral fractures present from 3.08 (2.10, 4.52) for 1 fracture to 9.36 (5.72, 15.32) for 3+. At a specificity of 90%, the model including X-ray data improved the sensitivity for predicting 2+ and 1+ incident fractures by 6 and 4 fold respectively compared with random guessing. At 75% specificity the improvements were 3.2 and 2.4 fold respectively. With the modelling restricted to the subjects who had BMD measurements (n=2,409), the AUC for predicting 1+ vs. 0 incident vertebral fractures improved from 0.72 (0.66, 0.79) to 0.76 (0.71, 0.82) upon adding femoral neck BMD (P=0.010). We conclude that for those with existing vertebral fractures, an accurately read spine X-ray will form a central component in future algorithms for targeting treatment, especially to the most vulnerable. The sensitivity of this approach to identifying vertebral fracture cases requiring anti-osteoporosis treatment, even when X-rays are ordered highly selectively, exceeds by a large margin the current standard of practice as recorded anywhere in the world.

External fixation techniques for distal radius fractures.

PubMed

Capo, John T; Swan, Kenneth G; Tan, Virak

2006-04-01

Fractures of the distal radius are common injuries. Low-energy or high-energy mechanisms may be involved. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. External fixation is a valuable instrument for fracture reduction and stabilization. Limited open incisions, early range of motion, and treatment of complex wounds are a few of the benefits of external fixation. Fixators may be spanning or nonbridging and may be used alone or in combination with other stabilization methods to obtain and maintain distal radius fracture reduction. Augmentation with percutaneous wires allows for optimal fracture stabilization with physiologic alignment of the wrist. Moderate distraction at the carpus does not induce postoperative stiffness. The distal radioulnar joint must be assessed and may need to be stabilized. Complications of external fixation are usually minor, but must be anticipated and treated early. Level V (expert opinion).

A Novel Approach for Treatment of Acetabular Fractures

PubMed Central

Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

2016-01-01

Background There is no single approach that provides adequate exposure for treatment of all types of acetabular fractures. We describe our experience with an easier, relatively less invasive pubic symphysis approach (PSA) for the treatment of acetabular fractures. Material/Methods Between March 2011 and March 2012, fifteen patients with acetabular fracture underwent surgery using the PSA technique. Fracture reduction and treatment outcomes were assessed by clinical and radiological examination. Operation time, intraoperative blood loss and postoperative complications were documented. Results Mean operative time was 222±78 minutes. Average blood loss was 993±361 mL. Anatomical reduction was achieved in all patients. Minimum follow-up period was 31 months. Postoperative hypoesthesia in the area of innervation of the lateral femoral cutaneous nerve was reported in one patient, with spontaneous recovery at one month after surgery. No complications were reported during the follow-up period. At the most recent follow up, clinical outcomes were graded as “excellent” in six patients, “good” in eight patients and “fair” in one patient based on the modified Merle d’Aubigné-Postel score. Conclusions PSA appears to be a timesaving and safe approach for treatment of acetabular fractures that affords good visual access and allows for excellent fracture reduction. Our preliminary results revealed a much lower incidence of complications than traditional approaches, suggesting PSA is an alternative for treatment of acetabular fractures. PMID:27734825

Impact of microbial activity on the hydraulic properties of fractured chalk.

PubMed

Arnon, Shai; Adar, Eilon; Ronen, Zeev; Yakirevich, Alexander; Nativ, Ronit

2005-02-01

The impact of microbial activity on fractured chalk transmissivity was investigated on a laboratory scale. Long-term experiments were conducted on six fractured chalk cores (20 cm diameter, 23-44 cm long) containing a single natural fracture embedded in a porous matrix. Biodegradation experiments were conducted under various conditions, including several substrate and oxygen concentrations and flow rates. 2,4,6-Tribromophenol (TBP) was used as a model contaminant (substrate). TBP biodegradation efficiency depended mainly on the amount of oxygen. However, under constant oxygen concentration at the core inlet, elevating the flow rates increased the removal rate of TBP. Transmissivity reduction was clearly related to TBP removal rate, following an initial slow decline and a further sharp decrease with time. The fracture's transmissivity was reduced by as much as 97% relative to the initial value, with no leveling off of the clogging process. For the most extreme cases, reductions of 262 and 157 microm in the equivalent hydraulic apertures were recorded for fractures with initial apertures of 495 and 207 microm, respectively. The reductions in fracture transmissivity occurred primarily because of clogging by bacterial cells and extracellular polymeric substances (EPS) produced by the bacteria. Most of the biodegradation activity was concentrated near the fracture inlet, where the most suitable biodegradation conditions (nutrients and oxygen) prevailed, suggesting that the clogging had occurred in that vicinity. The clogging must have changed the structure of the fracture void, thereby reducing the active volume participating in flow and transport processes. This phenomenon caused accelerated transport of non-reactive tracers and doubled the fracture's dispersivity under constant flow rates.

Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015).

PubMed

De Arburn Parent, Rebecca; Benamou, Jérôme; Gatineau, Matthieu; Clerfond, Pierre; Planté, Jérôme

2017-06-15

OBJECTIVE To determine outcomes and complication rates of open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs. DESIGN Retrospective case series. ANIMALS 102 miniature- and toy-breed dogs (105 fractures) weighing ≤ 7 kg (15.4 lb) that had undergone open reduction and cranial bone plate fixation of a fracture involving the distal aspect of the radius and ulna from 2008 through 2015. PROCEDURES Medical records were reviewed and information extracted regarding dog and fracture characteristics, surgical variables, and follow-up examination data (including postoperative complications). Postoperative radiographs were examined for distal fragment size, implant placement, apposition, alignment, and healing stage. A long-term follow-up questionnaire was completed by telephone interview with dog owners at least 6 months after surgery. RESULTS Mean length of the distal bone fragment in all fractures was 19.2 mm, with a mean distal-to-total radial length ratio of 0.21. At last follow-up examination (typically 6 weeks after surgery), 97 (95%) dogs had no signs of lameness; minor lameness was identified in 5 (5%) dogs. Complications developed in 26 (25%) fractures (23 [22%] minor and 3 [3%] major complications). Sixty-eight of 71 (96%) owners rated the overall and long-term outcome as excellent and 3 (4%) as good; 68 of 71 (96%) dogs reportedly had no signs of residual lameness. CONCLUSIONS AND CLINICAL RELEVANCE Open reduction and cranial bone plate fixation for the treatment of radius-ulna fractures in miniature- and toy-breed dogs provided an excellent outcome with a low complication rate.

Quantifying voids effecting delamination in carbon/epoxy composites: static and fatigue fracture behavior

NASA Astrophysics Data System (ADS)

Hakim, I.; May, D.; Abo Ras, M.; Meyendorf, N.; Donaldson, S.

2016-04-01

On the present work, samples of carbon fiber/epoxy composites with different void levels were fabricated using hand layup vacuum bagging process by varying the pressure. Thermal nondestructive methods: thermal conductivity measurement, pulse thermography, pulse phase thermography and lock-in-thermography, and mechanical testing: modes I and II interlaminar fracture toughness were conducted. Comparing the parameters resulted from the thermal nondestructive testing revealed that voids lead to reductions in thermal properties in all directions of composites. The results of mode I and mode II interlaminar fracture toughness showed that voids lead to reductions in interlaminar fracture toughness. The parameters resulted from thermal nondestructive testing were correlated to the results of mode I and mode II interlaminar fracture toughness and voids were quantified.

Pediatric mandibular fractures treated by rigid internal fixation.

PubMed

Wong, G B

1993-09-01

Mandibular fractures in the pediatric patient population are relatively uncommon. These patients present with their own unique treatment requirements. Most fractures have been treated conservatively by dental splints. Closed reduction techniques with maxillomandibular fixation (MMF) in very young children can pose several concerns, including cooperation, compliance and adequate nutritional intake. Rigid internal fixation of unstable mandibular fractures using miniplates and screws circumvents the need for MMF and allows immediate jaw mobilization. At major pediatric trauma institutions, there has been an increasing trend toward the use of this treatment when open reduction is necessary. This article presents a report of a five-year-old child who presented with bilateral mandibular fractures and was treated by rigid internal fixation and immediate mandibular mobilization.

Gradual Reduction of Chronic Fracture Dislocation of the Ankle Using Ilizarov/Taylor Spatial Frame

PubMed Central

Deland, Jonathan T.; Rozbruch, S. Robert

2010-01-01

With the advances in trauma care, chronic fracture dislocation of the ankle is not a condition commonly seen in modern clinical practice. When encountered, it can be difficult to preserve the ankle joint. We present a case of a 65-year-old female, with a chronic fracture dislocation of the ankle. The ankle joint was subluxated with posterior translation of the talus, displacement of the posterior malleolus fragment, and a distal fibula fracture. A minimally traumatic approach was devised to treat this complex fracture dislocation which included gradual reduction of the ankle with a Taylor spatial frame, followed by stabilization with internal fixation and removal of the frame. Bony union and restoration of the ankle joint congruency was achieved. PMID:22294963

A retrospective cohort study of displaced segmental radial head fractures: is 2 mm of articular displacement an indication for surgery?

PubMed

Furey, Matthew J; Sheps, David M; White, Neil J; Hildebrand, Kevin A

2013-05-01

Many investigators agree that 2 mm of articular displacement is a reasonable indication for open reduction and internal fixation of Mason type II fractures of the radial head. However, there is no evidence to support that this degree of articular displacement is predictive of poor outcomes in conservatively treated fractures. We hypothesized there would be no difference between conservatively treated radial head fractures with greater 2 mm of displacement and those with less than 2 mm of displacement in terms of patient-reported or clinical outcomes. We reviewed databases of all radial head fractures in our region. The primary outcomes were the Patient-Rated Elbow Evaluation and Disabilities of the Arm, Shoulder and Hand questionnaires. Secondary outcomes included radiologic radiocapitellar arthritis and range of motion (ROM) at follow-up. Postinjury treatment protocols, as well as patient factors, were examined for their effects on outcome. The results showed no significant difference in any outcome for conservatively treated radial head fractures with 2 mm (P = .8) or even 3 mm (P = .6) of articular displacement over a mean follow-up of 4.4 years. Early ROM and physiotherapy showed no significant differences in any outcome measure. Dominant hand injury showed no significant difference in patient-reported outcomes; however, ROM was significantly decreased on examination. This retrospective review suggests that fracture displacement of 2 to 3 mm is not necessarily an indication for surgical fixation in isolated fractures of the radial head. In addition, it appears that postinjury ROM/physiotherapy does not play a large role in improving patient outcome. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study.

PubMed

Saengsin, Jirawat; Vaseenon, Tanawat; Pattamapaspong, Nuttaya; Kritsaneephaiboon, Apipop

2017-08-01

A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P<0.05). Images from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted. Copyright © 2017 Elsevier Ltd. All rights reserved.

Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences.

PubMed

Vesnaver, Ales

2008-10-01

Treatment of intra-articular fractures of the mandibular condyle head is conservative at most institutions dealing with facial fractures. Recently, reports had been published about benefits of surgical treatment in these fractures. From July 2004 until the end of June 2006, 13 patients with 16 displaced intra-articular fractures of the mandibular condyle were treated with open reduction and internal fixation at the Department of Oral and Maxillofacial Surgery in Ljubljana, Slovenia, using the preauricular approach and the lag screw technique. Twelve of the 13 patients could open their mouths for 40 mm or more, and 10 had a deflection of the chin of less than 2 mm upon maximal opening. None of the patients experienced pain upon rest, palpation, or chewing. Occlusion was not noted as altered in any of the cases, neither subjectively, nor on examination. There were no cases of postoperative weakness of the temporal branch of the facial nerve. Surgical treatment of intra-articular condyle fractures using the preauricular approach achieves a good exposure and enables proper reduction. Stable fixation of fractured bony fragments can be achieved using the lag screw technique. Another benefit of open exposure is revision and repair of TMJ soft tissues. With the appropriate surgical technique, the surgical procedure is safe and leads to good results.

Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources.

PubMed

Brorson, Stig

2011-04-01

The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed. I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus. A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search. Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years. The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

Rereduction for Redisplacement of Both-Bone Forearm Shaft Fractures in Children.

PubMed

Eismann, Emily A; Parikh, Shital N; Jain, Viral V

2016-06-01

There is a high rate of redisplacement after closed reduction and cast treatment of displaced both-bone forearm shaft fractures in children. Little evidence is available on the efficacy of rereduction of these redisplaced fractures. This study evaluates the impact of rereduction on radiographic outcomes and compares the cost to surgical stabilization. This retrospective study included 31 children (mean age, 6.3 y; 18 boys) treated with rereduction for redisplacement of a displaced both-bone forearm shaft fracture between 2008 and 2013. Angulation was measured on anteroposterior and lateral radiographs of the radius and ulna at injury, after reduction, at redisplacement, after rereduction, and at fracture union. Average procedure costs for rereduction and surgical stabilization were calculated. Initial reduction decreased apex volar angulation (initially >20 degrees) of both bones to a median of ≤2 degrees. After an average of 15 days (range, 4 to 35 d), apex volar angulation of the radius worsened to 9 degrees, and apex ulnar angulation worsened to >10 degrees for both bones. For every 5 days after initial reduction, apex ulnar angulation of the radius worsened by 4 degrees. Rereduction reduced apex ulnar and volar angulation of both bones to <5 degrees, which was maintained after cast removal. There were no complications. The average procedure cost for rereduction was $2056 compared with $4589 for surgical stabilization with or without implant removal. Rereduction of both-bone forearm shaft fractures after redisplacement following initial closed reduction had satisfactory radiographic outcomes and is a safe, effective, and less expensive option than surgical stabilization. Level IV-therapeutic.

Zoledronic Acid in Reducing Clinical Fracture and Mortality after Hip Fracture

PubMed Central

Lyles, Kenneth W.; Colón-Emeric, Cathleen S.; Magaziner, Jay S.; Adachi, Jonathan D.; Pieper, Carl F.; Mautalen, Carlos; Hyldstrup, Lars; Recknor, Chris; Nordsletten, Lars; Moore, Kathy A.; Lavecchia, Catherine; Zhang, Jie; Mesenbrink, Peter; Hodgson, Patricia K.; Abrams, Ken; Orloff, John J.; Horowitz, Zebulun; Eriksen, Erik Fink; Boonen, Steven

2008-01-01

BACKGROUND Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS The rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction (P = 0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P = 0.02), and the respective rates of new nonvertebral fractures were 7.6% and 10.7% (P = 0.03). In the safety analysis, 101 of 1054 patients in the zoledronic acid group (9.6%) and 141 of 1057 patients in the placebo group (13.3%) died, a reduction of 28% in deaths from any cause in the zoledronic-acid group (P = 0.01). The most frequent adverse events in patients receiving zoledronic acid were pyrexia, myalgia, and bone and musculoskeletal pain. No cases of osteonecrosis of the jaw were reported, and no adverse effects on the healing of fractures were noted. The rates of renal and cardiovascular adverse events, including atrial fibrillation and stroke, were similar in the two groups. CONCLUSIONS An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and improved survival. (ClinicalTrials.gov number, NCT00046254.) PMID:17878149

Effect of Measured Welding Residual Stresses on Crack Growth

NASA Technical Reports Server (NTRS)

Hampton, Roy W.; Nelson, Drew; Doty, Laura W. (Technical Monitor)

1998-01-01

Welding residual stresses in thin plate A516-70 steel and 2219-T87 aluminum butt weldments were measured by the strain-gage hole drilling and X-ray diffraction methods. The residual stress data were used to construct 3D strain fields which were modeled as thermally induced strains. These 3D strain fields were then analyzed with the WARP31) FEM fracture analysis code in order to predict their effect on fatigue and on fracture. For analyses of fatigue crack advance and subsequent verification testing, fatigue crack growth increments were simulated by successive saw-cuts and incremental loading to generate, as a function of crack length, effects on crack growth of the interaction between residual stresses and load induced stresses. The specimen experimental response was characterized and compared to the WARM linear elastic and elastic-plastic fracture mechanics analysis predictions. To perform the fracture analysis, the plate material's crack tearing resistance was determined by tests of thin plate M(T) specimens. Fracture analyses of these specimen were performed using WARP31D to determine the critical Crack Tip Opening Angle [CTOA] of each material. These critical CTOA values were used to predict crack tearing and fracture in the weldments. To verify the fracture predictions, weldment M(T) specimen were tested in monotonic loading to fracture while characterizing the fracture process.

Periprosthetic Fractures Following Total Knee Arthroplasty

PubMed Central

Kim, Nam Ki

2015-01-01

Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality. PMID:25750888

Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations.

PubMed

Kirzner, N; Zotov, P; Goldbloom, D; Curry, H; Bedi, H

2018-04-01

Aims The aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations. Patients and Methods A total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction. Results Significantly better functional outcomes were seen in the bridge plate group. These patients had a mean AOFAS score of 82.5 points, compared with 71.0 for the screw group and 63.3 for the combination group (p < 0.001). Similarly, the mean Manchester Oxford Foot Questionnaire score was 25.6 points in the bridge plate group, 38.1 in the screw group, and 45.5 in the combination group (p < 0.001). Functional outcome was dependent on the quality of reduction (p < 0.001). A trend was noted which indicated that plate fixation is associated with a better anatomical reduction (p = 0.06). Myerson types A and C2 significantly predicted a poorer functional outcome, suggesting that total incongruity in either a homolateral or divergent pattern leads to worse outcomes. The greater the number of columns fixed the worse the outcome (p < 0.001). Conclusion Patients treated with dorsal bridge plating have better functional and radiological outcomes than those treated with transarticular screws or a combination technique. Cite this article: Bone Joint J 2018;100-B:468-74.

Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

PubMed Central

Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed

2016-01-01

BACKGROUND: Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture. AIM: The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients. MATERIAL AND METHODS: The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails. RESULTS: United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group. CONCLUSION: Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with “Talwarkar” square nails which is also again a simple method with better results than conservative methods. PMID:28028411

New equations for predicting postoperative risk in patients with hip fracture.

PubMed

Hirose, Jun; Ide, Junji; Irie, Hiroki; Kikukawa, Kenshi; Mizuta, Hiroshi

2009-12-01

Predicting the postoperative course of patients with hip fractures would be helpful for surgical planning and risk management. We therefore established equations to predict the morbidity and mortality rates in candidates for hip fracture surgery using the Estimation of Physiologic Ability and Surgical Stress (E-PASS) risk-scoring system. First we evaluated the correlation between the E-PASS scores and postoperative morbidity and mortality rates in all 722 patients surgically treated for hip fractures during the study period (Group A). Next we established equations to predict morbidity and mortality rates. We then applied these equations to all 633 patients with hip fractures treated at seven other hospitals (Group B) and compared the predicted and actual morbidity and mortality rates to assess the predictive ability of the E-PASS and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems. The ratio of actual to predicted morbidity and mortality rates was closer to 1.0 with the E-PASS than the POSSUM system. Our data suggest the E-PASS scoring system is useful for defining postoperative risk and its underlying algorithm accurately predicts morbidity and mortality rates in patients with hip fractures before surgery. This information then can be used to manage their condition and potentially improve treatment outcomes. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Expedited patient-specific assessment of contact stress exposure in the ankle joint following definitive articular fracture reduction.

PubMed

Kern, Andrew M; Anderson, Donald D

2015-09-18

Acute injury severity, altered joint kinematics, and joint incongruity are three important mechanical factors linked to post-traumatic osteoarthritis (PTOA). Finite element analysis (FEA) was previously used to assess the influence of increased contact stress due to joint incongruity on PTOA development. While promising agreement with PTOA development was seen, the inherent complexities of contact FEA limited the numbers of subjects that could be analyzed. Discrete element analysis (DEA) is a simplified methodology for contact stress computation, which idealizes contact surfaces as a bed of independent linear springs. In this study, DEA was explored as an expedited alternative to FEA contact stress exposure computation. DEA was compared to FEA using results from a previously completed validation study of two cadaveric human ankles, as well as a previous study of post-operative contact stress exposure in 11 patients with tibial plafond fracture. DEA-computed maximum contact stresses were within 19% of those experimentally measured, with 90% of the contact area having computed contact stress values within 1MPa of those measured. In the 11 fractured ankles, maximum contact stress and contact area differences between DEA and FEA were 0.85 ± 0.64 MPa and 22.5 ± 11.5mm(2). As a predictive measure for PTOA development, both DEA and FEA had 100% concordance with presence of OA (KL grade ≥ 2) and >95% concordance with KL grade at 2 years. These results support DEA as a reasonable alternative to FEA for computing contact stress exposures following surgical reduction of a tibial plafond fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review

PubMed Central

Behr, Ian; Blint, Andy; Trenhaile, Scott

2013-01-01

Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome. PMID:26403884

Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients.

PubMed

Nagura, Issei; Fujioka, Hiroyuki; Kurosaka, Masahiro; Mori, Hiroyuki; Mitani, Makoto; Ozaki, Akihiro; Fujii, Hideo; Nabeshima, Yuji

2012-01-01

Calcaneal avulsion fractures are not uncommon, and they are probably more likely in patients with osteoporosis. Closed manipulation for this type of fracture often fails to achieve acceptable reduction, and open reduction and internal fixation are usually required. However, open reduction and internal fixation with either a lag screw or Steinmann pins do not provide satisfactory fixation in patients with diabetes and elderly patients because of the presence of porotic bone. Levi described a tension band fixation system used to treat a calcaneal avulsion fracture using a simple technique performed with a transverse Kirschner wire through the os calcaneus, securing a figure-of-8 metal tension band wiring to the fragment. We report the successful treatment of 3 patients with calcaneal avulsion fractures using a modified tension band wiring technique, resulting in satisfactory recovery. Re-displacement of the fragment during the initial follow-up period was not reported, and bony union was achieved in all patients. We believe this technique is a useful surgical option for the treatment of calcaneal avulsion fractures. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Treatment of subtalar calcanean fractures using trans-osseous limited lateral approach.

PubMed

Ragab, Abdelaleem H; Mubark, Islam M; Nagi, Ahmed M; Abdelnaby, Mohamed Aly

2014-01-01

Calcaneal fractures are the most common fractures of the tarsal bones. The majority of these fractures are produced by axial force like a fall from a height. Controversy still exists on the best line of treatment. This study is to evaluate the results of trans-osseous limited lateral approach as a minimally invasive surgical treatment of the displaced intra-articular calcaneal fractures. The study included forty two patients (46 feet) with displaced intra-articular calcaneal fractures admitted to El-Hadra University Hospital. They were treated by trans-osseous open reduction of subtalar joint and internal fixation by k-wires consuming the trans-osseous limited lateral approach. Out of 42 patients, 36 pateints (85.7%) were males. Using calcaneal fracture scoring system, the mean score was 67.55+17.35. Satisfactory results were found in 26 patients (61.9%), while 16 patients (38.1%) had unsatisfactory results. There was significant relationship between classification of the fracture and the final results (the more the grade of the fracture, the worse the final score) (x 2 =5.914, p=0.05). The value of calcaneal angles were significantly improved after surgery including bohler angle (p=0.0001), gissane angle (p=0.0001), calcaneal pitch angle (p=0.001) and calcaneofibular space (p=0.0021). 1. Trans-osseous limited lateral approach is an effective method for management of intra articular calcaneal fractures. 2. Anatomical reduction for intra articular calcaneal fractures is essential. 3. Functional outcome of intra articular calcaneal fractures depends upon the initial damage of the articular cartilage. 4. There is a need for multi-center prospective randomized study for accurate assessment of the results of operative management of intra articular calcaneal fractures involving pre and post-operative CT for assessment of reduction and using a rational scoring system and a long period of follow up.

Prediction of forming limit in hydro-mechanical deep drawing of steel sheets using ductile fracture criterion

NASA Astrophysics Data System (ADS)

Oh, S.-T.; Chang, H.-J.; Oh, K. H.; Han, H. N.

2006-04-01

It has been observed that the forming limit curve at fracture (FLCF) of steel sheets, with a relatively higher ductility limit have linear shapes, similar to those of a bulk forming process. In contrast, the FLCF of sheets with a relatively lower ductility limit have rather complex shapes approaching the forming limit curve at neck (FLCN) towards the equi-biaxial strain paths. In this study, the FLCFs of steel sheets were measured and compared with the fracture strains predicted from specific ductile fracture criteria, including a criterion suggested by the authors, which can accurately describe FLCFs with both linear and complex shapes. To predict the forming limit for hydro-mechanical deep drawing of steel sheets, the ductile fracture criteria were integrated into a finite element simulation. The simulation, results based on the criterion suggested by authors accurately predicted the experimetal, fracture limits of steel sheets for the hydro-mechanical deep drawing process.

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine: Does it Correlate With Level-specific Bone Mineral Density Scores?

PubMed

Hey, Hwee Weng Dennis; Hwee Weng, Dennis Hey; Tan, Jun Hao; Jun, Hao Tan; Tan, Chuen Seng; Chuen, Seng Tan; Tan, Hsi Ming Bryan; Ming, Bryan Tan Hsi; Lau, Puang Huh Bernard; Huh, Bernard Lau Puang; Hee, Hwan Tak; Hwan, Tak Hee

2015-12-01

A case-control study. In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. 93 patients followed up for a mean duration of 25.1 months (12-96) had a mean age of 76.8 years (47-99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of -2.860 (95% confidence interval -3.268 to -2.452) and nonfractured vertebra had a mean T-score of -2.180 (95% confidence interval -2.373 to -1.986). A T-score of -2.2 or lower is predictive of refracture at that vertebra (P = 0.047). Odds ratio increases with decreasing T-scores from -2.2 or lower to -2.6 or lower. A T-score of -2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P = 0.049) and loss of preoperative anterior vertebral height (P = 0.017) are associated with refracture. Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower T-scores from -2.2 or less to -2.6 or less. They have a low positive predictive value, but a high negative predictive value for subsequent fractures. Other significant associations with subsequent refractures include age and anterior vertebral height. 4.

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon

PubMed Central

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization. PMID:29766123

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon.

PubMed

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer; Mayberry, John

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.

[Isolated Displaced Fracture of the Acromion - Case Report].

PubMed

Krtička, M; Ira, D

2016-01-01

Displaced fractures of the acromion are rare injuries. A 45-year-old lady presented with an isolated acromion fracture (type III, Kuhn classification) resulting from a direct blow to the top of her right shoulder in a fall while skiing. After standard clinical and radiological examination of the shoulder, an open reduction and internal plate fixation using a postero-superior approach to the scapula was performed. Early rehabilitation of the arm and shoulder was initiated. At 50 days after surgery the patient achieved a full range of motion in her right shoulder and muscle strength equal to that of the contralateral extremity. By 12 weeks radiographic union of the fracture was recorded. The final functional outcome after open reduction and internal plate fixation of the fracture was comparable with results reported in the literature and, in comparison with conservative treatment, the risk of non-union was significantly reduced. acromion fracture, scapula, osteosynthesis.

[Progress on treatment and research of quadrilateral plate fractures of acetabular].

PubMed

Peng, Ye; Zhang, Li-hai; Tang, Pei-fu

2015-05-01

Acetabular is an important human joint for weight bearing. Quadrilateral plate is a crucial structure of medial acetabulum with special morphology and important function. Quadrilateral plate fractures are common fracture in acetabulum. Quadrilateral plate fracture is hard to expose and reduction because it is in the medial of acetabulum. At the same time,the bone in the quadrilateral plate is not easy to fixed for thinning bones and adjacent to the articular cavity. The operator should know well about the anatomy and choose the suitable internal fixation. After quadrilateral plate fractures, the femur head maybe displace medially even break into pelvis. That make reduction and treatment always be a challenge. With different kinds of fractures,the efficacy of treatment is not the same. This paper intend to review the relation of anatomic features,approaches, internal fixations, key point of treatment and efficacy.

Optimisation of composite bone plates for ulnar transverse fractures.

PubMed

Chakladar, N D; Harper, L T; Parsons, A J

2016-04-01

Metallic bone plates are commonly used for arm bone fractures where conservative treatment (casts) cannot provide adequate support and compression at the fracture site. These plates, made of stainless steel or titanium alloys, tend to shield stress transfer at the fracture site and delay the bone healing rate. This study investigates the feasibility of adopting advanced composite materials to overcome stress shielding effects by optimising the geometry and mechanical properties of the plate to match more closely to the bone. An ulnar transverse fracture is characterised and finite element techniques are employed to investigate the feasibility of a composite-plated fractured bone construct over a stainless steel equivalent. Numerical models of intact and fractured bones are analysed and the mechanical behaviour is found to agree with experimental data. The mechanical properties are tailored to produce an optimised composite plate, offering a 25% reduction in length and a 70% reduction in mass. The optimised design may help to reduce stress shielding and increase bone healing rates. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Rib fractures in trauma patients: does operative fixation improve outcome?

PubMed

Majak, Peter; Næss, Pål A

2016-12-01

Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

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

Narr, W.; Currie, J.B.

The occurrence of natural fracture systems in subsurface rock can be predicted if careful evaluation is made of the ecologic processes that affect sedimentary strata during their cycle of burial, diagenesis, uplift, and erosional unloading. Variations in the state of stress within rock arise, for example, from changes in temperature, pore pressure, weight of overburden, or tectonic loading. Hence geologic processes acting on a sedimentary unit should be analyzed for their several contributions to the state of stress, and this information used to compute a stress history. From this stress history, predictions may be made as to when in themore » burial cycle to expect fracture (joint) formation, what type of fractures (extension or shear) may occur, and which geologic factors are most favorable to development of fractures. A stress history is computed for strata of the naturally fractured Altamont oil field in Utah's Uinta basin. Calculations suggest that fractures formed in extension, that the well-cemented rocks are those most likely to be fractured, that fractures began to develop only after stata were uplifted and denuded of overburden. Geologic evidence on fracture genesis and development is in accord with the stress history prediction. Stress history can be useful in evaluating a sedimentary basin for naturally fractured reservoir exploration plays.« less

Inverted distal clavicle anatomic locking plate for displaced medial clavicle fracture.

PubMed

Wang, Yong; Jiang, Jiannong; Dou, Bin; Zhang, Panjun

2015-09-01

Fractures of the medial clavicle are rare injuries. Recently, open reduction and internal fixation has been recommended for displaced medial clavicle fractures in order to prevent non-union and dysfunction. Because of the rarity of this injury, the optimal fixation device has not yet been established. In this report, we describe a case of a 40-year-old male patient who sustained a significantly displaced medial clavicle fracture treated by open reduction and internal fixation using an inverted distal clavicle anatomic locking plate. At the 12 months follow-up, the patient recovered well, had returned to pre-injury job, and was quite satisfied with the outcome. Internal fixation of medial clavicle fracture using an inverted distal clavicle anatomic locking plate of the ipsilateral side appears to be a good treatment option.

Simultaneous Middle Third Clavicle Fracture and Type 3 Acromioclavicular Joint Dislocation; A Case Report

PubMed Central

Solooki, Saeed; Azad, Ali

2014-01-01

Simultaneous middle third clavicle fracture and acromioclavicular joint dislocation is a rare combination injury, as a result of high-energy trauma. We report a patient with a middle third clavicle fracture and ipsilateral grade three-acromioclavicular joint dislocation, which is a rare combination. The patient wanted to get back to work as soon as possible, so the fracture was fixed with reconstruction plate after open reduction and plate contouring; and acromioclavicular joint dislocation was reduced and fixed with two full threaded cancellous screws. One screw was inserted through the plate to the coracoid process. Clinical and radiographic finding revealed complete union of clavicle fracture and anatomical reduction of acromioclavicular joint with pain free full joint range of motion one year after operation. PMID:25207318

Is fibular fracture displacement consistent with tibiotalar displacement?

PubMed

van den Bekerom, Michel P J; van Dijk, C Niek

2010-04-01

We believed open reduction with internal fixation is required for supination-external rotation ankle fractures located at the level of the distal tibiofibular syndesmosis (Lauge-Hanssen SER II and Weber B) with 2 mm or more fibular fracture displacement. The rationale for surgery for these ankle fractures is based on the notion of elevated intraarticular contact pressures with lateral displacement. To diagnose these injuries, we presumed that in patients with a fibular fracture with at least 2 mm fracture displacement, the lateral malleolus and talus have moved at least 2 mm in a lateral direction without medial displacement of the proximal fibula. We reviewed 55 adult patients treated operatively for a supination-external rotation II ankle fracture (2 mm or more fibular fracture displacement) between 1990 and 1998. On standard radiographs, distance from the tibia to the proximal fibula, distance from the tibia to the distal fibula, and displacement at the level of the fibular fracture were measured. These distances were compared preoperatively and postoperatively. We concluded tibiotalar displacement cannot be reliably assessed at the level of the fracture. Based on this and other studies, we believe there is little evidence to perform open reduction and internal fixation of supination-external rotation II ankle fractures. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study.

PubMed

Shui, Xiaolong; Ying, Xiaozhou; Kong, Jianzhong; Feng, Yongzeng; Hu, Wei; Guo, Xiaoshan; Wang, Gang

2015-08-01

Our objective was to measure the sagittal plane rotational (flexion and extension) displacement of hemipelvis radiologically and analyze the ratio of flexion and extension displacement of unstable pelvic fractures. We used 8 cadaveric models to study the radiographic evidence of pelvic fractures in the sagittal plane. We performed pelvic osteotomy on 8 cadavers to simulate anterior and posterior pelvic ring injury. Radiological data were measured in the flexion and extension group under different angles (5°, 10°, 15°, 20°, and 25°). We retrospectively reviewed 164 patients who were diagnosed with a unilateral fracture of the pelvis. Pelvic ring displacement was identified and recorded radiographically in cadaveric models. The flexion and extension displacement of pelvic fractures was measured in terms of the vertical distance of fracture from the top of iliac crest to the pubic tubercle (CD) or from the top of iliac crest to the lowest point of ischial tuberosity (AB). Fifty-seven pelves showed flexion displacement and 15 showed extension displacement. Closed reduction including internal fixation and external fixation was successfully used in 141 cases (86.0 %). The success rates of closed reduction in flexion and extension displacement groups were 77 and 73 %, respectively, which were lower than in unstable pelvic ring fractures. The sagittal plane rotation (flexion and extension) displacement of pelvic fractures could be measured by special points and lines on the radiographs. Minimally invasive reduction should be based on clearly identified differences between the sagittal plane rotation and the vertical displacement of pelvic fractures.

Ball-joint versus single monolateral external fixators for definitive treatment of tibial shaft fractures.

PubMed

Beltsios, Michail; Mavrogenis, Andreas F; Savvidou, Olga D; Karamanis, Eirineos; Kokkalis, Zinon T; Papagelopoulos, Panayiotis J

2014-07-01

To compare modular monolateral external fixators with single monolateral external fixators for the treatment of open and complex tibial shaft fractures, to determine the optimal construct for fracture union. A total of 223 tibial shaft fractures in 212 patients were treated with a monolateral external fixator from 2005 to 2011; 112 fractures were treated with a modular external fixator with ball-joints (group A), and 111 fractures were treated with a single external fixator without ball-joints (group B). The mean follow-up was 2.9 years. We retrospectively evaluated the operative time for fracture reduction with the external fixator, pain and range of motion of the knee and ankle joints, time to union, rate of malunion, reoperations and revisions of the external fixators, and complications. The time for fracture reduction was statistically higher in group B; the rate of union was statistically higher in group B; the rate of nonunion was statistically higher in group A; the mean time to union was statistically higher in group A; the rate of reoperations was statistically higher in group A; and the rate of revision of the external fixator was statistically higher in group A. Pain, range of motion of the knee and ankle joints, rates of delayed union, malunion and complications were similar. Although modular external fixators are associated with faster intraoperative fracture reduction with the external fixator, single external fixators are associated with significantly better rates of union and reoperations; the rates of delayed union, malunion and complications are similar.

Treatment of mandibular symphyseal fracture combined with dislocated intracapsular condylar fractures.

PubMed

Xu, Xiaofeng; Shi, Jun; Xu, Bing; Dai, Jiewen; Zhang, Shilei

2015-03-01

To evaluate the treatment methods of mandibular symphyseal fracture combined with dislocated intracapsular condylar fractures (MSF&DICF) and to compare the effect of different treatment methods of condylar fractures. Twenty-eight patients with MSF&DICF were included in this study. Twenty-two sites were treated by open reduction, and all the medial condylar fragments were fixed with titanium screws; whereas the other 22 sites underwent close treatment. The surgical effect between these 2 groups was compared based on clinical examination and radiographic examination results. Seventeen of 22 condyle fractures were repositioned in the surgery group, whereas 4 of 22 condyle fractures were repositioned in the close treatment group. Statistical difference was observed between these 2 groups (P < 0.01). Functional outcomes of the patients treated in the surgical treatment group also were better than those in the close treatment group. The dislocated intracapsular condyle fractures should be treated by surgical reduction with the maintenance of the attachment of lateral pterygoid muscle, which is beneficial to repositioning the dislocated condyle to its original physiological position, to closure of the mandibular lingual gap, to restore the mandibular width.

Miniplate for osteosynthesis in a 9-year-old with symphysis fracture: clinical report.

PubMed

Srinivasan, Ila; Kumar, Naveen; Jaganathan, Udhya; Bhandari, Arihant

2013-09-01

Osteosynthesis using minimum material in pediatric mandibular fractures is the key, due to the limited space available in the mandible, especially in the mental foramen and apical region. There is an important role of open reduction and rigid internal fixation in re-establishing facial height, width and projection. During the early years of growth and development, there is a high osteogenic potential of the bones. The thick periosteum allows for rapid consolidation and remodeling at the site of fracture. Primary teeth have short, bulbous crowns which compromise stable maxillomandibular fixation during fracture reduction and stabilization using traditional methods. Further, stability of the fractured segments may be hampered because of the displaced or mobile permanent anterior teeth in the mixed dentition along the line of fracture. This clinical report outlines the use of miniplate with monocortical screws in a 9-year-old boy with symphysis fracture. How to cite this article: Srinivasan I, Kumar N, Jaganathan U, Bhandari A. Miniplate for Osteosynthesis in a 9-Year-Old with Symphysis Fracture: Clinical Report. Int J Clin Pediatr Dent 2013;6(3):213-216.

Management of distal humeral coronal shear fractures

PubMed Central

Yari, Shahram S; Bowers, Nathan L; Craig, Miguel A; Reichel, Lee M

2015-01-01

Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. PMID:25984515

[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.

Constitutive relationships and physical basis of fault strength due to flash heating

USGS Publications Warehouse

Beeler, N.M.; Tullis, T.E.; Goldsby, D.L.

2008-01-01

We develop a model of fault strength loss resulting from phase change at asperity contacts due to flash heating that considers a distribution of contact sizes and nonsteady state evolution of fault strength with displacement. Laboratory faulting experiments conducted at high sliding velocities, which show dramatic strength reduction below the threshold for bulk melting, are well fit by the model. The predicted slip speed for the onset of weakening is in the range of 0.05 to 2 m/s, qualitatively consistent with the limited published observations. For this model, earthquake stress drops and effective shear fracture energy should be linearly pressure-dependent, whereas the onset speed may be pressure-independent or weakly pressure-dependent. On the basis of the theory, flash weakening is expected to produce large dynamic stress drops, small effective shear fracture energy, and undershoot. Estimates of the threshold slip speed, stress drop, and fracture energy are uncertain due to poor knowledge of the average ontact dimension, shear zone thickness and gouge particle size at seismogenic depths. Copyright 2008 by the American Geophysical Union.

An investigation of new metal framework design for metal ceramic restorations.

PubMed

O'Boyle, K H; Norling, B K; Cagna, D R; Phoenix, R D

1997-09-01

Metal ceramic restorations have been implicated in the discoloration of associated gingival tissues. Attempts to remedy this by altering the design of the metal frameworks for such restorations may lead to unacceptable decreases in fracture resistance. This study evaluated a new metal framework design for metal-ceramic restorations. Twenty artificial crowns were fabricated with various degrees of facial metal reduction; 0, 1, 2, and 3 mm. The study was conducted in two parts. The first part evaluated changes in light transmission into adjacent root tissue. A light box was fabricated so sample crowns could be illuminated on a mounted natural tooth. The root of the tooth remained outside the light box, and the light transmitted through the crowns into root tissue was measured with a light meter. The second part of the study evaluated changes in fracture strength. The sample crowns were subjected to a vertical load until fracture with use of an Instron machine at a crosshead speed of 1 mm per minute. The load at fracture was recorded. Results indicated a statistically significant increase in light transmission with 1 mm framework reduction or greater, and fracture strengths did not decrease with up to 1 mm of framework reduction. A 1 mm facial axial reduction of the metal framework may be indicated for anterior metal-ceramic restorations.

FRAX®: Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

PubMed Central

Briot, Karine; Paternotte, Simon; Kolta, Sami; Eastell, Richard; Felsenberg, Dieter; Reid, David M.; Glüer, Claus-C.; Roux, Christian

2013-01-01

Purposes The aim of this study was to analyse how well FRAX® predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population. Patients and methods The OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAX® performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI). Results 85 (4.9%) patients had incident major fractures over 6 years. FRAX® with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAX® with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAX®. Conclusions This study shows that FRAX® with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population. PMID:24386199

Radiographic Measurement of Displacement in Acetabular Fractures: A Systematic Review of the Literature.

PubMed

Dodd, Andrew; Osterhoff, Georg; Guy, Pierre; Lefaivre, Kelly A

2016-06-01

To report methods of measurement of radiographic displacement and radiographic outcomes in acetabular fractures described in the literature. A systematic review of the English literature was performed using EMBASE and Medline in August 2014. Inclusion criteria were studies of operatively treated acetabular fractures in adults with acute (<6 weeks) open reduction and internal fixation that reported radiographic outcomes. Exclusion criteria included case series with <10 patients, fractures managed >6 weeks from injury, acute total hip arthroplasty, periprosthetic fractures, time frame of radiographic outcomes not stated, missing radiographic outcome data, and non-English language articles. Basic information collected included journal, author, year published, number of fractures, and fracture types. Specific data collected included radiographic outcome data, method of measuring radiographic displacement, and methods of interpreting or categorizing radiographic outcomes. The number of reproducible radiographic measurement techniques (2/64) and previously described radiographic interpretation methods (4) were recorded. One radiographic reduction grading criterion (Matta) was used nearly universally in articles that used previously described criteria. Overall, 70% of articles using this criteria documented anatomic reductions. The current standard of measuring radiographic displacement in publications dealing with acetabulum fractures almost universally lacks basic description, making further scientific rigor, such as testing reproducibility, impossible. Further work is necessary to standardize radiographic measurement techniques, test their reproducibility, and qualify their validity or determine which measurements are important to clinical outcomes. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Low-energy fracture of posterolateral tibial plateau: treatment by a posterolateral prone approach.

PubMed

Yu, Guang-Rong; Xia, Jiang; Zhou, Jia-Qian; Yang, Yun-Feng

2012-05-01

Most of the posterolateral tibial plateau fractures are caused by low-energy injury. The posterior fracture fragment could not be exposed and reduced well through traditional approaches. The aim of this study was to review the results of surgical treatment of this kind of fracture using posterolateral approach with patient in prone position. The low-energy posterolateral fracture is defined as the main part of articular depression or split fragment limited within the posterior half of the lateral column. Direct reduction and buttress plate fixation through the posterolateral prone approach was applied in all the patients. In our series, 15 of 132 (11.4%) patients with tibial plateau fractures were identified as low-energy posterolateral fractures. The clinical outcomes were available in 14 of the 15 patients through phone interviews and chart reviews. Mean follow-up was 35.1 months (range: 24-48 months). All the patients had anatomic or good reductions (≤ 2 mm step/gap). Average range of motion was 0.7 degrees to 123.2 degrees (5-110 degrees to 0-140 degrees). The complications were limited to one superficial wound infection, two slight flexion contractures, and five implants removal. The average modified hospital for special surgery knee score was 93.4 (range: 86-100). The posterolateral prone approach provides excellent visualization, which can facilitate the reduction and posterior buttress plate fixation for low-energy posterolateral tibial plateau fractures and shows encouraging results. V, therapeutic study.

Cerclage wire and lag screw fixation of the lateral malleolus in supination and external rotation fractures of the ankle.

PubMed

Bajwa, Amarjit S; Gantz, D E

2005-01-01

Wound dehiscence and exposed lateral hardware can occur after open reduction internal fixation of lateral malleolus. The bulk of a lateral plate and the minimum soft tissue over the lateral malleolus may contribute to this situation. The objective of this study was to evaluate a series of patients with lateral malleolar fractures treated with operative reduction using minimal hardware. We wanted to observe whether there was any loss of reduction and whether there were any incidences of soft tissue disruption. Fifty-two patients with long spiral fracture of the lateral malleolus in a supination-external rotation injury were treated with two or three 3.5-mm lag screws inserted 1 cm apart and 1 or 2 circlage wires. Less rigid fixation was supplemented with a below-the-knee plaster cast. All patients were followed up until clinical and radiological evidence of fracture healing at 6, 10, and 14 weeks postoperatively. By 10 weeks, all patients were full weight bearing, although most patients still limped. At 14 weeks' follow-up, there were no infections or wound dehiscences. All patients were able to return to their activities of daily living. All the fractures had united without loss of original position. Two fractures of the posterior bone spikes seen during surgery united uneventfully. Long spiral fractures of the lateral malleolus of the ankle can be treated successfully with 2 or 3 lag screws and circlage wires without compromising the outcome of the fracture healing.

Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures.

PubMed

Tian, Yun; Zhou, Fang; Ji, Hongquan; Zhang, Zhishan; Guo, Yan

2011-12-01

Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation. We conducted a retrospective comparison of the modified tension band technique and the titanium cable-cannulated screw tension band technique. We retrospectively reviewed 101 patients aged 22 to 85 years (mean, 56.6 years) with AO/OTA 34-C1 fractures (n = 68) and 34-C2 fractures (n = 33). Fifty-two patients were in the modified tension band group and 49 were in the titanium cable-cannulated screw tension band group. Followup was at least 1 year (range, 1-3 years). Comparison criteria were fracture reduction, fracture healing time, and the Iowa score for knee function. The titanium cable-cannulated screw tension band group showed improved fracture reduction, reduced healing time, and better Iowa score, compared with the modified tension band group. In the modified tension band group, eight patients experienced wire migration, three of these requiring a second operation. There were no complications in the titanium cable-cannulated screw tension band group. The titanium cable-cannulated screw tension band technique showed superior results and should be considered as an alternative method for treatment of transverse patellar fractures. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

The Benefits of Maximum Likelihood Estimators in Predicting Bulk Permeability and Upscaling Fracture Networks

NASA Astrophysics Data System (ADS)

Emanuele Rizzo, Roberto; Healy, David; De Siena, Luca

2016-04-01

The success of any predictive model is largely dependent on the accuracy with which its parameters are known. When characterising fracture networks in fractured rock, one of the main issues is accurately scaling the parameters governing the distribution of fracture attributes. Optimal characterisation and analysis of fracture attributes (lengths, apertures, orientations and densities) is fundamental to the estimation of permeability and fluid flow, which are of primary importance in a number of contexts including: hydrocarbon production from fractured reservoirs; geothermal energy extraction; and deeper Earth systems, such as earthquakes and ocean floor hydrothermal venting. Our work links outcrop fracture data to modelled fracture networks in order to numerically predict bulk permeability. We collected outcrop data from a highly fractured upper Miocene biosiliceous mudstone formation, cropping out along the coastline north of Santa Cruz (California, USA). Using outcrop fracture networks as analogues for subsurface fracture systems has several advantages, because key fracture attributes such as spatial arrangements and lengths can be effectively measured only on outcrops [1]. However, a limitation when dealing with outcrop data is the relative sparseness of natural data due to the intrinsic finite size of the outcrops. We make use of a statistical approach for the overall workflow, starting from data collection with the Circular Windows Method [2]. Then we analyse the data statistically using Maximum Likelihood Estimators, which provide greater accuracy compared to the more commonly used Least Squares linear regression when investigating distribution of fracture attributes. Finally, we estimate the bulk permeability of the fractured rock mass using Oda's tensorial approach [3]. The higher quality of this statistical analysis is fundamental: better statistics of the fracture attributes means more accurate permeability estimation, since the fracture attributes feed directly into the permeability calculations. The application of Maximum Likelihood Estimators can have important consequences, especially when we aim to predict the tendency of fracture attributes towards smaller and larger scales than those observed, in order to build consistent, useable models from outcrop observations. The procedures presented here aim to understand whether the average permeability of a fracture network can be predicted, reducing its uncertainties; and if outcrop measurements of fracture attributes can be used directly to generate statistically identical fracture network models, which can then be easily up-scaled into larger areas or volumes. Gale et al. "Natural Fracture in shale: A review and new observations", AAPG Bulletin 98.11 (2014). Mauldon et al. "Circular scanlines and circular windows: new tools for characterizing the geometry of fracture traces", Journal of Structural Geology, 23 (2001). Oda "Permeability tensor for discontinuous rock masses", Geotechnique 35.4 (1985).

Predictive Power of Distal Radial Metaphyseal Tenderness for Diagnosing Occult Fracture.

PubMed

Glickel, Steven Z; Hinojosa, Lauren; Eden, Claire M; Balutis, Elaine; Barron, O Alton; Catalano, Louis W

2017-10-01

To correlate the physical examination finding of distal radial metaphyseal tenderness with plain radiographic and magnetic resonance imaging after acute wrist injury to diagnose occult distal radius fractures. We hypothesized that persistent distal radial metaphyseal tenderness 2 weeks after acute injuries is predictive of an occult fracture. Twenty-nine adult patients presented, after acute trauma, with distal radial metaphyseal tenderness and initial plain radiographs and/or fluoroscopic images that did not show a distal radius fracture. Patients were reevaluated clinically and radiographically at approximately 2 weeks after initial presentation. Patients with persistent distal radial tenderness and negative radiographs underwent magnetic resonance imaging to definitively diagnose an occult distal radius fracture. We calculated the sensitivity and positive predictive value for persistent distal radial metaphyseal tenderness using a 95% confidence interval and standard formulas. Both radiographs and magnetic resonance imaging were used as our endpoint diagnosis for a distal radius fracture. We diagnosed 28 occult distal radius fractures, 8 by follow-up radiograph and 20 by magnetic resonance imaging. The positive predictive value for patients who completed the protocol was 96%. One patient who did not have an occult distal radius fracture had a fracture of the ulnar styloid. Tenderness of the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite both normal plain radiographs and fluoroscopic images. Diagnostic III. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Avoidance of malreduction of proximal femoral shaft fractures with the use of a minimally invasive nail insertion technique (MINIT).

PubMed

Russell, Thomas A; Mir, Hassan R; Stoneback, Jason; Cohen, Jose; Downs, Brandon

2008-07-01

To determine our rate of malalignment in proximal femoral shaft fractures treated with intramedullary (IM) nails, with and without the use of a minimally invasive nail insertion technique (MINIT). Retrospective study. Level 1 trauma center. Between July 1, 2003, and June 31, 2005, 100 consecutive proximal femoral shaft fractures (97 patients) were treated with IM nails. The average age of the 56 men and 41 women was 43.5 years (range, 17 to 96 years). There were 92 closed fractures and 8 open fractures. Fractures were classified according to the Russell-Taylor classification (69 type 1A, 11 type 1B, 3 type 2A, 17 type 2B). All patients underwent antegrade IM nailing using a fracture table in the supine (83) or lateral (17) position. A total of 72 entry portals were trochanteric, and 28 were piriformis. Seventy-seven percent of the femurs were opened with MINIT, a technique that uses a percutaneous cannulated channel reamer over a guide pin as opposed to the standard method of Kuntscher, which employs a femoral awl. Nails were locked proximally using standard locking in 37 fractures, and recon mode in 63. Fracture reduction was examined on immediate postoperative films to determine angulation in the coronal and sagittal planes. Criteria for acceptable reduction were less than 5 degrees angulation in any plane. In addition, surgical position, entry portal, mechanism of injury, Russell-Taylor classification, OTA classification, open or closed fracture, open or closed reduction, and type of implant used were analyzed for significance. The frequency of malalignment was 10% for the entire group of patients. Malalignment occurred in 26% of fractures treated without the use of the MINIT and in 5.2% when the MINIT was used (P < 0.01). There was no statistically significant difference between the different Russell-Taylor fracture types, although there was a trend towards more malalignment in type 2A and 2B fractures (P = 0.06). None of the other factors studied had a statistically significant effect on malalignment. A whole-model test of the factors that were surgeon-controlled (use of the MINIT, surgical position, open or closed reduction, type of implant used, and entry portal) found that only use of the MINIT had a statistically significant effect on malalignment (P < 0.01). The results indicate that use of the minimally invasive nail insertion technique (MINIT) significantly decreases the occurrence of malalignment in proximal femoral shaft fractures.

Predicting bulk permeability using outcrop fracture attributes: The benefits of a Maximum Likelihood Estimator

NASA Astrophysics Data System (ADS)

Rizzo, R. E.; Healy, D.; De Siena, L.

2015-12-01

The success of any model prediction is largely dependent on the accuracy with which its parameters are known. In characterising fracture networks in naturally fractured rocks, the main issues are related with the difficulties in accurately up- and down-scaling the parameters governing the distribution of fracture attributes. Optimal characterisation and analysis of fracture attributes (fracture lengths, apertures, orientations and densities) represents a fundamental step which can aid the estimation of permeability and fluid flow, which are of primary importance in a number of contexts ranging from hydrocarbon production in fractured reservoirs and reservoir stimulation by hydrofracturing, to geothermal energy extraction and deeper Earth systems, such as earthquakes and ocean floor hydrothermal venting. This work focuses on linking fracture data collected directly from outcrops to permeability estimation and fracture network modelling. Outcrop studies can supplement the limited data inherent to natural fractured systems in the subsurface. The study area is a highly fractured upper Miocene biosiliceous mudstone formation cropping out along the coastline north of Santa Cruz (California, USA). These unique outcrops exposes a recently active bitumen-bearing formation representing a geological analogue of a fractured top seal. In order to validate field observations as useful analogues of subsurface reservoirs, we describe a methodology of statistical analysis for more accurate probability distribution of fracture attributes, using Maximum Likelihood Estimators. These procedures aim to understand whether the average permeability of a fracture network can be predicted reducing its uncertainties, and if outcrop measurements of fracture attributes can be used directly to generate statistically identical fracture network models.

Evaluation of the Three Parameter Weibull Distribution Function for Predicting Fracture Probability in Composite Materials

DTIC Science & Technology

1978-03-01

for the risk of rupture for a unidirectionally laminat - ed composite subjected to pure bending. (5D This equation can be simplified further by use of...C EVALUATION OF THE THREE PARAMETER WEIBULL DISTRIBUTION FUNCTION FOR PREDICTING FRACTURE PROBABILITY IN COMPOSITE MATERIALS. THESIS / AFIT/GAE...EVALUATION OF THE THREE PARAMETER WE1BULL DISTRIBUTION FUNCTION FOR PREDICTING FRACTURE PROBABILITY IN COMPOSITE MATERIALS THESIS Presented

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.

[Treatment of open tile type C pelvic fractures by open reduction and internal fixation through anterior and posterior approaches at early stage].

PubMed

Li, Baichuan

2014-05-01

To explore the effectiveness of open reduction and internal fixation through anterior and posterior approaches in treatment of open Tile type C pelvic fractures at early stage. Between January 2009 and April 2012, 12 patients with open Tile C pelvic fractures were treated. There were 7 males and 5 females, aged 6-53 years (median, 31 years). Of 12 cases, 4 were classified as Tile type C1, 6 as Tile type C2, and 2 as Tile type C3; 5 were rated as Gustilo type II and 7 as Gustilo type III. The injury severity score was 18-57 (mean, 37.2). The interval of injury and admission ranged from 15 minutes to 3 days (median, 50 minutes). The debridement and external fixation were performed at first stage; then open reduction and internal fixation were used through anterior approach (reconstruction plate) and posterior approach (cannulated lag screws). The vacuum sealing drainage was performed during treatment until the wounds healed. Delayed healing of incison was obtained in 12 cases because of wound infection. Anatomical reduction or approximate anatomical reduction was achieved in all 12 cases. The patients were followed up 3-39 months (median, 18 months). No loosening of internal fixation or fracture displacement was observed during follow-up. The fracture healing time was 7-13 weeks (mean, 9.7 weeks). At last follow-up, according to the Matta standard, the outcome was excellent in 10 cases and good in 2 cases; according to Majeed score, the results were excellent in 9 cases, good in 1, and poor in 2. Early internal fixation operation of open Tile type C pelvic fractures can effectively restore the pelvic anatomical structure and stability, reduce the complication, and achieve satisfactory effectiveness.

Planning acetabular fracture reduction using patient-specific multibody simulation of the hip

NASA Astrophysics Data System (ADS)

Oliveri, Hadrien; Boudissa, Mehdi; Tonetti, Jerome; Chabanas, Matthieu

2017-03-01

Acetabular fractures are a challenge in orthopedic surgery. Computer-aided solutions were proposed to segment bone fragments, simulate the fracture reduction or design the osteosynthesis fixation plates. This paper addresses the simulation part, which is usually carried out by freely moving bone fragments with six degrees of freedom to reproduce the pre-fracture state. Instead we propose a different paradigm, closer to actual surgeon's requirements: to simulate the surgical procedure itself rather than the desired result. A simple, patient-specific, biomechanical multibody model is proposed, integrating the main ligaments and muscles of the hip joint while accounting for contacts between bone fragments. Main surgical tools and actions can be simulated, such as clamps, Schanz screws or traction of the femur. Simulations are computed interactively, which enables clinicians to evaluate different strategies for an optimal surgical planning. Six retrospective cases were studied, with simple and complex fracture patterns. After interactively building the models from preoperative CT, gestures from the surgical reports were reproduced. Results of the simulations could then be compared with postoperative CT data. A qualitative study shows the model behavior is excellent and the simulated reductions fit the observed data. A more quantitative analysis is currently being completed. Two cases are particularly significant, for which the surgical reduction actually failed. Simulations show it was indeed not possible to reduce these fractures with the chosen approach. Had our simulator being used, a better planning may have avoided a second surgery to these patients.

Fracture behaviors of ceramic tissue scaffolds for load bearing applications

NASA Astrophysics Data System (ADS)

Entezari, Ali; Roohani-Esfahani, Seyed-Iman; Zhang, Zhongpu; Zreiqat, Hala; Dunstan, Colin R.; Li, Qing

2016-07-01

Healing large bone defects, especially in weight-bearing locations, remains a challenge using available synthetic ceramic scaffolds. Manufactured as a scaffold using 3D printing technology, Sr-HT-Gahnite at high porosity (66%) had demonstrated significantly improved compressive strength (53 ± 9 MPa) and toughness. Nevertheless, the main concern of ceramic scaffolds in general remains to be their inherent brittleness and low fracture strength in load bearing applications. Therefore, it is crucial to establish a robust numerical framework for predicting fracture strengths of such scaffolds. Since crack initiation and propagation plays a critical role on the fracture strength of ceramic structures, we employed extended finite element method (XFEM) to predict fracture behaviors of Sr-HT-Gahnite scaffolds. The correlation between experimental and numerical results proved the superiority of XFEM for quantifying fracture strength of scaffolds over conventional FEM. In addition to computer aided design (CAD) based modeling analyses, XFEM was conducted on micro-computed tomography (μCT) based models for fabricated scaffolds, which took into account the geometric variations induced by the fabrication process. Fracture strengths and crack paths predicted by the μCT-based XFEM analyses correlated well with relevant experimental results. The study provided an effective means for the prediction of fracture strength of porous ceramic structures, thereby facilitating design optimization of scaffolds.

[Roof folding and rotary pushing for the treatment of back to back fractures of distal radius and ulna in children].

PubMed

Xu, Ping; Dong, Xiao-jun; Lu, Zhou-tong; Wang, Gongjun; Zhang, Han-qing; Chen, Xuan-ning; Li, Dong

2015-09-01

To evaluate the technique and the clinical effect of folding roof and rotary pushing in treatment of children with distal radius and ulna fracture of "back to back". From January 2012 to February 2014,38 children with distal radius and ulna fracture of "back to back" were treated by using the technique of folding roof and rotary pushing to reset and splint fixation including 23 males and 15 females with an average age of 9.5 years old ranging from 6 to 14 years old. Injury time was from 45 min to 3 days (averaged 1.3 days). All cases was unilateral closed fracture without symptoms of nerve injury occurred. The wrist joint anteroposterior and lateral radiographs showed double fracture of radius and ulna, and the broken end of radius was typical "back to back" displacement. The quality of reduction was assessed according to Dienst recommendation on the combination of Aro measurement, and the therapeutic effect was evaluated using standard of Anderson function. All patients were followed up from 3 to 13 months with an average of 6 months. There were no iatrogenic nerve injury. Thirty cases were treated successfully for the first time, 8 cases were again reset successfully; 28 cases were anatomical reduction, 7 cases were near anatomic reduction, 3 cases were functional reduction. At the second day 7 cases with hand and finger swelling appeared in multiple reset patients. Quality results of reduction were excellent in 33 cases, good in 5 cases. According to the standard of Anderson function evaluation, 35 cases were excellent, 3 cases were good. All fractures were healed with of deformity of wrist. Using the technique of folding roof and rotary pushing in treatment of children with distal radius and ulna fracture of "back to back" is very successful, the patient's limb function recovered well, the whole operation process is simple.

A prospective study of mandibular trabecular bone to predict fracture incidence in women: a low-cost screening tool in the dental clinic.

PubMed

Jonasson, Grethe; Sundh, Valter; Ahlqwist, Margareta; Hakeberg, Magnus; Björkelund, Cecilia; Lissner, Lauren

2011-10-01

Bone structure is the key to the understanding of fracture risk. The hypothesis tested in this prospective study is that dense mandibular trabeculation predicts low fracture risk, whereas sparse trabeculation is predictive of high fracture risk. Out of 731 women from the Prospective Population Study of Women in Gothenburg with dental examinations at baseline 1968, 222 had their first fracture in the follow-up period until 2006. Mandibular trabeculation was defined as dense, mixed dense plus sparse, and sparse based on panoramic radiographs from 1968 and/or 1980. Time to fracture was ascertained and used as the dependent variable in three Cox proportional hazards regression analyses. The first analysis covered 12 years of follow-up with self-reported endpoints; the second covered 26 years of follow-up with hospital verified endpoints; and the third combined the two follow-up periods, totaling 38 years. Mandibular trabeculation was the main independent variable predicting incident fractures, with age, physical activity, alcohol consumption and body mass index as covariates. The Kaplan-Meier curve indicated a graded association between trabecular density and fracture risk. During the whole period covered, the hazard ratio of future fracture for sparse trabeculation compared to mixed trabeculation was 2.9 (95% CI: 2.2-3.8, p<0.0001), and for dense versus mixed trabeculation was 0.21 (95% CI: 0.1-0.4, p<0.0001). The trabecular pattern was a highly significant predictor of future fracture risk. Our findings imply that dentists, using ordinary dental radiographs, can identify women at high risk for future fractures at 38-54 years of age, often long before the first fracture occurs. Copyright © 2011 Elsevier Inc. All rights reserved.

Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months After Surgery for Hip Fracture Repair.

PubMed

Tanaka, Ryo; Umehara, Takuya; Fujimura, Takafumi; Ozawa, Junya

2016-12-01

To develop and assess a clinical prediction rule (CPR) to predict declines in activities of daily living (ADL) at 6 months after surgery for hip fracture repair. Prospective, cohort study. From hospital to home. Patients (N=104) with hip fractures after surgery. Not applicable. ADL were assessed using the Barthel Index at 6 months after surgery. At 6 months after surgery, 86 patients (82.6%) were known to be alive, 1 patient (1.0%) had died, and 17 (16.3%) were lost to follow-up. Thirty-two patients (37.2%) did not recover their ADL at 6 months after surgery to levels before fracture. The classification and regression trees methodology was used to develop 2 models to predict a decline in ADL: (1) model 1 included age, type of fracture, and care level before fracture (sensitivity=75.0%, specificity=81.5%, positive predictive value=70.6%, positive likelihood ratio=4.050); and (2) model 2 included the degree of independence 2 weeks postsurgery for ADL chair transfer, ADL ambulation, and age (sensitivity=65.6%, specificity=87.0%, positive predictive value=75.0%, positive likelihood ratio=5.063). The areas under the receiver operating characteristic curves of both CPR models were .825 (95% confidential interval, .728-.923) and .790 (95% confidence interval, .683-.897), respectively. CPRs with moderate accuracy were developed to predict declines in ADL at 6 months after surgery for hip fracture repair. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

[An improved reduction technique for depression fractures of lateral tibial plateau].

PubMed

Wang, Hongchuan; Lou, Hua; Liu, Kai; Jiang, Junwei

2013-01-01

To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Between January 2008 and December 2010; 48 patients (48 knees) with depression fractures of the lateral tibial plateau (Schatzker II or III fractures) were treated. There were 32 males and 16 females with an average age of 45.8 years (range, 16-79 years). All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average (range, 1-3 years). At last follow-up, the knee extension was (-0.5 +/- 0.3) degrees, and the knee flexion was (136.9 +/- 8.8) degrees. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was (1.0 +/- 0.7) mm at immediate postoperatively and (1.2 +/- 0.7) mm at last follow-up, showing no significant difference (t = -1.42, P = 0.20), but significant differences were found when compared with that at preoperation [(12.2 +/- 8.0) mm, P < 0.05]. This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction. The short-term effectiveness is good, but futher follow-up is necessary to determine the long-term results.

Intramedullary nailing of humeral shaft fractures.

PubMed

Pickering, Robert M; Crenshaw, Andrew H; Zinar, Daniel M

2002-01-01

The development of interlocking humeral nail systems has greatly broadened the indications for nailing of humeral shaft fracture. Rotational control is better than with earlier nail systems, and most nails have an oblong distal hole that allows axial loading of the fracture site with muscle contraction. When nailing is done with closed technique, loss of the fracture hematoma and periosteal stripping are avoided. Even when open reduction is required, periosteal stripping can be kept to a minimum. Surgical wounds are smaller, even when open reduction is necessary, and when closed nailing is done, bone grafting is unnecessary. Intramedullary nails are ideal for segmental fractures, pathologic fractures, and fractures in osteopenic bone. Because the arm usually is not a weight-bearing extremity, hardware failure is rare and union rates are equivalent to those of compression plate and screw fixation. Compression plates and external fixation certainly have their place for some fracture patterns and for severe wounds that are unsuitable for intramedullary nailing. The surgeon should be well versed in all three techniques and should be able to rapidly choose among these, depending upon the fracture pattern, skin wound, associated injuries, and overall condition of the patient.

Predicting the 10-year risk of hip and major osteoporotic fracture in rheumatoid arthritis and in the general population: an independent validation and update of UK FRAX without bone mineral density.

PubMed

Klop, Corinne; de Vries, Frank; Bijlsma, Johannes W J; Leufkens, Hubert G M; Welsing, Paco M J

2016-12-01

FRAX incorporates rheumatoid arthritis (RA) as a dichotomous predictor for predicting the 10-year risk of hip and major osteoporotic fracture (MOF). However, fracture risk may deviate with disease severity, duration or treatment. Aims were to validate, and if needed to update, UK FRAX for patients with RA and to compare predictive performance with the general population (GP). Cohort study within UK Clinical Practice Research Datalink (CPRD) (RA: n=11 582, GP: n=38 755), also linked to hospital admissions for hip fracture (CPRD-Hospital Episode Statistics, HES) (RA: n=7221, GP: n=24 227). Predictive performance of UK FRAX without bone mineral density was assessed by discrimination and calibration. Updating methods included recalibration and extension. Differences in predictive performance were assessed by the C-statistic and Net Reclassification Improvement (NRI) using the UK National Osteoporosis Guideline Group intervention thresholds. UK FRAX significantly overestimated fracture risk in patients with RA, both for MOF (mean predicted vs observed 10-year risk: 13.3% vs 8.4%) and hip fracture (CPRD: 5.5% vs 3.1%, CPRD-HES: 5.5% vs 4.1%). Calibration was good for hip fracture in the GP (CPRD-HES: 2.7% vs 2.4%). Discrimination was good for hip fracture (RA: 0.78, GP: 0.83) and moderate for MOF (RA: 0.69, GP: 0.71). Extension of the recalibrated UK FRAX using CPRD-HES with duration of RA disease, glucocorticoids (>7.5 mg/day) and secondary osteoporosis did not improve the NRI (0.01, 95% CI -0.04 to 0.05) or C-statistic (0.78). UK FRAX overestimated fracture risk in RA, but performed well for hip fracture in the GP after linkage to hospitalisations. Extension of the recalibrated UK FRAX did not improve predictive performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Progressive damage, fracture predictions and post mortem correlations for fiber composites

NASA Technical Reports Server (NTRS)

1985-01-01

Lewis Research Center is involved in the development of computational mechanics methods for predicting the structural behavior and response of composite structures. In conjunction with the analytical methods development, experimental programs including post failure examination are conducted to study various factors affecting composite fracture such as laminate thickness effects, ply configuration, and notch sensitivity. Results indicate that the analytical capabilities incorporated in the CODSTRAN computer code are effective in predicting the progressive damage and fracture of composite structures. In addition, the results being generated are establishing a data base which will aid in the characterization of composite fracture.

[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.

The evolution of selective estrogen receptor modulators in osteoporosis therapy

PubMed Central

2012-01-01

Selective estrogen receptor modulators (SERMs), which exhibit estrogen receptor agonist or antagonist activity based on the target tissue, have evolved through multiple generations for the prevention and/or treatment of postmenopausal osteoporosis. An ideal SERM would protect bone without stimulating the breast or endometrium. Raloxifene, lasofoxifene, and bazedoxifene have demonstrated unique preclinical profiles. Raloxifene, lasofoxifene, and bazedoxifene have shown significant reduction in the risk of vertebral fracture and improvement in bone mineral density versus placebo in postmenopausal women with osteoporosis. Raloxifene has been shown to reduce the risk of non-vertebral fractures in women with severe prevalent fractures at baseline. Lasofoxifene 0.5 mg, but not lasofoxifene 0.25 mg, has shown reduction in the incidence of non-vertebral fractures. Bazedoxifene 20 mg has been associated with a significant reduction in the risk of non-vertebral fracture versus placebo and raloxifene 60 mg in women at higher baseline fracture risk. Neither raloxifene, lasofoxifene, nor bazedoxifene has shown an increase in the incidence of endometrial hyperplasia or carcinoma. All SERMs have been associated with increased venous thromboembolic events and hot flushes. SERMs are effective alternatives for women who cannot tolerate or are unwilling to take bisphosphonates and may be appropriate for women at higher risk of fracture, particularly younger women who expect to remain on therapy for many years and are concerned about the long-term safety of bisphosphonates. PMID:22853318

[Principles of management of periprosthetic fractures].

PubMed

Röderer, G; Gebhard, F; Scola, A

2016-03-01

The increasing numbers of primary total hip and knee replacements have subsequently led to growing rates of periprosthetic fractures. In many cases geriatric patients with osteopenia or osteoporotic bone quality are affected. The goal of treatment is the retention or reconstruction of joint function using open reduction and internal fixation or a revision prosthesis. The aim of this article is a description of the basic principles of treatment of periprosthetic fractures of the lower extremities. An exact description of the fracture using current classification systems with imaging diagnostics is mandatory. This also includes an assessment of the stability of the prosthesis. In the case of a stable prosthesis and a good bone stock open reduction and internal fixation should be performed. In these cases locking plates are standard procedure. If fracture reduction is possible minimally invasive procedures can be performed which help to reduce the surgical trauma and accelerate rehabilitation. If the prosthesis is loose it has to be exchanged for a revision implant. If vast bony defects result they can be augmented using wedges. Conservative treatment plays only a subordinate role in selected cases. Periprosthetic fractures show an increasing incidence and occur more frequently in the geriatric patient population. Due to comorbidities and poor bone quality surgical treatment is a challenge. The fracture must be exactly classified using the appropriate classification system in order to clarify if the prosthesis can be retained or if it has to be exchanged.

Relating Cohesive Zone Model to Linear Elastic Fracture Mechanics

NASA Technical Reports Server (NTRS)

Wang, John T.

2010-01-01

The conditions required for a cohesive zone model (CZM) to predict a failure load of a cracked structure similar to that obtained by a linear elastic fracture mechanics (LEFM) analysis are investigated in this paper. This study clarifies why many different phenomenological cohesive laws can produce similar fracture predictions. Analytical results for five cohesive zone models are obtained, using five different cohesive laws that have the same cohesive work rate (CWR-area under the traction-separation curve) but different maximum tractions. The effect of the maximum traction on the predicted cohesive zone length and the remote applied load at fracture is presented. Similar to the small scale yielding condition for an LEFM analysis to be valid. the cohesive zone length also needs to be much smaller than the crack length. This is a necessary condition for a CZM to obtain a fracture prediction equivalent to an LEFM result.

A decision-analytic approach to predict state regulation of hydraulic fracturing.

PubMed

Linkov, Igor; Trump, Benjamin; Jin, David; Mazurczak, Marcin; Schreurs, Miranda

2014-01-01

The development of horizontal drilling and hydraulic fracturing methods has dramatically increased the potential for the extraction of previously unrecoverable natural gas. Nonetheless, the potential risks and hazards associated with such technologies are not without controversy and are compounded by frequently changing information and an uncertain landscape of international politics and laws. Where each nation has its own energy policies and laws, predicting how a state with natural gas reserves that require hydraulic fracturing will regulate the industry is of paramount importance for potential developers and extractors. We present a method for predicting hydraulic fracturing decisions using multiple-criteria decision analysis. The case study evaluates the decisions of five hypothetical countries with differing political, social, environmental, and economic priorities, choosing among four policy alternatives: open hydraulic fracturing, limited hydraulic fracturing, completely banned hydraulic fracturing, and a cap and trade program. The result is a model that identifies the preferred policy alternative for each archetypal country and demonstrates the sensitivity the decision to particular metrics. Armed with such information, observers can predict each country's likely decisions related to natural gas exploration as more data become available or political situations change. Decision analysis provides a method to manage uncertainty and address forecasting concerns where rich and objective data may be lacking. For the case of hydraulic fracturing, the various political pressures and extreme uncertainty regarding the technology's risks and benefits serve as a prime platform to demonstrate how decision analysis can be used to predict future behaviors.

Fracture strength of the particulate-reinforced ultra-high temperature ceramics based on a temperature dependent fracture toughness model

NASA Astrophysics Data System (ADS)

Wang, Ruzhuan; Li, Weiguo; Ji, Baohua; Fang, Daining

2017-10-01

The particulate-reinforced ultra-high temperature ceramics (pUHTCs) have been particularly developed for fabricating the leading edge and nose cap of hypersonic vehicles. They have drawn intensive attention of scientific community for their superior fracture strength at high temperatures. However, there is no proper model for predicting the fracture strength of the ceramic composites and its dependency on temperature. In order to account for the effect of temperature on the fracture strength, we proposed a concept called energy storage capacity, by which we derived a new model for depicting the temperature dependent fracture toughness of the composites. This model gives a quantitative relationship between the fracture toughness and temperature. Based on this temperature dependent fracture toughness model and Griffith criterion, we developed a new fracture strength model for predicting the temperature dependent fracture strength of pUHTCs at different temperatures. The model takes into account the effects of temperature, flaw size and residual stress without any fitting parameters. The predictions of the fracture strength of pUHTCs in argon or air agreed well with the experimental measurements. Additionally, our model offers a mechanism of monitoring the strength of materials at different temperatures by testing the change of flaw size. This study provides a quantitative tool for design, evaluation and monitoring of the fracture properties of pUHTCs at high temperatures.

Parameter Prediction of Hydraulic Fracture for Tight Reservoir Based on Micro-Seismic and History Matching

NASA Astrophysics Data System (ADS)

Zhang, Kai; Ma, Xiaopeng; Li, Yanlai; Wu, Haiyang; Cui, Chenyu; Zhang, Xiaoming; Zhang, Hao; Yao, Jun

Hydraulic fracturing is an important measure for the development of tight reservoirs. In order to describe the distribution of hydraulic fractures, micro-seismic diagnostic was introduced into petroleum fields. Micro-seismic events may reveal important information about static characteristics of hydraulic fracturing. However, this method is limited to reflect the distribution area of the hydraulic fractures and fails to provide specific parameters. Therefore, micro-seismic technology is integrated with history matching to predict the hydraulic fracture parameters in this paper. Micro-seismic source location is used to describe the basic shape of hydraulic fractures. After that, secondary modeling is considered to calibrate the parameters information of hydraulic fractures by using DFM (discrete fracture model) and history matching method. In consideration of fractal feature of hydraulic fracture, fractal fracture network model is established to evaluate this method in numerical experiment. The results clearly show the effectiveness of the proposed approach to estimate the parameters of hydraulic fractures.

Mobility one week after a hip fracture - can it be predicted?

PubMed

Fitzgerald, Michelle; Blake, Catherine; Askin, David; Quinlan, John; Coughlan, Tara; Cunningham, Caitriona

2018-05-01

Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fracture function at an early stage. This study aimed to identify independent predictors of mobility outcome one week post hip fracture surgery. All hip fracture inpatients (n=77) were included in this 6 month prospective observational cohort study. Predictor variables were obtained on the first postoperative day and included premorbid function using the New Mobility Score (NMS). Mobility outcome measures one week postoperatively included the Cumulated Ambulatory Score (CAS). Data were analysed with SPSS using binary multiple logistic regression analysis RESULTS: Patients who fell outdoors (OR 3.848; 95% CI, 1.053-14.061), had no delay to surgery (OR 5.472; 95% CI, 1.073-27.907) and had high pre-fracture function (OR3.366; 95% CI, 1.042-10.879) were predicted to achieve independent mobility (CAS = 6) one week postoperatively. Fall location, time to surgery and baseline function predict independent mobility one week after hip fracture, and can be used for early rehabilitation stratification. The NMS and CAS are recommended as standardised hip fracture clinical measures. Orthogeriatric and physiotherapy service initiatives may improve early functional outcome. Copyright © 2017. Published by Elsevier Ltd.

Treatment of displaced intra-articular calcaneal fractures with triangular tube-to-bar external fixation: long-term clinical follow-up and radiographic analysis.

PubMed

Roukis, Thomas S; Wünschel, Markus; Lutz, Hans-Peter; Kirschner, Peter; Zgonis, Thomas

2008-04-01

Sixty-six feet (62 patients) with displaced intra-articular calcaneal fractures underwent manual reduction and distraction with the use of a triangular tube-to-bar external fixation device and were retrospectively reviewed at a minimum of 1-year post-operative. Final radiographic follow-up revealed complete consolidation in all fractures, maintenance of reduction, and limited degenerative osteoarthrosis about the subtalar joint. Our results indicate that with proper application and attention to detail, restoration of calcaneal morphology using triangular tube-to-bar external fixation should be considered a viable alternative in the treatment of displaced intra-articular fractures of the calcaneus.

[Locked volar plating for complex distal radius fractures: maintaining radial length].

PubMed

Jeudy, J; Pernin, J; Cronier, P; Talha, A; Massin, P

2007-09-01

Maintaining radial length, likely to be the main challenge in the treatment of complex distal radius fractures, is necessary for complete grip-strength and pro-supination range recovery. In spite of frequent secondary displacements, bridging external-fixation has remained the reference method, either isolated or in association with additional percutaneous pins or volar plating. Also, there seems to be a relation between algodystrophy and the duration of traction applied on the radio-carpal joint. Fixed-angle volar plating offers the advantage of maintaining the reduction until fracture healing, without bridging the joint. In a prospective study, forty-three consecutive fractures of the distal radius with a positivated ulnar variance were treated with open reduction and fixed-angle volar plating. Results were assessed with special attention to the radial length and angulation obtained and maintained throughout treatment, based on repeated measurements of the ulnar variance and radial angulation in the first six months postoperatively. The correction of the ulnar variance was maintained until complete recovery, independently of initial metaphyseal comminution, and of the amount of radial length gained at reduction. Only 3 patients lost more than 1 mm of radial length after reduction. The posterior tilt of the distal radial epiphysis was incompletely reduced in 13 cases, whereas reduction was partially lost in 6 elderly osteoporotic female patients. There was 8 articular malunions, all of them less than 2 mm. Secondary displacements were found to be related to a deficient locking technique. Eight patients developed an algodystropy. The risk factors for algodystrophy were articular malunion, associated posterior pining, and associated lesions of the ipsilateral upper limb. Provided that the locking technique was correct, this type of fixation appeared efficient in maintaining the radial length in complex fractures of the distal radius. The main challenge remains the reduction of displaced articular fractures. Based on these results, it is not possible to conclude that this method is superior to external fixation.

A simulation trainer for complex articular fracture surgery.

PubMed

Yehyawi, Tameem M; Thomas, Thaddeus P; Ohrt, Gary T; Marsh, J Lawrence; Karam, Matthew D; Brown, Thomas D; Anderson, Donald D

2013-07-03

The purposes of this study were (1) to develop a physical model to improve articular fracture reduction skills, (2) to develop objective assessment methods to evaluate these skills, and (3) to assess the construct validity of the simulation. A surgical simulation was staged utilizing surrogate tibial plafond fractures. Multiple three-segment radio-opacified polyurethane foam fracture models were produced from the same mold, ensuring uniform surgical complexity between trials. Using fluoroscopic guidance, five senior and seven junior orthopaedic residents reduced the fracture through a limited anterior window. The residents were assessed on the basis of time to completion, hand movements (tracked with use of a motion capture system), and quality of the obtained reduction. All but three of the residents successfully reduced and fixed the fracture fragments (one senior resident and two junior residents completed the reduction but were unsuccessful in fixating all fragments). Senior residents had an average time to completion of 13.43 minutes, an average gross articular step-off of 3.00 mm, discrete hand motions of 540 actions, and a cumulative hand motion distance of 79 m. Junior residents had an average time to completion of 14.75 minutes, an average gross articular step-off of 3.09 mm, discrete hand motions of 511 actions, and a cumulative hand motion distance of 390 m. The large difference in cumulative hand motion distance, despite comparable numbers of discrete hand motion events, indicates that senior residents were more precise in their hand motions. The present experiment establishes the basic construct validity of the simulation trainer. Further studies are required to demonstrate that this laboratory-based model for articular fracture reduction training, along with an objective assessment of performance, can be used to improve resident surgical skills.

The Adult Monteggia Fracture: Patterns and Incidence of Annular Ligament Incarceration Among 121 Cases at a Single Institution Over 19 Years.

PubMed

Hamaker, Max; Zheng, Amy; Eglseder, W Andrew; Pensy, Raymond A

2018-01-01

The purposes of this study were to identify the relative frequency of Monteggia fracture patterns and to investigate the required frequency of open reduction of the proximal radiocapitellar joint. We identified 121 Monteggia fractures at a Level I trauma center from 1996 to 2015 and included 119 in this study. These fractures were identified using a database search for the appropriate International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes as well as individual surgeons' logs. Two fellowship-trained hand surgeons reviewed the identified patients' x-rays and operative notes. Each fracture was classified using Bado's original description, excluding transolecranon and Monteggia variants. Bado I lesion represented 68% (81 of 119) of Monteggia fractures. Annular ligament incarceration preventing radial head reduction occurred in approximately 17% (14 of 81) of this Bado type. Revision fixation of the ulna was not necessary (none of 119 cases) and functional range of motion (average arc, 117°) was recovered in most patients. The reoperation rate of 20% (23 of 119) was related to the severity of the presenting injury and hardware prominence. Most radial head dislocations associated with Monteggia fractures occur anteriorly and will reduce with anatomic plating of the ulna. In cases where the radial head fails to reduce, entrapment of the annular ligament can be expected and open reduction is required. Revision fixation of the ulna to achieve reduction of the radial head is uncommon in our experience. Prognostic IV. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Predicting the Macroscopic Fracture Energy of Epoxy Resins from Atomistic Molecular Simulations

DOE PAGES

Meng, Zhaoxu; Bessa, Miguel A.; Xia, Wenjie; ...

2016-12-06

Predicting the macroscopic fracture energy of highly crosslinked glassy polymers from atomistic simulations is challenging due to the size of the process zone being large in these systems. Here, we present a scale-bridging approach that links atomistic molecular dynamics simulations to macroscopic fracture properties on the basis of a continuum fracture mechanics model for two different epoxy materials. Our approach reveals that the fracture energy of epoxy resins strongly depends on the functionality of epoxy resin and the component ratio between the curing agent (amine) and epoxide. The most intriguing part of our study is that we demonstrate that themore » fracture energy exhibits a maximum value within the range of conversion degrees considered (from 65% to 95%), which can be attributed to the combined effects of structural rigidity and post-yield deformability. Our study provides physical insight into the molecular mechanisms that govern the fracture characteristics of epoxy resins and demonstrates the success of utilizing atomistic molecular simulations towards predicting macroscopic material properties.« less

Predicting the Macroscopic Fracture Energy of Epoxy Resins from Atomistic Molecular Simulations

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

Meng, Zhaoxu; Bessa, Miguel A.; Xia, Wenjie

Predicting the macroscopic fracture energy of highly crosslinked glassy polymers from atomistic simulations is challenging due to the size of the process zone being large in these systems. Here, we present a scale-bridging approach that links atomistic molecular dynamics simulations to macroscopic fracture properties on the basis of a continuum fracture mechanics model for two different epoxy materials. Our approach reveals that the fracture energy of epoxy resins strongly depends on the functionality of epoxy resin and the component ratio between the curing agent (amine) and epoxide. The most intriguing part of our study is that we demonstrate that themore » fracture energy exhibits a maximum value within the range of conversion degrees considered (from 65% to 95%), which can be attributed to the combined effects of structural rigidity and post-yield deformability. Our study provides physical insight into the molecular mechanisms that govern the fracture characteristics of epoxy resins and demonstrates the success of utilizing atomistic molecular simulations towards predicting macroscopic material properties.« less

Empirically Based Composite Fracture Prediction Model From the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW)

PubMed Central

Compston, Juliet E.; Chapurlat, Roland D.; Pfeilschifter, Johannes; Cooper, Cyrus; Hosmer, David W.; Adachi, Jonathan D.; Anderson, Frederick A.; Díez-Pérez, Adolfo; Greenspan, Susan L.; Netelenbos, J. Coen; Nieves, Jeri W.; Rossini, Maurizio; Watts, Nelson B.; Hooven, Frederick H.; LaCroix, Andrea Z.; March, Lyn; Roux, Christian; Saag, Kenneth G.; Siris, Ethel S.; Silverman, Stuart; Gehlbach, Stephen H.

2014-01-01

Context: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. Objective: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles. Design: This was a prospective, observational cohort study. Setting: The study was conducted at primary care practices in 10 countries. Patients: Women aged 55 years or older participated in the study. Intervention: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures. Main Outcome Measure: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. Results: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase. Conclusions: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model. PMID:24423345

Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW)

PubMed Central

Roux, C.; Wyman, A.; Hooven, F. H.; Gehlbach, S. H.; Adachi, J. D.; Chapurlat, R. D.; Compston, J. E.; Cooper, C.; Díez-Pérez, A.; Greenspan, S. L.; LaCroix, A. Z.; Netelenbos, J. C.; Pfeilschifter, J.; Rossini, M.; Saag, K. G.; Sambrook, P. N.; Silverman, S.; Siris, E. S.; Watts, N. B.; Boonen, S.

2016-01-01

Purpose Most fracture studies have focused on hip and vertebral fractures, but there is growing evidence that non-hip, non-vertebral (NHNV) fractures also result in substantial morbidity and healthcare costs. We sought to assess the effect of NHNV fractures on quality of life. Methods We analyzed 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the GLOW registry, a prospective, multinational, observational cohort study. Health-related quality of life (HRQL) was analyzed using EuroQol EQ-5D and the SF-36 health survey. Results Among 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The amount of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for women with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Significant reductions in SF-36 physical function were found only for spine and major NHNV fractures. Conclusion This prospective study shows that NHNV fractures have a detrimental effect on HRQL. As NHNV fractures account for >80% of incident fractures, efforts to optimize osteoporosis care should include prevention of NHNV fractures. PMID:22398855

Remodeling of a nontreated displaced parasymphyseal fracture of a child.

PubMed

Kerem, Hakan; Usluer, Ayşen; Yoleri, Levent

2011-07-01

There have been considerable advances in the management of craniomaxillofacial injuries in children. Conservative approaches such as close observation, a liquid-to-soft diet, and analgesics can be used for the management of mandibular fractures without displacement and malocclusion. However, displaced fractures need to be an anatomic reduction and immobilization. The basic principle of displaced mandibular fractures in both children and adults is the stabilization of fracture fragments forming the pretraumatic contour and occlusion state until osteosynthesis occurs. The major differences of pediatric fractures from adults are the flexibility of bones and very rapid healing pattern. Therefore, reduction in pediatric age group must be accomplished earlier. This case was an 11-year-old boy presented with a severely displaced parasymphyseal mandibular fracture resulting from a fall. He was given a soft diet and analgesic, given anti-inflammatory treatment of edema, and scheduled for operation. Subsequently, it was surprisingly observed that there was a significant improvement in the fracture line on the 12th posttraumatic day. The comparison of maxillofacial computed tomographic scans of the first and 12th posttraumatic days revealed a noteworthy remodeling and a remarkable approximation of the fracture lines. It can be concluded that bone remodelization in the pediatric age groups is perfect and very rapid, even in severely displaced fractures.

LORENZ: a system for planning long-bone fracture reduction

NASA Astrophysics Data System (ADS)

Birkfellner, Wolfgang; Burgstaller, Wolfgang; Wirth, Joachim; Baumann, Bernard; Jacob, Augustinus L.; Bieri, Kurt; Traud, Stefan; Strub, Michael; Regazzoni, Pietro; Messmer, Peter

2003-05-01

Long bone fractures belong to the most common injuries encountered in clinical routine trauma surgery. Preoperative assessment and decision making is usually based on standard 2D radiographs of the injured limb. Taking into account that a 3D - imaging modality such as computed tomography (CT) is not used for diagnosis in clinical routine, we have designed LORENZ, a fracture reduction planning tool based on such standard radiographs. Taking into account the considerable success of so-called image free navigation systems for total knee replacement in orthopaedic surgery, we assume that a similar tool for long bone fracture reposition should have considerable impact on computer-aided trauma surgery in a standard clinical routine setup. The case for long bone fracture reduction is, however, somewhat more complicated since not only scale independent angles indicating biomechanical measures such as varus and valgus are involved. Reduction path planning requires that the individual anatomy and the classification of the fracture is taken into account. In this paper, we present the basic ideas of this planning tool, it's current state, and the methodology chosen. LORENZ takes one or more conventional radiographs of the broken limb as input data. In addition, one or more x-rays of the opposite healthy bone are taken and mirrored if necessary. A most adequate CT model is being selected from a database; currently, this is achieved by using a scale space approach on the digitized x-ray images and comparing standard perspective renderings to these x-rays. After finding a CT-volume with a similar bone, a triangulated surface model is generated, and the surgeon can break the bone and arrange the fragments in 3D according to the x-ray images of the broken bone. Common osteosynthesis plates and implants can be loaded from CAD-datasets and are visualized as well. In addition, LORENZ renders virtual x-ray views of the fracture reduction process. The hybrid surface/voxel rendering engine of LORENZ also features full collision detection of fragments and implants by using the RAPID collision detection library. The reduction path is saved, and a TCP/IP interface to a robot for executing the reduction was added. LORENZ is platform independent and was programmed using Qt, AVW and OpenGL. We present a prototype for computer-aided fracture reduction planning based on standard radiographs. First test on clinical CT-Xray image pairs showed good performance; a current effort focuses on improving the speed of model retrieval by using orthonormal image moment decomposition, and on clinical evaluation for both training and surgical planning purposes. Furthermore, user-interface aspects are currently under evaluation and will be discussed.

The role of previous falls in major osteoporotic fracture prediction in conjunction with FRAX in older Chinese men and women: the Mr. OS and Ms. OS cohort study in Hong Kong.

PubMed

Su, Y; Leung, J; Kwok, T

2018-06-01

Falls are a major concern in terms of fracture risk. Although awareness rising for the absence of falls in the FRAX algorithm, our study only identified the independent predictive role of previous recurrent falls and their better conjunction use with FRAX for major osteoporotic fracture prediction in older Chinese men.

Surrogate Modeling of High-Fidelity Fracture Simulations for Real-Time Residual Strength Predictions

NASA Technical Reports Server (NTRS)

Spear, Ashley D.; Priest, Amanda R.; Veilleux, Michael G.; Ingraffea, Anthony R.; Hochhalter, Jacob D.

2011-01-01

A surrogate model methodology is described for predicting, during flight, the residual strength of aircraft structures that sustain discrete-source damage. Starting with design of experiment, an artificial neural network is developed that takes as input discrete-source damage parameters and outputs a prediction of the structural residual strength. Target residual strength values used to train the artificial neural network are derived from 3D finite element-based fracture simulations. Two ductile fracture simulations are presented to show that crack growth and residual strength are determined more accurately in discrete-source damage cases by using an elastic-plastic fracture framework rather than a linear-elastic fracture mechanics-based method. Improving accuracy of the residual strength training data does, in turn, improve accuracy of the surrogate model. When combined, the surrogate model methodology and high fidelity fracture simulation framework provide useful tools for adaptive flight technology.

A Multi-Parameter Approach for Calculating Crack Instability

NASA Technical Reports Server (NTRS)

Zanganeh, M.; Forman, R. G.

2014-01-01

An accurate fracture control analysis of spacecraft pressure systems, boosters, rocket hardware and other critical low-cycle fatigue cases where the fracture toughness highly impacts cycles to failure requires accurate knowledge of the material fracture toughness. However, applicability of the measured fracture toughness values using standard specimens and transferability of the values to crack instability analysis of the realistically complex structures is refutable. The commonly used single parameter Linear Elastic Fracture Mechanics (LEFM) approach which relies on the key assumption that the fracture toughness is a material property would result in inaccurate crack instability predictions. In the past years extensive studies have been conducted to improve the single parameter (K-controlled) LEFM by introducing parameters accounting for the geometry or in-plane constraint effects]. Despite the importance of the thickness (out-of-plane constraint) effects in fracture control problems, the literature is mainly limited to some empirical equations for scaling the fracture toughness data] and only few theoretically based developments can be found. In aerospace hardware where the structure might have only one life cycle and weight reduction is crucial, reducing the design margin of safety by decreasing the uncertainty involved in fracture toughness evaluations would result in lighter hardware. In such conditions LEFM would not suffice and an elastic-plastic analysis would be vital. Multi-parameter elastic plastic crack tip field quantifying developments combined with statistical methods] have been shown to have the potential to be used as a powerful tool for tackling such problems. However, these approaches have not been comprehensively scrutinized using experimental tests. Therefore, in this paper a multi-parameter elastic-plastic approach has been used to study the crack instability problem and the transferability issue by considering the effects of geometrical constraints as well as the thickness. The feasibility of the approach has been examined using a wide range of specimen geometries and thicknesses manufactured from 7075-T7351 aluminum alloy.

Rates of non-vertebral osteoporotic fractures in rheumatoid arthritis and postfracture osteoporosis care in a period of evolving clinical practice guidelines.

PubMed

Roussy, Jean-Pascal; Bessette, Louis; Bernatsky, Sasha; Rahme, Elham; Lachaine, Jean

2014-07-01

In 2002, guidelines for the management of osteoporosis were published by Osteoporosis Canada and widely disseminated. We aimed to assess if those guidelines had any impact on clinical practice and ultimately on fracture rates in rheumatoid arthritis (RA). This was an observational study using the Quebec healthcare databases. To quantify the use of osteoporosis drugs, hormone replacement therapy (HRT), bone mineral density (BMD) testing, and fracture rates, quarterly age-standardized rates between 1998 and 2008 were calculated. A time series approach was used to predict fracture rates from 2003 onward, based on the earlier data. The provision of postfracture osteoporosis care, as defined by the initiation of osteoporosis drugs, HRT, or BMD testing, was examined; and logistic regressions identified factors associated with care. The study population in each quarter was mainly composed of older women. The use of osteoporosis drugs and BMD testing increased over the study period. The actual fracture rates from 2003 onward fell within the projected rates and their 95 % CI indicating no reduction. A total of 1,279 subjects were included in the postfracture care analysis. Over time, the likelihood of receiving osteoporosis care increased by 64 % (OR = 1.64, 95 % CI 1.27-2.11), and the two strongest predictors of care were female gender and corticosteroid use. Over our study period, fracture rates remained stable in this RA population. However, the use of osteoporosis drugs, BMD testing, and provision of postfracture osteoporosis care improved, which may result from gradual adoption of guidelines.

Open reduction and internal fixation of mandibular fracture in an 11-month-old infant: a case report

PubMed Central

Kim, Tae-Wan; Seo, Eun-Woo

2013-01-01

Mandibular fractures in infants are rare. This case report describes management of a mandibular fracture in an 11-month-old infant using a microplate and screws with open reduction. The surgical treatment was successful. Because the bone fragments were displaced and only the primary incisors had erupted, conservative treatment, such as an acrylic splint and circummandibular wiring, was not recommended. Nine weeks after surgery, the microplate was removed. The results showed complete clinical and radiological bone healing with normal eruption of deciduous teeth. PMID:24471024

A partitioned model order reduction approach to rationalise computational expenses in nonlinear fracture mechanics

PubMed Central

Kerfriden, P.; Goury, O.; Rabczuk, T.; Bordas, S.P.A.

2013-01-01

We propose in this paper a reduced order modelling technique based on domain partitioning for parametric problems of fracture. We show that coupling domain decomposition and projection-based model order reduction permits to focus the numerical effort where it is most needed: around the zones where damage propagates. No a priori knowledge of the damage pattern is required, the extraction of the corresponding spatial regions being based solely on algebra. The efficiency of the proposed approach is demonstrated numerically with an example relevant to engineering fracture. PMID:23750055

[Case-control study on transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after distal radius fracture].

PubMed

Wang, Yan-jie; Wang, Shi-gang; Miao, Shu-juan; Su, Xia

2011-06-01

To investigate the effects of open reduction by palm side for the distal radius fracture and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after operation. From March 2000 to March 2007, 32 patients (8 males and 24 females, ranging in age from 46 to 66 years) with distal radius fracture were treated with open reduction by palm side and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection; while 30 patients (7 males and 23 females,ranging in age from 45 to 65 years) only with open reduction by palm side and T shape plate internal fixation. The incidences of delayed carpal tunnel syndrome between the two groups were compared. Among 32 patients treated with open reduction by palm side and T shape plate internal fixation with anterior transverse carpal ligament resection, 3 patients had delayed carpal tunnel syndrome; while in 30 patients treated with open reduction by palm side and T shape plate internal fixation, 10 patients had delayed carpal tunnel syndrome. There was significant statistically difference (P < 0.05%). Simultaneous anterior transverse carpal ligament resection can effectively prevent the delayed carpal tunnel syndrome occurrence for the distal radius fracture with open reduction by palm side.

Preferential pathways in complex fracture systems and their influence on large scale transport

NASA Astrophysics Data System (ADS)

Willmann, M.; Mañé, R.; Tyukhova, A.

2017-12-01

Many subsurface applications in complex fracture systems require large-scale predictions. Precise predictions are difficult because of the existence of preferential pathways at different scales. The intrinsic complexity of fracture systems increases within fractured sedimentary formations, because also the coupling of fractures and matrix has to be taken into account. This interplay of fracture system and the sedimentary matrix is strongly controlled by the actual fracture aperture of an individual fracture. And an effective aperture cannot be easily be determined because of the preferential pathways along the fracture plane. We investigate the influence of these preferential pathways on large scale solute transport and upscale the aperture. By explicitly modeling flow and particle tracking in individual fractures, we develop a new effective transport aperture, which is weighted by the aperture along the preferential paths, a Lagrangian aperture. We show that this new aperture is consistently larger than existing definitions of effective flow and transport apertures. Finally, we apply our results to a fractured sedimentary formation in Northern Switzerland.

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.

Evaluation of easily measured risk factors in the prediction of osteoporotic fractures

PubMed Central

Bensen, Robert; Adachi, Jonathan D; Papaioannou, Alexandra; Ioannidis, George; Olszynski, Wojciech P; Sebaldt, Rolf J; Murray, Timothy M; Josse, Robert G; Brown, Jacques P; Hanley, David A; Petrie, Annie; Puglia, Mark; Goldsmith, Charlie H; Bensen, W

2005-01-01

Background Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk. Methods Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (<65, 65–69, 70–74, 75–79, 80+ years), rising from a chair with arms (yes, no), weight (< 57, ≥ 57kg), maternal history of hip facture (yes, no), prior fracture after age 50 (yes, no), hip T-score (>-1, -1 to >-2.5, ≤-2.5), and current smoking status (yes, no). Multivariable logistic regression analysis was conducted. Results The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93) was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were: low body weight (1.57; 95% CI: 1.04, 2.37), current smoking (1.95; 95% CI: 1.20, 3.18) and age between 75–79 years (1.96; 95% CI: 1.10, 3.51). New wrist fractures were significantly identified by low body weight (1.71, 95% CI: 1.01, 2.90) and prior fracture after 50 years (1.96; 95% CI: 1.19, 3.22). Predictors of new rib fractures include a maternal history of a hip facture (2.89; 95% CI: 1.04, 8.08) and a prior fracture after 50 years (2.16; 95% CI: 1.20, 3.87). Conclusion This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated into routine clinical practice. PMID:16143046

Operative treatment of distal femoral fractures above total knee arthroplasty with the indirect reduction technique: a long-term follow-up study.

PubMed

Kolb, Klaus; Koller, Heiko; Lorenz, Ingo; Holz, Ulrich; Marx, Frank; Grützner, Paul; Kolb, Werner

2009-04-01

The complication rate of conventional plate osteosynthesis (CPO) of periprosthetic femoral fractures above total knee arthroplasties (TKA) is high. Indirect reduction techniques were introduced to reduce surgical dissection at the fracture site. Twenty-one patients (4 men and 17 women) with femoral fractures above well-fixed total knee arthroplasties were consecutively treated with the indirect reduction technique. AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of the Problems of Internal Fixation) Type 33A fractures were included. The mean age was 78 years (range, 67-94 years). Four fractures were stabilised with bone grafts, three in combination with bone cement. Nineteen of the patients were seen at a 1-year follow-up, 15 were seen after a long-term follow-up of 9 years (range, 7-12 years). There was only one implant failure in a comminuted fracture with severe osteoporosis, no infection, and no non-union. At the 1-year follow-up malalignment of 5 degrees varus occurred in one patient. The mean range of motion of the eighteen patients was 98 degrees (range, 65-110 degrees). The mean knee society score was 74 (range, 62-84), the mean function score was 52 (range, 39-72). At the long-term follow-up, the mean range of motion of the patients was 101 degrees (range, 65-115 degrees). The mean knee society score was 77 (range, 65-88), the mean function score was 55 (range, 40-75). Our results suggest the 95 degrees condylar blade plate in the indirect reduction technique is still a good implant with good long-term results. It works best in proximal fractures when there is minimal comminution of the distal fragment in the hands of an experienced trauma surgeon. Knee function and range of motion increased less over time.

Use of a Hybrid Operating Room to Improve Reduction of Syndesmotic Injuries in Ankle Fractures: A Case Report.

PubMed

Cancienne, Jourdan M; Crosen, Matelin P; Yarboro, Seth R

2016-01-01

Ankle fractures are one of the most common orthopedic injuries requiring operative treatment, and approximately 1 in 4 ankle fractures will have an associated distal tibiofibular syndesmosis disruption. Syndesmotic reduction is crucial to restoring ankle function and preventing the development of arthritis. The hybrid operating room provides 3-dimensional intraoperative imaging capabilities that can enable the surgeon to ensure the syndesmosis is appropriately reduced, particularly by comparing it with the contralateral ankle. By confirming the syndesmosis reduction intraoperatively, the risk of a return to the operating room for revision surgery is decreased. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Predictors of non-vertebral fracture in older Chinese males and females: Mr. OS and Ms. OS (Hong Kong).

PubMed

Kwok, Timothy Chi Yui; Su, Yi; Khoo, Chyi Chyi; Leung, Jason; Kwok, Anthony; Orwoll, Eric; Woo, Jean; Leung, Ping Chung

2017-05-01

Clinical risk factors to predict fracture are useful in guiding management of patients with osteoporosis or falls. Clinical predictors may however be population specific because of differences in lifestyle, environment and ethnicity. Four thousand community-dwelling Chinese males and females with average ages of 72.4 and 72.6 years were followed up for incident fractures, with an average of 6.5 and 8.8 years, respectively. Clinical information was collected, and bone mineral density (BMD) measurements were carried out at baseline. Stepwise Cox regression models were used to identify risk factors of nonvertebral fractures, with BMD as covariate. Areas under the receiver-operating characteristic (ROC) curve (AUC) were compared among different risk models. The incidence rates of nonvertebral fractures were 10.3 and 20.5 per 1000 person years in males and females, respectively. In males, age ≥80, history of a fall in the past year, fracture history, chronic obstructive pulmonary disease, impaired visual depth perception and low physical health-related quality of life were significant fracture risk factors, independent of BMD. In females, the significant factors were fracture history, low visual acuity and slow narrow walking speed. The clinical risk factors had a significant influence on fracture risk irrespective of osteoporosis status, even having a better risk discrimination than BMD alone, especially in males. The best risk prediction model consisted both BMD and clinical risk factors. Clinical risk factors have additive value to hip BMD in predicting nonvertebral fractures in older Chinese people and may predict them better than BMD alone in older Chinese males.

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

PubMed Central

Vasiliadis, Elias S; Grivas, Theodoros B; Psarakis, Spyridon A; Papavasileiou, Evangelos; Kaspiris, Angelos; Triantafyllopoulos, Georgios

2009-01-01

Background Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces. Materials and methods Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II). In 17 cases (6 of group I and 11 of group II) a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed. Results All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV) but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II. Conclusion Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament repair, in order to restore normal movement of talus against the mortise. Both Ilizarov and hinged external fixators are unable to restore ligamentous stability. External fixation is recommended only for fractures of the ankle joint caused by axial compression because it is biomechanically superior and has a lower complication rate. PMID:19754962

Comparison of various approaches for the treatment of fractures of the mandibular condylar process.

PubMed

Handschel, Jörg; Rüggeberg, Tim; Depprich, Rita; Schwarz, Frank; Meyer, Ulrich; Kübler, Norbert R; Naujoks, Christian

2012-12-01

Fractures of the mandibular condyle process are the most common fractures of the lower jaw. Unfortunately, the type of treatment is still a matter of debate. The aim of this investigation was to compare the outcome of different treatment approaches regarding function and surgical side-effects. 111 fractures of the mandibular condyle representing all types according to the classification of Spiessl and Schroll were included. Both closed reduction (CR) and open reduction with internal fixation (ORIF) including the retromandibular/transparotid, submandibular, preauricular and intraoral approach were performed. The clinical examination included functional and aesthetic aspects at least 1 year after the fracture. The majority of fractures (45%) were classified into Type II and IV according to Spiessl and Schroll followed by fractures without any displacement or dislocation (29.7%). The submandibular approach showed the worst outcome regarding permanent palsy of the facial nerve and hypertrophic scarring. No significant differences between the various approaches were detected in the functional status in any diagnosis group. Inferior condylar neck fractures benefit from ORIF by an intraoral approach whereas in high condylar neck fractures the retromandibular/transparotid approach shows the best results. Fractures of the condylar head were almost all treated by CR and our results cannot contribute to the debate of CR vs. ORIF in this type of fracture. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[Effect factors analysis of knee function recovery after distal femoral fracture operation].

PubMed

Bei, Chaoyong; Wang, Ruiying; Tang, Jicun; Li, Qiang

2009-09-01

To investigate the effect factors of knee function recovery after operation in distal femoral fractures. From January 2001 to May 2007, 92 cases of distal femoral fracture were treated. There were 50 males and 42 females, aged 20-77 years old (average 46.7 years old). Fracture was caused by traffic accident in 48 cases, by falling from height in 26 cases, by bruise in 12 cases and by tumble in 6 cases. According to Müller's Fracture classification, there were 29 cases of type A, 12 cases of type B and 51 cases of type C. According to American Society of Anesthesiologists (ASA) classification, there were 21 cases of grade I, 39 cases of grade II, 24 cases of grade III, and 8 cases of grade IV. The time from injury to operation was 4 hours to 24 days with an average of 7 days. Anatomical plate was used in 43 cases, retrograde interlocking intramedullary nail in 37 cases, and bone screws, bolts and internal fixation with Kirschner pins in 12 cases. After operation, the HSS knee function score was used to evaluate efficacy. Ten related factors were applied for statistical analysis, to knee function recovery after operation in distal femoral fractures, such as age, sex, preoperative ASA classification, injury to surgery time, fracture type, treatment, reduction quality, functional exercise after operation, whether or not CPM functional training and postoperative complications. Wound healed by first intention in 88 cases, infection occurred in 4 cases. All patients followed up 16-32 months with an average of 23.1 months. Clinical union of fracture was achieved within 3-7 months after operation. Extensor device adhesions and the scope of activities of <80 degrees occurred in 29 cases, traumatic arthritis in 25 cases, postoperative fracture displacement in 6 cases, mild knee varus or valgus in 7 cases and implant loosening in 6 cases. According to HSS knee function score, the results were excellent in 52 cases, good in 15 cases, fair in 10 cases and poor in 15 cases with an excellent and good rate of 72.83%. Single factor analysis showed that age, preoperative ASA classification, fracture type, reduction quality, whether or not CPM functional exercise, and postoperative complications were significantly in knee function recovery (P < 0.05). logistic regression analysis showed that the fracture type, quality of reduction, whether or not CPM functional exercise, and age were major factors in the knee joint function recovery. Age, preoperative ASA classification, fracture type, reduction quality, and whether or not CPM functional training, postoperative complications factors may affect the knee joint function recovery. Adjustment to the patient's preoperative physical status, fractures anatomic reduction and firm fixation, early postoperative active and passive functional exercises, less postoperative complications can maximize the restoration of knee joint function.

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.

Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct.

PubMed

Chiu, Chih-Hao; Cheng, Chun-Ying; Tsai, Min-Chain; Chang, Shih-Sheng; Chen, Alvin Chao-Yu; Chen, Yeung-Jen; Chan, Yi-Sheng

2013-08-01

To present the radiologic and clinical results of posteromedial fractures treated with arthroscopy-assisted reduction and buttress plate and cannulated screw fixation. Twenty-five patients with posteromedial tibial plateau fractures treated by the described technique were included in this study. According to the Schatzker classification, there were 5 type IV fractures (20%), 2 type V fractures (8%), and 18 type VI fractures (72%). The mean age at operation was 46 years (range, 21 to 79 years). The mean follow-up period was 86 months (range, 60 to 108 months). Clinical and radiologic outcomes were scored by the Rasmussen system. Subjective data were collected to assess swelling, difficulty climbing stairs, joint stability, ability to work and participate in sports, and overall patient satisfaction with recovery. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up in comparison with the films taken at the time of injury. The mean postoperative Rasmussen clinical score was 25.9 (range, 18 to 29), and the mean radiologic score was 15.8 (range, 10 to 18). All 25 fractures achieved successful union, and 92% had good or excellent clinical and radiologic results. The 3 fracture types did not significantly differ in Rasmussen scores or rates of satisfactory results (P > .05). Secondary osteoarthritis was noted in 6 injured knees (24%). Arthroscopy-assisted reduction with buttress plate and cannulated screw fixation can restore posteromedial tibial plateau fractures of the knee with well-documented radiographic healing, good clinical outcomes, and low complication rates. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Teaching the Basics: Development and Validation of a Distal Radius Reduction and Casting Model.

PubMed

Seeley, Mark A; Fabricant, Peter D; Lawrence, J Todd R

2017-09-01

Approximately one-third of reduced pediatric distal radius fractures redisplace, resulting in further treatment. Two major modifiable risk factors for loss of reduction are reduction adequacy and cast quality. Closed reduction and immobilization of distal radius fractures is an Accreditation Council for Graduate Medical Education residency milestone. Teaching and assessing competency could be improved with a life-like simulation training tool. Our goal was to develop and validate a realistic distal radius fracture reduction and casting simulator as determined by (1) a questionnaire regarding the "realism" of the model and (2) the quantitative assessments of reduction time, residual angulation, and displacement. A distal radius fracture model was created with radiopaque bony segments and articulating elbows and shoulders. Simulated periosteum and internal deforming forces required proper reduction and casting techniques to achieve and maintain reduction. The forces required were estimated through an iterative process through feedback from experienced clinicians. Embedded monofilaments allowed for quantitative assessment of residual displacement and angulation through the use of fluoroscopy. Subjects were asked to perform closed reduction and apply a long arm fiberglass cast. Primary performance variables assessed included reduction time, residual angulation, and displacement. Secondary performance variables consisted of number of fluoroscopic images, casting time, and cast index (defined as the ratio of the internal width of the forearm cast in the sagittal plane to the internal width in the coronal plane at the fracture site). Subject grading was performed by two blinded reviewers. Interrater reliability was nearly perfect across all measurements (intraclass correlation coefficient range, 0.94-0.99), thus disagreements in measurements were handled by averaging the assessed values. After completion the participants answered a Likert-based questionnaire regarding the realism of simulation. Eighteen participants consented to participate in the study (eight attending pediatric orthopaedic surgeons, six junior residents, four senior residents). The performances of junior residents (Postgraduate Year [PGY] 1-2), senior residents (PGY 3-5), and attending surgeons were compared using one-way ANOVA with Tukey's-adjusted pairwise comparisons. The majority of participants (15 of 18) felt that the model looked, felt, and moved like a human forearm. All participants strongly agreed that the model taught the basic steps of fracture reduction and should be implemented in orthopaedic training. Attending surgeons reduced fractures in less time than junior residents (60 ± 27 seconds versus 460 ± 62 seconds; mean difference, 400 seconds; 95% CI, 335-465 seconds; p < 0.001). Residual angulation was greater for junior residents when compared with attending surgeons on AP (7° ± 5° versus 0.7° ± 0.9°; mean difference, 6.3°; 95% CI, 3°-11°; p = 0.003) and lateral (27° ± 7° versus 7° ± 5°; mean difference, 20°; 95% CI, 13°-27°; p = 0.001) radiographs. Similarly, residual displacement was greater for junior residents than either senior residents (mean difference, 16 mm; 95% CI, 2-34 mm; p = 0.05) or attending surgeons (mean difference, 15 mm; 95% CI, 3-27 mm; p = 0.02) on lateral images. There were no differences identified in secondary performance variables (number of fluoroscopic images, casting time, and cast index) between groups. This is the first distal radius fracture reduction model to incorporate an elbow and shoulder and allow quantitative assessment of the fracture reduction. This simulator may be useful in an orthopaedic resident training program to help them reach a defined minimum level of competency. This simulator also could easily be integrated in other accreditation and training programs, including emergency medicine. Level II, therapeutic study.

Experimental and analytical investigation of the fracture processes of boron/aluminum laminates containing notches

NASA Technical Reports Server (NTRS)

Johnson, W. S.; Bigelow, C. A.; Bahei-El-din, Y. A.

1983-01-01

Experimental results for five laminate orientations of boron/aluminum composites containing either circular holes or crack-like slits are presented. Specimen stress-strain behavior, stress at first fiber failure, and ultimate strength were determined. Radiographs were used to monitor the fracture process. The specimens were analyzed with a three-dimensional elastic-elastic finite-element model. The first fiber failures in notched specimens with laminate orientation occurred at or very near the specimen ultimate strength. For notched unidirectional specimens, the first fiber failure occurred at approximately one-half of the specimen ultimate strength. Acoustic emission events correlated with fiber breaks in unidirectional composites, but did not for other laminates. Circular holes and crack-like slits of the same characteristic length were found to produce approximately the same strength reduction. The predicted stress-strain responses and stress at first fiber failure compared very well with test data for laminates containing 0 deg fibers.

Investigating Some Technical Issues on Cohesive Zone Modeling of Fracture

NASA Technical Reports Server (NTRS)

Wang, John T.

2011-01-01

This study investigates some technical issues related to the use of cohesive zone models (CZMs) in modeling fracture processes. These issues include: why cohesive laws of different shapes can produce similar fracture predictions; under what conditions CZM predictions have a high degree of agreement with linear elastic fracture mechanics (LEFM) analysis results; when the shape of cohesive laws becomes important in the fracture predictions; and why the opening profile along the cohesive zone length needs to be accurately predicted. Two cohesive models were used in this study to address these technical issues. They are the linear softening cohesive model and the Dugdale perfectly plastic cohesive model. Each cohesive model constitutes five cohesive laws of different maximum tractions. All cohesive laws have the same cohesive work rate (CWR) which is defined by the area under the traction-separation curve. The effects of the maximum traction on the cohesive zone length and the critical remote applied stress are investigated for both models. For a CZM to predict a fracture load similar to that obtained by an LEFM analysis, the cohesive zone length needs to be much smaller than the crack length, which reflects the small scale yielding condition requirement for LEFM analysis to be valid. For large-scale cohesive zone cases, the predicted critical remote applied stresses depend on the shape of cohesive models used and can significantly deviate from LEFM results. Furthermore, this study also reveals the importance of accurately predicting the cohesive zone profile in determining the critical remote applied load.

Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures.

PubMed

You, H-J; Moon, K-C; Yoon, E-S; Lee, B-I; Park, S-H

2016-03-01

Fractures of the mandibular condyle are one of the most common craniofacial fractures. However, the diagnosis and treatment of these fractures is controversial because of the multiple surgical approaches available. The purposes of this study were to identify surgery-related technical tips for better outcomes and to evaluate the results as well as complications encountered during 7 years of endoscope use to supplement the limited intraoral approach in the treatment of mandibular condylar fractures. Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-assisted reduction surgery. Postoperative facial bone computed tomography and panoramic radiography demonstrated adequate reduction of the condylar fractures in all patients. No condylar resorption was detected, and most patients displayed a satisfactory functional and structural recovery. There was no facial nerve damage or transitory hypoesthesia, and there were no visible scars after the surgery. Transoral endoscope-assisted treatment is a challenging but reliable method with lower morbidity and a rapid recovery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Seismic Reservoir Characterization for Assessment of CO2 EOR at the Mississippian Reservoir in South-Central Kansas

NASA Astrophysics Data System (ADS)

Tsoflias, G. P.; Graham, B.; Haga, L.; Watney, L.

2017-12-01

The Mississippian in Kansas and Oklahoma is a highly heterogeneous, fractured, oil producing reservoir with thickness typically below seismic resolution. At Wellington field in south-central Kansas CO2 was injected in the Mississippian reservoir for enhanced oil recovery. This study examines the utility of active source surface seismic for characterization of Mississippian reservoir properties and monitoring CO2. Analysis of post-stack 3D seismic data showed the expected response of a gradational transition (ramp velocity) where thicker reservoir units corresponded with lower reflection amplitudes, lower frequency and a 90o phase change. Reflection amplitude could be correlated to reservoir thickness. Pre-stack gather analysis showed that porosity zones of the Mississippian reservoir exhibit characteristic AVO response. Simultaneous AVO inversion estimated P- and S-Impedances, which along with formation porosity logs and post-stack seismic data attributes were incorporated in multi-attribute linear-regression analysis and predicted reservoir porosity with an overall correlation of 0.90 to well data. The 3D survey gather azimuthal anisotropy analysis (AVAZ) provided information on the fault and fracture network and showed good agreement to the regional stress field and well data. Mississippian reservoir porosity and fracture predictions agreed well with the observed mobility of the CO2 in monitoring wells. Fluid substitution modeling predicted acoustic impedance reduction in the Mississippian carbonate reservoir introduced by the presence of CO2. Future work includes the assessment of time-lapse seismic, acquired after the injection of CO2. This work demonstrates that advanced seismic interpretation methods can be used successfully for characterization of the Mississippian reservoir and monitoring of CO2.

Estimation of microbial metabolism and co-occurrence patterns in fracture groundwaters of deep crystalline bedrock at Olkiluoto, Finland

NASA Astrophysics Data System (ADS)

Bomberg, M.; Lamminmäki, T.; Itävaara, M.

2015-08-01

The microbial diversity in oligotrophic isolated crystalline Fennoscandian Shield bedrock fracture groundwaters is great but the core community has not been identified. Here we characterized the bacterial and archaeal communities in 12 water conductive fractures situated at depths between 296 and 798 m by high throughput amplicon sequencing using the Illumina HiSeq platform. The great sequencing depth revealed that up to 95 and 99 % of the bacterial and archaeal communities, respectively, were composed of only a few common species, i.e. the core microbiome. However, the remaining rare microbiome contained over 3 and 6 fold more bacterial and archaeal taxa. Several clusters of co-occurring rare taxa were identified, which correlated significantly with physicochemical parameters, such as salinity, concentration of inorganic or organic carbon, sulphur, pH and depth. The metabolic properties of the microbial communities were predicted using PICRUSt. The rough prediction showed that the metabolic pathways included commonly fermentation, fatty acid oxidation, glycolysis/gluconeogenesis, oxidative phosphorylation and methanogenesis/anaerobic methane oxidation, but carbon fixation through the Calvin cycle, reductive TCA cycle and the Wood-Ljungdahl pathway was also predicted. The rare microbiome is an unlimited source of genomic functionality in all ecosystems. It may consist of remnants of microbial communities prevailing in earlier conditions on Earth, but could also be induced again if changes in their living conditions occur. In this study only the rare taxa correlated with any physicochemical parameters. Thus these microorganisms can respond to environmental change caused by physical or biological factors that may lead to alterations in the diversity and function of the microbial communities in crystalline bedrock environments.

Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study.

PubMed

Yu, Ruby; Leung, Jason; Woo, Jean

2014-08-01

We examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis. A cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26-2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P < .05) using the NRI approach. In addition, the combination of osteoporosis and sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76-6.90) compared with those with normal BMD and without sarcopenia. This study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the integration of BMD and other clinical risk factors, and suggests that the combination of osteoporosis and sarcopenia could identify a subgroup with a particularly high fracture risk. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Effect of tritium and decay helium on the fracture toughness properties of stainless steel weldments

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

Morgan, M. J.; West, S.; Tosten, M. H.

2008-07-15

J-Integral fracture toughness tests were conducted on tritium-exposed-and- aged Types 304L and 21-6-9 stainless steel weldments in order to measure the combined effects of tritium and its decay product, helium-3 on the fracture toughness properties. Initially, weldments have fracture toughness values about three times higher than base-metal values. Delta-ferrite phase in the weld microstructure improved toughness provided no tritium was present in the microstructure. After a tritium-exposure-and-aging treatment that resulted in {approx}1400 atomic parts per million (appm) dissolved tritium, both weldments and base metals had their fracture toughness values reduced to about the same level. The tritium effect was greatermore » in weldments (67 % reduction vs. 37% reduction) largely because the ductile discontinuous delta-ferrite phase was embrittled by tritium and decay helium. For both base metals and weldments, fracture toughness values decreased with increasing decay helium content in the range tested (50-800 appm). (authors)« less

TRITIUM AND DECAY HELIUM EFFECTS ON THE FRACTURE TOUGHNESS PROPERTIES OF STAINLESS STEEL WELDMENTS

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

Morgan, M; Scott West, S; Michael Tosten, M

2007-08-31

J-Integral fracture toughness tests were conducted on tritium-exposed-and-aged Types 304L and 21-6-9 stainless steel weldments in order to measure the combined effects of tritium and its decay product, helium-3 on the fracture toughness properties. Initially, weldments have fracture toughness values about three times higher than base-metal values. Delta-ferrite phase in the weld microstructure improved toughness provided no tritium was present in the microstructure. After a tritium-exposure-and-aging treatment that resulted in {approx}1400 atomic parts per million (appm) dissolved tritium, both weldments and base metals had their fracture toughness values reduced to about the same level. The tritium effect was greater inmore » weldments (67 % reduction vs. 37% reduction) largely because the ductile discontinuous delta-ferrite interfaces were embrittled by tritium and decay helium. Fracture toughness values decreased for both base metals and weldments with increasing decay helium content in the range tested (50-200 appm).« less

High fracture probability predicts fractures in a 4-year follow-up in women from the RAC-OST-POL study.

PubMed

Pluskiewicz, W; Adamczyk, P; Czekajło, A; Grzeszczak, W; Drozdzowska, B

2015-12-01

In 770 postmenopausal women, the fracture incidence during a 4-year follow-up was analyzed in relation to the fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator) predicted at baseline. Incident fractures occurred in 62 subjects with a higher prevalence in high-risk subgroups. Prior fracture, rheumatoid arthritis, femoral neck T-score and falls increased independent of fracture incidence. The aim of the study was to analyze the incidence of fractures during a 4-year follow-up in relation to the baseline fracture probability and risk. Enrolled in the study were 770 postmenopausal women with a mean age of 65.7 ± 7.3 years. Bone mineral density (BMD) at the proximal femur, clinical data, and fracture probability using the FRAX tool and risk using the Garvan calculator were determined. Each subject was asked yearly by phone call about the incidence of fracture during the follow-up period. Of the 770 women, 62 had a fracture during follow-up, and 46 had a major fracture. At baseline, BMD was significantly lower, and fracture probability and fracture risk were significantly higher in women who had a fracture. Among women with a major fracture, the percentage with a high baseline fracture probability (>10 %) was significantly higher than among those without a fracture (p < 0.01). Fracture incidence during follow-up was significantly higher among women with a high baseline fracture probability (12.7 % vs. 5.2 %) and a high fracture risk (9.2 vs. 5.3 %) so that the "fracture-free survival" curves were significantly different (p < 0.05). The number of clinical risk factors noted at baseline was significantly associated with fracture incidence (chi-squared = 20.82, p < 0.01). Prior fracture, rheumatoid arthritis, and femoral neck T-score were identified as significant risk factors for major fractures (for any fractures, the influence of falls was also significant). During follow-up, fracture incidence was predicted by baseline fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator). A number of clinical risk factors and a prior fracture, rheumatoid arthritis, femoral neck T-score, and falls were independently associated with an increased incidence of fractures. [Corrected

Early predictive value of supine and upright X-ray films of odontoid fractures treated with halo-vest immobilization.

PubMed

Kim, David H; Vaccaro, Alexander R; Affonso, Jesse; Jenis, Louis; Hilibrand, Alan S; Albert, Todd J

2008-01-01

Although halo-vest immobilization remains a common form of treatment for type II odontoid fractures, nonunion and C1-2 instability may be the result in up to 20% to 40% of patients. Supine and upright lateral X-ray films may allow early identification of patients likely to fail halo-vest treatment and earlier surgical treatment with decreased morbidity from prolonged unsuccessful halo-vest immobilization. A prospective cohort study was performed. Twenty patients with type II odontoid fractures. Posttreatment nonunion and C1-2 instability as determined by plain X-ray films and computed tomography scan. Both supine and upright lateral X-ray films were obtained immediately after halo-vest application and at the 2-week, 6-week, and 3-month follow-up. Flexion-extension lateral X-ray films were obtained after halo-vest removal. Patients with nonunion or instability underwent computed tomography scan. Upright X-ray films were compared serially to identify loss of reduction. Pairs of supine and upright X-ray films were compared to measure any change in displacement or angulation upon transition from supine to upright position. Nonunion patients were compared with healed patients to determine any difference in fracture behavior based on serial supine and upright X-ray films. Twenty patients with type II odontoid fractures were identified during the study period. Three patients with multiple trauma underwent immediate surgical stabilization. Three elderly patients with nondisplaced fractures were treated in a cervical orthosis. Fourteen patients initiated and completed 3 months of halo-vest immobilization. After halo-vest removal, 4 of 14 patients (29%) showed radiographic nonunion or instability. In all 4 nonunion patients, supine and upright radiographs at 2 weeks revealed change in fracture angulation > or =5 degrees between the supine and upright positions. In three of these patients standard serial upright lateral X-ray films failed to identify any loss of reduction. In the remaining patient, progressive angulation of 15 degrees was observed. No measurable change in angulation between supine and upright X-ray films was observed in any patient who healed successfully with halo-vest treatment. Obtaining both supine and upright lateral X-ray films during the follow-up period may identify patients at risk for failure of halo-vest treatment as early as 2 weeks after initiation of treatment. A change in fracture angulation > or =5 degrees suggests an increased risk of treatment failure and the potential benefit of early surgical stabilization.

High Incidence of Vertebral Fractures in Children with Acute Lymphoblastic Leukemia 12 Months After the Initiation of Therapy

PubMed Central

Alos, Nathalie; Grant, Ronald; Ramsay, Timothy; Halton, Jacqueline; Cummings, Elizabeth A.; Miettunen, Paivi M.; Abish, Sharon; Atkinson, Stephanie; Barr, Ronald; Cabral, David A.; Cairney, Elizabeth; Couch, Robert; Dix, David B.; Fernandez, Conrad V.; Hay, John; Israels, Sara; Laverdière, Caroline; Lentle, Brian; Lewis, Victor; Matzinger, MaryAnn; Rodd, Celia; Shenouda, Nazih; Stein, Robert; Stephure, David; Taback, Shayne; Wilson, Beverly; Williams, Kathryn; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M.

2014-01-01

Purpose Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported. Patient and Methods We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semi-quantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures. Results Of the 155 children, 25 (16%, 95% Confidence Interval (CI) 11% to 23%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. Thirteen of the 25 children with incident vertebral fractures (52%) also had fractures at baseline. Vertebral fractures at baseline increased the odds of an incident fracture at 12 months by an odds ratio of 7.3 (95% CI 2.3 to 23.1, p = 0.001). In addition, for every one standard deviation reduction in spine BMD Z-score at baseline, there was 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI 1.2 to 2.7, p = 0.006). Conclusion Children with ALL have a high incidence of vertebral fractures after 12 months of chemotherapy, and the presence of vertebral fractures and reductions in spine BMD Z-scores at baseline are highly associated clinical features. PMID:22734031

Influence of Subjectivity in Geological Mapping on the Net Penetration Rate Prediction for a Hard Rock TBM

NASA Astrophysics Data System (ADS)

Seo, Yongbeom; Macias, Francisco Javier; Jakobsen, Pål Drevland; Bruland, Amund

2018-05-01

The net penetration rate of hard rock tunnel boring machines (TBM) is influenced by rock mass degree of fracturing. This influence is taken into account in the NTNU prediction model by the rock mass fracturing factor ( k s). k s is evaluated by geological mapping, the measurement of the orientation of fractures and the spacing of fractures and fracture type. Geological mapping is a subjective procedure. Mapping results can therefore contain considerable uncertainty. The mapping data of a tunnel mapped by three researchers were compared, and the influence of the variation in geological mapping was estimated to assess the influence of subjectivity in geological mapping. This study compares predicted net penetration rates and actual net penetration rates for TBM tunneling (from field data) and suggests mapping methods that can reduce the error related to subjectivity. The main findings of this paper are as follows: (1) variation of mapping data between individuals; (2) effect of observed variation on uncertainty in predicted net penetration rates; (3) influence of mapping methods on the difference between predicted and actual net penetration rate.

[Effective analysis of percutaneous reduction and Kirschner pin fixation for the treatment of intraarticular fractures of the calcaneus in children].

PubMed

Huang, Zhong-sheng; Zhao, Zhen; Ji, Ying-yao; Li, Ke-lun; Zheng, Ju-han; Ni, Jian-guang; Xu, Can-zhen; Zheng, Li-cheng

2011-10-01

To introduce and evaluate the clinical effects of percutaneous reduction and Kirschner pin fixation for the treatment of intraarticular fractures of the calcaneus in children. From March 2001 to February 2009,12 patients with intraarticular calcaneal fractures were treated by percutaneous reduction and Kirschner pin fixation (13 feet). There were 8 males and 4 females,ranging in age from 3 to 14,with an average of 8.7 years. According to Essex-Lopresti classification, among 5 feet were tongue fractures and 8 feet were compressed fractures. According to Sanders classification, 9 feet were type II and 4 feet were type III. The Biihler angle and Gissane angle of the calcaneus were obtained before and after operation. All patients were evaluated according to Maryland Foot Score. All the patients were followed up for 16-71 months (means 35.9 months),and all the incisions were healed without complications and infection. The preoperative X-ray film showed that Böhler angle was (19.7+/-5.3) degrees, Gissane angle was (137.3+/-7.5) degrees. The postoperative X-ray film demonstrated that Böhler angle was (32.6+/-3.7) degrees, Gissane angle was (125.4+/-2.9) degrees. There was a significant difference between preoperative and postoperative (P<0.01). The average Maryland score was 96.3+/-2.4 (range, 92 to 100 points). Percutaneous reduction and Kirschner pin fixation is an effective minimally invasive way to treat intraarticular fractures of the calcaneus in children, it has many advantages such as minimal invasion, reliable fixation and satisfactory effects.

Elevated temperature fracture of RS/PM alloy 8009; Part 1: Fracture mechanics behavior

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

Porr, W.C. Jr.; Gangloff, R.P.

1994-02-01

Increasing temperature and decreasing loading rate degrade the planes strain initiation (K[sub ICi] from the J integral) and growth (tearing modulus, T[sub R]) fracture toughnesses of RS/PM 8009 (Al-8.5Fe-1.3V-1.7Si, wt pct). K[sub ICi] decreases with increasing temperature from 25[degree]C to 175[degree]C (33 to 15 MPa[radical]m at 316[degree]C) without a minimum. T[sub R] is greater than zero at all temperatures and is minimized at 200[degree]C. A four order-of-magnitude decrease in loading rate, at 175[degree]C, results in a 2.5-fold decrease in K[sub ICi] and a 5-fold reduction in T[sub R]. K[sub ICi] and T[sub R] are anisotropic for extruded 8009 but aremore » isotropic for cross-rolled plate. Cross rolling does not improve the magnitude or adverse temperature dependence of toughness. Delamination occurs along oxide-decorated particle boundaries for extruded but not cross-rolled 8009. Delamination toughening plays no role in the temperature dependence of K[sub ICi], however, T[sub R] is increased by this mechanism. Macroscopic work softening and flow localization do not occur for notch-root deformation; such uniaxial tensile phenomena may not be directly relevant to crack-tip fracture. Micromechanical modeling, employing temperature-dependent flow strength, modulus, and constrained fracture strain, reasonably predicts the temperature dependencies of K[sub ICi] and T[sub R] for 8009.« less

A theoretical and experimental technique to measure fracture properties in viscoelastic solids

NASA Astrophysics Data System (ADS)

Freitas, Felipe Araujo Colares De

Prediction of crack growth in engineering structures is necessary for better analysis and design. However, this prediction becomes quite complex for certain materials in which the fracture behavior is both rate and path dependent. Asphaltic materials used in pavements have that intrinsic complexity in their behavior. A lot of research effort has been devoted to better understanding viscoelastic behavior and fracture in such materials. This dissertation presents a further refinement of an experimental test setup, which is significantly different from standard testing protocols, to measure viscoelastic and fracture properties of nonlinear viscoelastic solids, such as asphaltic materials. The results presented herein are primarily for experiments with asphalt, but the test procedure can be used for other viscoelastic materials as well. Even though the test is designed as a fracture test, experiments on the investigated materials have uncovered very complex phenomena prior to fracture. Viscoelasticity and micromechanics are used to explain some of the physical phenomena observed in the tests. The material behavior prior to fracture includes both viscoelastic behavior and a necking effect, which is further discussed in the appendix of the present study. The dissertation outlines a theoretical model for the prediction of tractions ahead of the crack tip. The major contribution herein lies in the development of the experimental procedure for evaluating the material parameters necessary for deploying the model in the prediction of ductile crack growth. Finally, predictions of crack growth in a double cantilever beam specimens and asphalt concrete samples are presented in order to demonstrate the power of this approach for predicting crack growth in viscoelastic media.

To evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures: A prospective study

PubMed Central

Bali, Rishi K.; Sharma, Parveen; Jindal, Shalu; Gaba, Shivani

2013-01-01

Aims: The present study was undertaken to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures and to study the morbidity associated with the use of biodegradable plates and screws. Materials and Methods: This prospective study consisted of 10 patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection, comminuted and pathological fractures were excluded. All were plated with biodegradable system (Inion CPS) using standard plating principles and observed for a total period of 24 weeks. Characteristics of the fractures, ease of use of bioresorbable plate/screw system and post operative complications were assessed. Results: Of total 10 patients, eight patients were of midface fracture and two pediatric patients with mandibular fracture, with nine male and one female. The mean age was 32.8 years. Out of 20 plates and 68 screws applied to the 10 fractures sites; there were three incidences of screw breakage with no other intraoperative difficulties. Paresthesia of the infraorbital nerve was present in two patients, and recovered completely in four weeks after surgery. Fracture reduction was considered to be satisfactory in all cases. One patient developed postsurgical infection and was managed with oral antibiotics and analgesics. Conclusions: Favorable healing can be observed through the use of biodegradable plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood, however further studies with more sample size are required. PMID:24665170

To evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures: A prospective study.

PubMed

Bali, Rishi K; Sharma, Parveen; Jindal, Shalu; Gaba, Shivani

2013-07-01

The present study was undertaken to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures and to study the morbidity associated with the use of biodegradable plates and screws. This prospective study consisted of 10 patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection, comminuted and pathological fractures were excluded. All were plated with biodegradable system (Inion CPS) using standard plating principles and observed for a total period of 24 weeks. Characteristics of the fractures, ease of use of bioresorbable plate/screw system and post operative complications were assessed. Of total 10 patients, eight patients were of midface fracture and two pediatric patients with mandibular fracture, with nine male and one female. The mean age was 32.8 years. Out of 20 plates and 68 screws applied to the 10 fractures sites; there were three incidences of screw breakage with no other intraoperative difficulties. Paresthesia of the infraorbital nerve was present in two patients, and recovered completely in four weeks after surgery. Fracture reduction was considered to be satisfactory in all cases. One patient developed postsurgical infection and was managed with oral antibiotics and analgesics. Favorable healing can be observed through the use of biodegradable plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood, however further studies with more sample size are required.

Adhesion and interfacial fracture toughness between hard and soft materials

NASA Astrophysics Data System (ADS)

Rahbar, Nima; Wolf, Kurt; Orana, Argjenta; Fennimore, Roy; Zong, Zong; Meng, Juan; Papandreou, George; Maryanoff, Cynthia; Soboyejo, Wole

2008-11-01

This paper presents the results of a combined experimental and theoretical study of adhesion between hard and soft layers that are relevant to medical devices such as drug-eluting stents and semiconductor applications. Brazil disk specimens were used to measure the interfacial fracture energies between model parylene C and 316L stainless steel over a wide range of mode mixities. The trends in the overall fracture energies are predicted using a combination of adhesion theories and fracture mechanics concepts. The measured interfacial fracture energies are shown to be in good agreement with the predictions.

Intraoperative fluoroscopic evaluation of screw placement during pelvic and acetabular surgery.

PubMed

Yi, Chengla; Burns, Sean; Hak, David J

2014-01-01

The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and are gaining popularity in the management of pelvic and acetabular fractures. These techniques require knowledge and interpretation of various fluoroscopic images to ensure appropriate and safe screw placement. Given the anatomic complexity of the intrapelvic structures and the 2-dimensional nature of standard fluoroscopy, multiple images oriented in different planes are needed to assess the accuracy of guide wire and screw placement. This article reviews the fluoroscopic imaging of common screw orientations during pelvic and acetabular surgery.

[Dynamic magnetotherapy use in comprehensive treatment phlegmons of maxillofacial region and mandible fractures].

PubMed

Lepilin, A V; Raĭgorodckiĭ, Iu M; Nozdrachev, V G; Erokina, N L

2007-01-01

145 patients (60 with phlegmons of submandibular and submental regions, 85--with fractures of mandible) were observed and treated with the use of moving pulse magnetic field (MPMF) produced by special apparatus (AMO-ATOS-E, , Saratov-city), 60 patients with the same pathology were treated by traditional physical methods and served as control. Use of MPMF led to quicker patient recovery: quicker reduction (if compared with traditional physical methods of treatment) of oedema and soft tissue inflammatory infiltration, quicker relief from inflammatory reaction (according to data of cytokinin profile), improvement of tissue blood supply in the region of fractures in patients with mandible fractures. As the result--we had shortening treatment terms of such patients and complication number reduction.

Multi-scale modeling of microstructure dependent intergranular brittle fracture using a quantitative phase-field based method

DOE PAGES

Chakraborty, Pritam; Zhang, Yongfeng; Tonks, Michael R.

2015-12-07

In this study, the fracture behavior of brittle materials is strongly influenced by their underlying microstructure that needs explicit consideration for accurate prediction of fracture properties and the associated scatter. In this work, a hierarchical multi-scale approach is pursued to model microstructure sensitive brittle fracture. A quantitative phase-field based fracture model is utilized to capture the complex crack growth behavior in the microstructure and the related parameters are calibrated from lower length scale atomistic simulations instead of engineering scale experimental data. The workability of this approach is demonstrated by performing porosity dependent intergranular fracture simulations in UO 2 and comparingmore » the predictions with experiments.« less

Multi-scale modeling of microstructure dependent intergranular brittle fracture using a quantitative phase-field based method

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

Chakraborty, Pritam; Zhang, Yongfeng; Tonks, Michael R.

In this study, the fracture behavior of brittle materials is strongly influenced by their underlying microstructure that needs explicit consideration for accurate prediction of fracture properties and the associated scatter. In this work, a hierarchical multi-scale approach is pursued to model microstructure sensitive brittle fracture. A quantitative phase-field based fracture model is utilized to capture the complex crack growth behavior in the microstructure and the related parameters are calibrated from lower length scale atomistic simulations instead of engineering scale experimental data. The workability of this approach is demonstrated by performing porosity dependent intergranular fracture simulations in UO 2 and comparingmore » the predictions with experiments.« less

Fracture of mandibular condyle—to open or not to open: an attempt to settle the controversy.

PubMed

Rastogi, Sanjay; Sharma, Siddharth; Kumar, Sanjeev; Reddy, Mahendra P; Niranjanaprasad Indra, B

2015-06-01

To compare the outcome of the open method versus the closed method of treatment for mandibular condylar fracture. Fifty patients with fractures of the mandibular condylar processes were evaluated. All fractures were displaced, with a degree of deviation between the condylar fragment and the ascending ramus of 10 to 45 degrees (mediolaterally). The patients were randomly divided into two groups, with group 1 receiving open reduction internal fixation and group 2 receiving closed reduction. The follow-up was done over the period of 6 months. Statistically significant improvement was seen in group 1 compared with group 2 in terms of anatomic reduction of the condyle, shortening of the ascending ramus, occlusal status, and deviation on mouth opening. A statistically significant difference was seen in the patients treated with the open method, with improved temporomandibular joint functions and fewer short- and long-term complications compared with those treated with the closed method. Copyright © 2015 Elsevier Inc. All rights reserved.

Heterotopic ossification of the elbow after closed reduction and retrograde intramedullary nailing for radial neck fracture treated by anconeus interposition.

PubMed

Sreenivas, T; Menon, Jagdish; Nataraj, A R

2013-12-01

Heterotopic ossification around the elbow can lead to considerable functional disability. We describe a case of a 42-year-old man who developed heterotopic ossification of his elbow after closed reduction of the elbow dislocation and radial neck fracture and retrograde intramedullary nailing for radial neck fracture. During the follow-up after initial surgery, movements of the elbow were gradually deteriorated and diagnosed as heterotopic ossification of the elbow. Implant removal, radial head excision along with heterotopic mass, and also interposition of the anconeus muscle resulted in improvement of his elbow mobility. At 18 months of follow-up, patient had elbow flexion arc of 15°-110°, 70° of supination, and 50° of pronation without recurrence of heterotopic ossification. The uniqueness of this case lies in the treatment of heterotopic ossification of the elbow to prevent its recurrence, which was developed after retrograde intramedullary nailing for radial neck fracture following closed reduction.

A further study on seismic response of a set of parallel rock fractures filled with viscoelastic materials

NASA Astrophysics Data System (ADS)

Wu, W.; Zhu, J. B.; Zhao, J.

2013-02-01

The purpose of this study is to further investigate the seismic response of a set of parallel rock fractures filled with viscoelastic materials, following the work by Zhu et al. Dry quartz sands are used to represent the viscoelastic materials. The split Hopkinson rock bar (SHRB) technique is modified to simulate 1-D P-wave propagation across the sand-filled parallel fractures. At first, the displacement and stress discontinuity model (DSDM) describes the seismic response of a sand-filled single fracture. The modified recursive method (MRM) then predicts the seismic response of the sand-filled parallel fractures. The SHRB tests verify the theoretical predictions by DSDM for the sand-filled single fracture and by MRM for the sand-filled parallel fractures. The filling sands cause stress discontinuity across the fractures and promote displacement discontinuity. The wave transmission coefficient for the sand-filled parallel fractures depends on wave superposition between the fractures, which is similar to the effect of fracture spacing on the wave transmission coefficient for the non-filled parallel fractures.

Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly.

PubMed

Gary, Joshua L; Lefaivre, Kelly A; Gerold, Frank; Hay, Michael T; Reinert, Charles M; Starr, Adam J

2011-10-01

Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994 and 2007 were selected. 79 consecutive patients with 80 fractures were identified. Rate of conversion to total hip arthroplasty were used to construct a Kaplan-Meier curve showing survivorship of the native hip joint after treatment. 75 fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5-11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no conversions to arthroplasty beyond 4.7 years postoperatively. There were no statistically significant associations between conversion to arthroplasty and age, sex, closed vs. limited open reduction, and simple vs. complex fracture pattern. Percutaneous fixation is a viable treatment option for patients age 60 or greater with acetabular fractures. Rates of conversion to total hip arthroplasty are comparable to open treatment methods and if conversion is required, soft tissues are preserved for future surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

Low-dose CT of postoperative pelvic fractures: a comparison with radiography.

PubMed

Eriksson, Thomas; Berg, Per; Olerud, Claes; Shalabi, Adel; Hänni, Mari

2018-01-01

Background Computed tomography (CT) is superior to conventional radiography (CR) for assessing internal fixation of pelvic fractures, but with a higher radiation exposure. Low-dose CT (LDCT) could possibly have a sufficient diagnostic accuracy but with a lower radiation dose. Purpose To compare postoperative diagnostic accuracy of LDCT and CR after open reduction and internal fixation of pelvic fracture. Material and Methods Twenty-one patients were examined with LDCT and CR 0-9 days after surgery. The examinations were reviewed by two musculoskeletal radiologists. Hardware, degree of fracture reduction, image quality, and reviewing time were assessed, and effective radiation dose was calculated. Inter-reader agreement was calculated. Results LDCT was significantly better than CR in determining whether hardware positioning was assessable ( P < 0.001). Acetabular congruence was assessable in all fractured patients with LDCT. In 12 of the 32 assessments with CR of patients with an acetabular fracture, joint congruence was not assessable due to overlapping hardware ( P = 0.001). Image quality was significantly higher for LDCT. Median time to review was 240 s for LDCT compared to 180 s for CR. Effective dose was 0.79 mSv for LDCT compared to 0.32 mSv for CR ( P < 0.001). Conclusion LDCT is more reliable than CR in assessing hardware position and fracture reduction. Joint congruency is sometimes not possible to assess with CR, due to overlapping hardware. The image quality is higher, but also the effective dose, with LDCT than with CR.

Use of resorbable plates and screws in pediatric facial fractures.

PubMed

Eppley, Barry L

2005-03-01

The use of resorbable plates and screws for fixation of pediatric facial fractures is both well tolerated and effective. It enables realignment and stable positioning of rapidly healing fracture segments while obviating any future issues secondary to long-term metal retention. Forty-four pediatric facial fractures were treated over a 10-year period at our institution using differing techniques of polymeric bone fixation. Twenty-nine mandible fractures in patients under the age of 10 (age range, 6 months to 8 years) were treated. Displaced fractures of the symphysis, parasymphysis, body, and ramus underwent open reduction and either 1.5-mm or 2.0-mm plate and screw fixation in 14 patients. Subcondylar fractures were treated by a short period of maxillomandibular fixation (3 weeks) achieved with suture ligation between resorbable screws placed at the zygoma and symphysis or a circummandibular suture attached to a zygomatic screw. Fifteen patients (age range, 4 to 11 years) with isolated frontal, supraorbital, intraorbital, or orbitozygomatic fractures were treated by open reduction and internal fixation with 1.5-mm resorbable plates, mesh, and screws. No long-term implant-related complications were seen in any of the treated patients. Resorbable polylactic and polyglycolic acid plates and screws can be an effective fixation method for facial fractures in children in the primary and secondary dentition periods.

Maxillofacial fractures among Sudanese children at Khartoum Dental Teaching Hospital.

PubMed

Almahdi, Hatim M; Higzi, Mohammed A

2016-02-23

Maxillofacial fractures in children are less frequent compared to adults but result in special complications affecting the growth, function and esthetics. The study aimed at assessing the characteristics and the pattern of facial fractures among children seen at Khartoum Teaching Dental Hospital (KTDH). The study included 390 patients presenting with maxillofacial trauma at KTDH during a year period (2010-2011). A total of 390 patients, diagnosed with facial fractures, were seen at KTDH; 14.1% (55) were children below 16 years of age with the mean age of 10 years (SD ± 3.9). The ratio of males to females was 2.2:1. Most fractures were due to road traffic accidents (RTA) 56.4%, followed by daily living activities 21.8% and assault 16.4%. The most prevalent anatomic sites of fractures were mandible 77%; combination fractures i.e. more than one site 32.7% and zygomatic-complex (13.5%). Concomitant injuries were found in 9.1%. Almost half of the patients were managed conservatively 49.1%, closed reduction 34.5% and surgical open reduction 16.4%. The findings of this study indicated that pediatric facial fractures constitute 14.1% of the total number of facial fractures. RTA was the main cause, which should be considered in legislative and preventive strategies.

Prediction of Fracture Behavior in Rock and Rock-like Materials Using Discrete Element Models

NASA Astrophysics Data System (ADS)

Katsaga, T.; Young, P.

2009-05-01

The study of fracture initiation and propagation in heterogeneous materials such as rock and rock-like materials are of principal interest in the field of rock mechanics and rock engineering. It is crucial to study and investigate failure prediction and safety measures in civil and mining structures. Our work offers a practical approach to predict fracture behaviour using discrete element models. In this approach, the microstructures of materials are presented through the combination of clusters of bonded particles with different inter-cluster particle and bond properties, and intra-cluster bond properties. The geometry of clusters is transferred from information available from thin sections, computed tomography (CT) images and other visual presentation of the modeled material using customized AutoCAD built-in dialog- based Visual Basic Application. Exact microstructures of the tested sample, including fractures, faults, inclusions and void spaces can be duplicated in the discrete element models. Although the microstructural fabrics of rocks and rock-like structures may have different scale, fracture formation and propagation through these materials are alike and will follow similar mechanics. Synthetic material provides an excellent condition for validating the modelling approaches, as fracture behaviours are known with the well-defined composite's properties. Calibration of the macro-properties of matrix material and inclusions (aggregates), were followed with the overall mechanical material responses calibration by adjusting the interfacial properties. The discrete element model predicted similar fracture propagation features and path as that of the real sample material. The path of the fractures and matrix-inclusion interaction was compared using computed tomography images. Initiation and fracture formation in the model and real material were compared using Acoustic Emission data. Analysing the temporal and spatial evolution of AE events, collected during the sample testing, in relation to the CT images allows the precise reconstruction of the failure sequence. Our proposed modelling approach illustrates realistic fracture formation and growth predictions at different loading conditions.

Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?

PubMed

Labronici, Pedro José; Ferreira, Leonardo Termis; Dos Santos Filho, Fernando Claudino; Pires, Robinson Esteves Santos; Gomes, Davi Coutinho Fonseca Fernandes; da Silva, Luiz Henrique Penteado; Gameiro, Vinicius Schott

2017-02-01

Several so-called casting indices are available for objective evaluation of plaster cast quality. The present study sought to investigate four of these indices (gap index, padding index, Canterbury index, and three-point index) as compared to a reference standard (cast index) for evaluation of plaster cast quality after closed reduction of pediatric displaced distal forearm fractures. Forty-three radiographs from patients with displaced distal forearm fractures requiring manipulation were reviewed. Accuracy, sensitivity, specificity, false-positive probability, false-negative probability, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for each of the tested indices. Comparison among indices revealed diagnostic agreement in only 4.7% of cases. The strongest correlation with the cast index was found for the gap index, with a Spearman correlation coefficient of 0.94. The gap index also displayed the best agreement with the cast index, with both indices yielding the same result in 79.1% of assessments. When seeking to assess plaster cast quality, the cast index and gap index should be calculated; if both indices agree, a decision on quality can be made. If the cast and gap indices disagree, the padding index can be calculated as a tiebreaker, and the decision based on the most frequent of the three results. Calculation of the three-point index and Canterbury index appears unnecessary. Copyright © 2016 Elsevier Ltd. All rights reserved.

Validation of the Ottawa Knee Rule in Iran: a prospective study.

PubMed

Jalili, Mohammad; Gharebaghi, Hadi

2010-11-01

This study was designed to determine the accuracy of the Ottawa Knee Rule (OKR) when applied to patients with acute knee injury in the Iranian population of the Imam Hospital Emergency Department (ED) at. This prospective cohort validation study included a convenience sample of all patients with a blunt knee injury sustained in the preceding 7 days presenting to the ED of a tertiary care teaching hospital during the study period. Patients were assessed for the five variables comprising the OKR, and a standardised data form was completed for each patient. Standard knee radiographs were ordered on all patients irrespective of the determination of the rule. The rules were interpreted by the primary investigator on the basis of the data sheet and the final orthopaedist radiograph reading. Outcome measures of this study were: sensitivity, specificity, positive predictive value and negative predictive value of the OKR. A total of 283 patients were enrolled in the study. 22 fractures (7.77%) were detected. The decision rule had a sensitivity of 0.95 (95% CI 0.77 to 0.99), and a specificity of 0.44 (95% CI 0.37 to 0.50). The potential reduction in use of radiography was estimated to be 41%. The OKR missed only one fracture. Prospective validation has shown that the OKR is a highly sensitive tool for detecting knee fractures and has the potential to reduce the number of radiographs in patients with acute knee injuries.

Modified preauricular approach and rigid internal fixation for intracapsular condyle fracture of the mandible.

PubMed

He, Dongmei; Yang, Chi; Chen, Minjie; Bin, Jiang; Zhang, Xiaohu; Qiu, Yating

2010-07-01

This article reports a modified preauricular approach for intracapsular condyle fracture (ICF) of the mandible and evaluates the stability of various internal fixation methods in the temporomandibular joint (TMJ) division of the Shanghai Ninth People's Hospital. One hundred fifty-one patients with 208 ICFs diagnosed by panoramic radiograph and computed tomographic (CT) scan received open treatment in the TMJ division from 1999 to 2008. Their charts were reviewed. Classification of the fracture was based on coronal CT scan. Forty-three patients also underwent magnetic resonance imaging before the operation to check displacement of the disc. A modified preauricular approach was used for all patients. Various internal fixation methods from wire, to screw, to plate were evaluated for stability. There were 110 ICFs of type A fracture, 60 of type B fracture, 9 of type C fracture, 25 of type M fracture, and 4 fractures without displacement. A modified preauricular approach was used for open treatment, which can better expose and protect the TMJ and superficial temporal vessels. Wire and plate is the commonly used stable fixation method for type A, B, and M fractures, which accounted for 56.7% (101/178). Small fracture fragments were removed with disc repositioning for all type C fractures (n = 9) and some type B (n = 9) and M fractures (n = 5). Three type M fracture and 3 nondisplaced ICFs were treated closed. Eighty-nine patients with 115 ICFs had postoperative CT scan, which showed anatomic and nearly anatomic fracture reduction rates of 95.6%. Thirty-five patients with 44 ICFs had long-term follow-ups from 3 months to 5 years. Among them, 63.2% (n = 12/19) pediatric ICFs had continuous condyle growth after open reduction and rigid fixation; 92% adults had ICFs that healed well (n = 23/25). Postoperative complications were facial nerve injury (n = 3), TMJ clicking (n = 1), and condyle resorption that required plate removal (n = 4). A modified preauricular approach provides better exposure and protection of the TMJ and superficial temporal vessels. Wire and plate provides stable fixation for type A and some type B and M fractures. Open reduction and rigid fixation produce good results for adult patients. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Pediatric mandibular fractures: a free hand technique.

PubMed

Davison, S P; Clifton, M S; Davison, M N; Hedrick, M; Sotereanos, G

2001-01-01

The treatment of pediatric mandibular fractures is rare, controversial, and complicated by mixed dentition. To determine if open mandibular fracture repair with intraoral and extraoral rigid plate placement, after free hand occlusal and bone reduction, without intermaxillary fixation (IMF), is appropriate and to discuss postoperative advantages, namely, maximal early return of function and minimal oral hygiene issues. A group of 29 pediatric patients with a mandibular fracture were examined. Twenty pediatric patients (13 males and 7 females) with a mean age of 9 years (age range, 1-17 years) were treated using IMF. All patients were treated by the same surgeon (G.S.). Surgical time for plating was reduced by 1 hour, the average time to place patients in IMF. The patients who underwent open reduction internal fixation without IMF ate a soft mechanical diet by postoperative day 3 compared with postoperative day 16 for those who underwent IMF. Complication rates related to fixation technique were comparable at 20% for those who did not undergo IMF and 33% for those who did. We believe that free hand reduction is a valuable technique to reduce operative time for pediatric mandibular fractures. It maximizes return to function while minimizing the oral hygiene issues and hardware removal of intermaxillary function.

Intramedullary reduction and stabilisation of adult radial neck fractures.

PubMed

Keller, H W; Rehm, K E; Helling, J

1994-05-01

We report the treatment of six adult patients with displaced fractures of the radial neck by intramedullary reduction and stabilisation. Nine months after operation all the patients had good joint function, little or no pain, complete healing and no significant periarticular calcification. This simple semi-closed procedure may help to avoid resection of the radial head in some cases.

Risk Assessment of Bone Fracture During Space Exploration Missions to the Moon and Mars

NASA Technical Reports Server (NTRS)

Lewandowski, Beth E.; Myers, Jerry G.; Nelson, Emily S.; Licatta, Angelo; Griffin, Devon

2007-01-01

The possibility of a traumatic bone fracture in space is a concern due to the observed decrease in astronaut bone mineral density (BMD) during spaceflight and because of the physical demands of the mission. The Bone Fracture Risk Module (BFxRM) was developed to quantify the probability of fracture at the femoral neck and lumbar spine during space exploration missions. The BFxRM is scenario-based, providing predictions for specific activities or events during a particular space mission. The key elements of the BFxRM are the mission parameters, the biomechanical loading models, the bone loss and fracture models and the incidence rate of the activity or event. Uncertainties in the model parameters arise due to variations within the population and unknowns associated with the effects of the space environment. Consequently, parameter distributions were used in Monte Carlo simulations to obtain an estimate of fracture probability under real mission scenarios. The model predicts an increase in the probability of fracture as the mission length increases and fracture is more likely in the higher gravitational field of Mars than on the moon. The resulting probability predictions and sensitivity analyses of the BFxRM can be used as an engineering tool for mission operation and resource planning in order to mitigate the risk of bone fracture in space.

Risk Assessment of Bone Fracture During Space Exploration Missions to the Moon and Mars

NASA Technical Reports Server (NTRS)

Lewandowski, Beth E.; Myers, Jerry G.; Nelson, Emily S.; Griffin, Devon

2008-01-01

The possibility of a traumatic bone fracture in space is a concern due to the observed decrease in astronaut bone mineral density (BMD) during spaceflight and because of the physical demands of the mission. The Bone Fracture Risk Module (BFxRM) was developed to quantify the probability of fracture at the femoral neck and lumbar spine during space exploration missions. The BFxRM is scenario-based, providing predictions for specific activities or events during a particular space mission. The key elements of the BFxRM are the mission parameters, the biomechanical loading models, the bone loss and fracture models and the incidence rate of the activity or event. Uncertainties in the model parameters arise due to variations within the population and unknowns associated with the effects of the space environment. Consequently, parameter distributions were used in Monte Carlo simulations to obtain an estimate of fracture probability under real mission scenarios. The model predicts an increase in the probability of fracture as the mission length increases and fracture is more likely in the higher gravitational field of Mars than on the moon. The resulting probability predictions and sensitivity analyses of the BFxRM can be used as an engineering tool for mission operation and resource planning in order to mitigate the risk of bone fracture in space.

Material Characterization for Ductile Fracture Prediction

NASA Technical Reports Server (NTRS)

Hill, Michael R.

2000-01-01

The research summarized in this document provides valuable information for structural health evaluation of NASA infrastructure. Specifically, material properties are reported which will enable calibration of ductile fracture prediction methods for three high-toughness metallic materials and one aluminum alloy which can be found in various NASA facilities. The task of investigating these materials has also served to validate an overall methodology for ductile fracture prediction is currently being employed at NASA. In facilitating the ability to incorporate various materials into the prediction scheme, we have provided data to enable demonstration of the overall generality of the approach.

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 (

Bridge cable fracture detection with acoustic emission test (Conference Presentation)

NASA Astrophysics Data System (ADS)

Qu, Hongya; Li, Tiantian; Chen, Genda

2017-04-01

In this study, acoustic emission (AE) tests were conducted to detect and locate wire fracture in strands that are widely used in cable-stayed and suspension bridges. To effectively separate fracture signals from unwanted noises, distinct features of fracture, fracture-induced echo, and artificial tapping signals as well as their dependence on loading levels are characterized with short-time Fourier transform. To associate fracture scenarios with their acoustic features, two 20-foot-long ( 6.1 m) 270 ksi ( 1,862 MPa) steel strands of seven wires were tested with one wire notched off at center and support, respectively, up to 90% of its cross section area by 10% increment. Up to 80% reduction in cross section area of the notched wire, each strand was loaded to 20 kips ( 89 kN) corresponding to 35% of the minimum breaking strength and the acquired AE parameters such as hits, energy, and counts were found to change little. With a reduction of 90% of the section area of one wire, both strands were found to be fractured under approximately 16.5 kips ( 73.4 kN). The hits, energy, and counts of AE signals were all demonstrated to suddenly change with the fracture of the notched wire. However, only the counts of AE signals distributed over the length of the strands allow the localization of fracture point. The frequency band of fracture signals is significantly broader than that of either fracture-induced echo or artificial tapping noise. The time duration of artificial tapping noises is substantially longer than that of either fracture or fracture-induced echo. These distinct characteristics can be used to effectively separate fracture signals from noises for wire fracture detection and localization in practice.

A Review of Computational Spinal Injury Biomechanics Research and Recommendations for Future Efforts

DTIC Science & Technology

2011-09-01

wedge vertebral fractures . The approximate degree of height reduction determines the assignment of grade to the fractured verte- bra (reproduced with...permission of Mary Ann Liebert, Inc.). (b) Lateral radiograph of lumbar spine shows a mild wedge fracture (grade 1) of L3 vertebra. (c) Lateral ra...diograph of lumbar spine shows moderate wedge fracture (grade 2) of L3 vertebra and moderate crush fracture (grade 2) of L2 vertebra. (d) Lateral

Subject specific finite element modeling of periprosthetic femoral fracture using element deactivation to simulate bone failure.

PubMed

Miles, Brad; Kolos, Elizabeth; Walter, William L; Appleyard, Richard; Shi, Angela; Li, Qing; Ruys, Andrew J

2015-06-01

Subject-specific finite element (FE) modeling methodology could predict peri-prosthetic femoral fracture (PFF) for cementless hip arthoplasty in the early postoperative period. This study develops methodology for subject-specific finite element modeling by using the element deactivation technique to simulate bone failure and validate with experimental testing, thereby predicting peri-prosthetic femoral fracture in the early postoperative period. Material assignments for biphasic and triphasic models were undertaken. Failure modeling with the element deactivation feature available in ABAQUS 6.9 was used to simulate a crack initiation and propagation in the bony tissue based upon a threshold of fracture strain. The crack mode for the biphasic models was very similar to the experimental testing crack mode, with a similar shape and path of the crack. The fracture load is sensitive to the friction coefficient at the implant-bony interface. The development of a novel technique to simulate bone failure by element deactivation of subject-specific finite element models could aid prediction of fracture load in addition to fracture risk characterization for PFF. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Numerical investigations of rib fracture failure models in different dynamic loading conditions.

PubMed

Wang, Fang; Yang, Jikuang; Miller, Karol; Li, Guibing; Joldes, Grand R; Doyle, Barry; Wittek, Adam

2016-01-01

Rib fracture is one of the most common thoracic injuries in vehicle traffic accidents that can result in fatalities associated with seriously injured internal organs. A failure model is critical when modelling rib fracture to predict such injuries. Different rib failure models have been proposed in prediction of thorax injuries. However, the biofidelity of the fracture failure models when varying the loading conditions and the effects of a rib fracture failure model on prediction of thoracic injuries have been studied only to a limited extent. Therefore, this study aimed to investigate the effects of three rib failure models on prediction of thoracic injuries using a previously validated finite element model of the human thorax. The performance and biofidelity of each rib failure model were first evaluated by modelling rib responses to different loading conditions in two experimental configurations: (1) the three-point bending on the specimen taken from rib and (2) the anterior-posterior dynamic loading to an entire bony part of the rib. Furthermore, the simulation of the rib failure behaviour in the frontal impact to an entire thorax was conducted at varying velocities and the effects of the failure models were analysed with respect to the severity of rib cage damages. Simulation results demonstrated that the responses of the thorax model are similar to the general trends of the rib fracture responses reported in the experimental literature. However, they also indicated that the accuracy of the rib fracture prediction using a given failure model varies for different loading conditions.

The lingual splint: an often forgotten method for fixating pediatric mandibular fractures.

PubMed

Binahmed, Abdulaziz; Sansalone, Claudio; Garbedian, Justin; Sándor, George K B

2007-01-01

Maxillofacial fractures are uncommon in the pediatric population, and their treatment is unique due to the psychological, physiological, developmental and anatomical characteristics of children. We present the case of a boy who was treated in an outpatient dental clinic using a lingual splint for the reduction, stabilization and fixation of a mandibular body fracture. This technique is a reliable, noninvasive procedure that dentists may consider in selected cases by referral to an oral and maxillofacial surgeon. It also limits the discomfort and morbidity that can be associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients.

3D printing-based minimally invasive cannulated screw treatment of unstable pelvic fracture.

PubMed

Cai, Leyi; Zhang, Yingying; Chen, Chunhui; Lou, Yiting; Guo, Xiaoshan; Wang, Jianshun

2018-04-04

Open reduction and internal fixation of pelvic fractures could restore the stability of the pelvic ring, but there were several problems. Minimally invasive closed reduction cannulated screw treatment of pelvic fractures has lots advantages. However, how to insert the cannulated screw safely and effectively to achieve a reliable fixation were still hard for orthopedist. Our aim was to explore the significance of 3D printing technology as a new method for minimally invasive cannulated screw treatment of unstable pelvic fracture. One hundred thirty-seven patients with unstable pelvic fractures from 2014 to 2016 were retrospectively analyzed. Based on the usage of 3D printing technology for preoperative simulation surgery, they were assigned to 3D printing group (n = 65) and control group (n = 72), respectively. These two groups were assessed in terms of operative time, intraoperative fluoroscopy, postoperative reduction effect, fracture healing time, and follow-up function. The effect of 3D printing technology was evaluated through minimally invasive cannulated screw treatment. There was no significant difference in these two groups with respect to general conditions, such as age, gender, fracture type, time from injury to operation, injury cause, and combined injury. Length of surgery and average number of fluoroscopies were statistically different for 3D printing group and the control group (p < 0.01), i.e., 58.6 vs. 72.3 min and 29.3 vs. 37 min, respectively. Using the Matta radiological scoring systems, the reduction was scored excellent in 21/65 cases (32.3%) and good in 30/65 cases (46.2%) for the 3D printing group, versus 22/72 cases (30.6%) scored as excellent and 36/72 cases (50%) as good for the control group. On the other hand, using the Majeed functional scoring criteria, there were 27/65 (41.5%) excellent and 26/65 (40%) good cases for the 3D printing group in comparison to 30/72 (41.7%) and 28/72 (38.9%) cases for the control group, respectively. This suggests no significant difference between these two groups about the function outcomes. Full reduction and proper fixation of the pelvic ring and reconstruction of anatomical morphology are of great significance to patients' early functional exercise and for the reduction of long-term complications. This retrospective study has demonstrated the 3D printing technology as a potential approach for improving the diagnosis and treatment of pelvic fractures. The study was retrospectively registered at the Chinese Clinical Trial Registry, number: ChiCTR-TRC-17012798, trial registration date: 26 Sept. 2017.

Influence of Different Yield Loci on Failure Prediction with Damage Models

NASA Astrophysics Data System (ADS)

Heibel, S.; Nester, W.; Clausmeyer, T.; Tekkaya, A. E.

2017-09-01

Advanced high strength steels are widely used in the automotive industry to simultaneously improve crash performance and reduce the car body weight. A drawback of these multiphase steels is their sensitivity to damage effects and thus the reduction of ductility. For that reason the Forming Limit Curve is only partially suitable for this class of steels. An improvement in failure prediction can be obtained by using damage mechanics. The objective of this paper is to comparatively review the phenomenological damage model GISSMO and the Enhanced Lemaitre Damage Model. GISSMO is combined with three different yield loci, namely von Mises, Hill48 and Barlat2000 to investigate the influence of the choice of the plasticity description on damage modelling. The Enhanced Lemaitre Model is used with Hill48. An inverse parameter identification strategy for a DP1000 based on stress-strain curves and optical strain measurements of shear, uniaxial, notch and (equi-)biaxial tension tests is applied to calibrate the models. A strong dependency of fracture strains on the choice of yield locus can be observed. The identified models are validated on a cross-die cup showing ductile fracture with slight necking.

Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results.

PubMed

Lewine, Eliza; Kim, Jaehon M; Miller, Patricia E; Waters, Peter M; Mahan, Susan T; Snyder, Brian; Hedequist, Daniel; Bae, Donald S

2018-02-01

The purpose of this investigation was to compare the presentation and postoperative results of children treated for open and closed, completely displaced type III supracondylar humerus fractures (SCFs). Thirty patients with open and 66 patients with closed, completely displaced type III SCFs were evaluated. Open fractures underwent irrigation and debridement, and all patients were treated by open or closed reduction and pin fixation. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical data regarding mechanism of injury, neurovascular status, associated injuries, postoperative range of motion, infections, and pain. Radiographs were evaluated to quantify displacement, Baumann's angle, humeral capitellar angle, position of the anterior humeral line, and adequacy of reduction. Outcomes were assessed using Flynn criteria. Mean clinical follow-up for the open and closed fracture groups was 8.9 and 5.7 months, respectively. Both groups were similar with respect to age, sex distribution, weight and body mass index, laterality of involvement, and mechanism of injury. At presentation, 35% of closed SCFs and 23% of open SCFs presented with abnormal neurovascular status. There was a higher prevalence of diminished/absent pulses or distal limb ischemia in patients with open injuries (27%) compared with closed fractures (18%). Conversely, severely displaced closed fractures were more commonly associated with nerve injury/palsy at presentation (35%) than those with open fractures (23%). Spontaneous nerve recovery was seen in 87% within 3 to 6 months. Postoperative loss of reduction and malunion were more common in the closed fracture group. However, 84% of patients achieved good-to-excellent results by Flynn criteria, with no appreciable difference based upon open versus closed fractures. With timely wound and fracture treatment, the clinical and radiographic results of children treated for open SCFs is similar to those with closed type III injuries, with little increased risk for infection, malunion, or neurovascular compromise. Level III.

Internal fixation of complex fractures of the tarsal navicular with locking plates. A report of 10 cases.

PubMed

Cronier, P; Frin, J-M; Steiger, V; Bigorre, N; Talha, A

2013-06-01

Tarsal navicular fractures are rare and treatment of comminuted fractures is especially difficult. Since 2007, the authors have had access to 3D reconstruction from CT scan images and specific locking plates, and they decided to evaluate whether these elements improved management of these severe cases. Between 2007 and 2011, 10 comminuted tarsal navicular fractures were treated in a prospective study. All of the fractures were evaluated by 3D reconstruction from CT scan images, with suppression of the posterior tarsal bones. The surgical approach was chosen according to the type of lesion. Reduction was achieved with a mini-distractor when necessary, and stabilized by AO locking plate fixation (Synthes™). Patient follow-up included a clinical and radiological evaluation (Maryland Foot score, AOFAS score). Eight patients underwent postoperative CT scan. All patients were followed up after a mean 20.5 months. Union was obtained in all patients and arthrodesis was not necessary in any of them. The mean Maryland Foot score was 92.8/100, and the AOFAS score 90.6/100. One patient with an associated comminuted calcaneal fracture had minimal sequella from a compartment syndrome of the foot. The authors did not find any series in the literature that reported evaluating tarsal navicular fractures by 3D reconstruction from CT scan images. The images obtained after suppression of the posterior tarsal bones systematically showed a lateral plantar fragment attached to the plantar calcaneonavicular ligament, which is essential for stability, and which helped determine the reduction technique. Locking plate fixation of these fractures has never been reported. Comminuted fractures of the tarsal navicular were successfully treated with specific imaging techniques in particular 3D reconstructions of CT scan images to choose the surgical approach and the reduction technique. Locking plate fixation of the navicular seems to be a satisfactory solution for the treatment of these particularly difficult fractures. Level IV. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Faulting, fracturing and in situ stress prediction in the Ahnet Basin, Algeria — a finite element approach

NASA Astrophysics Data System (ADS)

Beekman, Fred; Badsi, Madjid; van Wees, Jan-Diederik

2000-05-01

Many low-efficiency hydrocarbon reservoirs are productive largely because effective reservoir permeability is controlled by faults and natural fractures. Accurate and low-cost information on basic fault and fracture properties, orientation in particular, is critical in reducing well costs and increasing well recoveries. This paper describes how we used an advanced numerical modelling technique, the finite element method (FEM), to compute site-specific in situ stresses and rock deformation and to predict fracture attributes as a function of material properties, structural position and tectonic stress. Presented are the numerical results of two-dimensional, plane-strain end-member FEM models of a hydrocarbon-bearing fault-propagation-fold structure. Interpretation of the modelling results remains qualitative because of the intrinsic limitations of numerical modelling; however, it still allows comparisons with (the little available) geological and geophysical data. In all models, the weak mechanical strength and flow properties of a thick shale layer (the main seal) leads to a decoupling of the structural deformation of the shallower sediments from the underlying sediments and basement, and results in flexural slip across the shale layer. All models predict rock fracturing to initiate at the surface and to expand with depth under increasing horizontal tectonic compression. The stress regime for the formation of new fractures changes from compressional to shear with depth. If pre-existing fractures exist, only (sub)horizontal fractures are predicted to open, thus defining the principal orientation of effective reservoir permeability. In models that do not include a blind thrust fault in the basement, flexural amplification of the initial fold structure generates additional fracturing in the crest of the anticline controlled by the material properties of the rocks. The folding-induced fracturing expands laterally along the stratigraphic boundaries under enhanced tectonic loading. Models incorporating a blind thrust fault correctly predict the formation of secondary syn- and anti-thetic mesoscale faults in the basement and sediments of the hanging wall. Some of these faults cut reservoir and/or seal layers, and thus may influence effective reservoir permeability and affect seal integrity. The predicted faults divide the sediments across the anticline in several compartments with different stress levels and different rock failure (and proximity to failure). These numerical model outcomes can assist classic interpretation of seismic and well bore data in search of fractured and overpressured hydrocarbon reservoirs.

Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

PubMed

Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

2016-11-01

Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

The ameloblastin extracellular matrix molecule enhances bone fracture resistance and promotes rapid bone fracture healing.

PubMed

Lu, Xuanyu; Li, Wenjin; Fukumoto, Satoshi; Yamada, Yoshihiko; Evans, Carla A; Diekwisch, Tom; Luan, Xianghong

2016-01-01

The extracellular matrix (ECM) provides structural support, cell migration anchorage, cell differentiation cues, and fine-tuned cell proliferation signals during all stages of bone fracture healing, including cartilaginous callus formation, callus remodeling, and bony bridging of the fracture gap. In the present study we have defined the role of the extracellular matrix protein ameloblastin (AMBN) in fracture resistance and fracture healing of mouse long bones. To this end, long bones from WT and AMBN(Δ5-6) truncation model mice were subjected to biomechanical analysis, fracture healing assays, and stem cell colony formation comparisons. The effect of exogenous AMBN addition to fracture sites was also determined. Our data indicate that lack of a functional AMBN in the bone matrix resulted in 31% decreased femur bone mass and 40% reduced energy to failure. On a cellular level, AMBN function inhibition diminished the proliferative capacity of fracture repair callus cells, as evidenced by a 58% reduction in PCNA and a 40% reduction in Cyclin D1 gene expression, as well as PCNA immunohistochemistry. In terms of fracture healing, AMBN truncation was associated with an enhanced and prolonged chondrogenic phase, resulting in delayed mineralized tissue gene expression and delayed ossification of the fracture repair callus. Underscoring a role of AMBN in fracture healing, there was a 6.9-fold increase in AMBN expression at the fracture site one week after fracture, and distinct AMBN immunolabeling in the fracture gap. Finally, application of exogenous AMBN protein to bone fracture sites accelerated callus formation and bone fracture healing (33% increase in bone volume and 19% increase in bone mineral density), validating the findings of our AMBN loss of function studies. Together, these data demonstrate the functional importance of the AMBN extracellular matrix protein in bone fracture prevention and rapid fracture healing. Copyright © 2016 International Society of Matrix Biology. Published by Elsevier B.V. All rights reserved.

The Ameloblastin extracellular matrix molecule enhances bone fracture resistance and promotes rapid bone fracture healing

PubMed Central

Lu, Xuanyu; Li, Wenjin; Fukumoto, Satoshi; Yamada, Yoshihiko; Evans, Carla; Diekwisch, Thomas G.H.; Luan, Xianghong

2016-01-01

The extracellular matrix (ECM) provides structural support, cell migration anchorage, cell differentiation cues, and fine-tuned cell proliferation signals during all stages of bone fracture healing, including cartilaginous callus formation, callus remodeling, and bony bridging of the fracture gap. In the present study we have defined the role of the extracellular matrix protein ameloblastin (AMBN) in fracture resistance and fracture healing of mouse long bones. To this end, long bones from WT and AMBNΔ5-6 truncation model mice were subjected to biomechanical analysis, fracture healing assays, and stem cell colony formation comparisons. The effect of exogenous AMBN addition to fracture sites was also determined. Our data indicate that lack of a functional AMBN in the bone matrix resulted in 31% decreased femur bone mass and 40% reduced energy to failure. On a cellular level, AMBN function inhibition diminished the proliferative capacity of fracture repair callus cells, as evidenced by a 58% reduction in PCNA and a 40% reduction in Cyclin D1 gene expression, as well as PCNA immunohistochemistry. In terms of fracture healing, AMBN truncation was associated with an enhanced and prolonged chondrogenic phase, resulting in delayed mineralized tissue gene expression and delayed ossification of the fracture repair callus. Underscoring a role of AMBN in fracture healing, there was a 6.9-fold increase in AMBN expression at the fracture site one week after fracture, and distinct AMBN immunolabeling in the fracture gap. Finally, application of exogenous AMBN protein to bone fracture sites accelerated callus formation and bone fracture healing (33% increase in bone volume and 19% increase in bone mineral density), validating the findings of our AMBN loss of function studies. Together, these data demonstrate the functional importance of the AMBN extracellular matrix protein in bone fracture prevention and rapid fracture healing. PMID:26899203

Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW).

PubMed

Roux, C; Wyman, A; Hooven, F H; Gehlbach, S H; Adachi, J D; Chapurlat, R D; Compston, J E; Cooper, C; Díez-Pérez, A; Greenspan, S L; Lacroix, A Z; Netelenbos, J C; Pfeilschifter, J; Rossini, M; Saag, K G; Sambrook, P N; Silverman, S; Siris, E S; Watts, N B; Boonen, S

2012-12-01

Among 50,461 postmenopausal women, 1,822 fractures occurred (57% minor non-hip, non-vertebral [NHNV], 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D, followed by major NHNV and hip fractures. Decreases in physical function and health status were greatest for spine or hip fractures. There is growing evidence that NHNV fractures result in substantial morbidity and healthcare costs. The aim of this prospective study was to assess the effect of these NHNV fractures on quality of life. We analyzed the 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the Global Longitudinal study of Osteoporosis in Women (GLOW). Health-related quality of life (HRQL) was analyzed using the EuroQol EQ-5D tool and the SF-36 health survey. Among 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The number of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for those with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Statistically significant reductions in SF-36 physical function were found for spine fractures, and were borderline significant for major NHNV fractures. This prospective study shows that NHNV fractures have a detrimental effect on HRQL. Efforts to optimize the care of osteoporosis patients should include the prevention of NHNV fractures.

Development of a binder fracture test to determine fracture energy.

DOT National Transportation Integrated Search

2012-04-01

It has been found that binder testing methods in current specifications do not accurately predict cracking performance at intermediate temperatures. Fracture energy has been determined to be strongly correlated to fracture resistance of asphalt mixtu...

[Operative treatment of displaced intra-articular calcaneal fractures].

PubMed

Zwipp, H; Rammelt, S; Amlang, M; Pompach, M; Dürr, C

2013-12-01

Anatomic reduction of displaced intra-articular calcaneal fractures with restoration of height, length, and axial alignment and reconstruction of the subtalar and calcaneocuboid joints. Displaced intra-articular calcaneal fractures with incongruity of the posterior facet of the subtalar joint, loss of height, and axial malalignment. High perioperative risk, soft tissue infection, advanced peripheral arterial disease (stage III), neurogenic osteoarthropathy, poor patient compliance (e. g., substance abuse). Extended lateral approach with the patient placed on the uninjured side. Reduction of the anatomic shape and joint surfaces according to the preoperative CT-based planning. Reduction of the medial wall and step-wise reconstruction of the posterior facet from medial to lateral. Reduction of the tuberosity and anterior process fragments to the posterior joint block and temporary fixation with Kirschner wires. Internal fixation with an anatomic lateral plate in a locking or nonlocking mode. Alternatively less invasive internal fixation with a calcaneus nail over a sinus tarsi approach for less severe fracture types. The lower leg is immobilized in a brace until the wound is healed. Range of motion exercises of the ankle and subtalar joints are initiated on the second postoperative day. Patients are mobilized in their own shoe with partial weight bearing of 20 kg for 6-12 weeks depending on fracture severity and bone quality. Over a 4-year period, 163 patients with 184 displaced, intra-articular calcaneal fractures were treated with a lateral plate via an extended approach. In all, 102 patients with 116 fractures were followed for a mean of 8 years. A surgical revision was necessary in 4 cases (3.4%) of postoperative hematoma, 2 (1.7%) superficial and 5 (4.3%) deep infections. Of the latter, 2 patients needed a free flap for definite wound coverage, no calcanectomy or amputation was needed. Secondary subtalar fusion for symptomatic posttraumatic arthritis was performed in 9 cases (7.8%). At follow-up, the AOFAS Ankle/Hindfoot Score averaged 70.2, the Zwipp Score averaged 76.0, the German versions of the Foot Function Index and SF-36 physical component averaged 32.8 and 42.2, respectively. Scores were significantly lower with increasing fracture severity according to the Sanders and Zwipp classifications, bilateral fractures, open fractures, and with work-related injuries. With less invasive fixation using a calcaneal nail, superficial wound edge necrosis was seen in 2 of 75 cases (2.7%).

In vitro simulation of pathological bone conditions to predict clinical outcome of bone tissue engineered materials

NASA Astrophysics Data System (ADS)

Nguyen, Duong Thuy Thi

According to the Centers for Disease Control, the geriatric population of ≥65 years of age will increase to 51.5 million in 2020; 40% of white women and 13% of white men will be at risk for fragility fractures or fractures sustained under normal stress and loading conditions due to bone disease, leading to hospitalization and surgical treatment. Fracture management strategies can be divided into pharmaceutical therapy, surgical intervention, and tissue regeneration for fracture prevention, fracture stabilization, and fracture site regeneration, respectively. However, these strategies fail to accommodate the pathological nature of fragility fractures, leading to unwanted side effects, implant failures, and non-unions. Compromised innate bone healing reactions of patients with bone diseases are exacerbated with protective bone therapy. Once these patients sustain a fracture, bone healing is a challenge, especially when fracture stabilization is unsuccessful. Traditional stabilizing screw and plate systems were designed with emphasis on bone mechanics rather than biology. Bone grafts are often used with fixation devices to provide skeletal continuity at the fracture gap. Current bone grafts include autologous bone tissue and donor bone tissue; however, the quality and quantity demanded by fragility fractures sustained by high-risk geriatric patients and patients with bone diseases are not met. Consequently, bone tissue engineering strategies are advancing towards functionalized bone substitutes to provide fracture reconstruction while effectively mediating bone healing in normal and diseased fracture environments. In order to target fragility fractures, fracture management strategies should be tailored to allow bone regeneration and fracture stabilization with bioactive bone substitutes designed for the pathological environment. The clinical outcome of these materials must be predictable within various disease environments. Initial development of a targeted treatment strategy should focus on simulating, in vitro, a physiological bone environment to predict clinical effectiveness of engineered bone and understand cellular responses due to the proposed agents and bioactive scaffolds. An in vitro test system can be the necessary catalyst to reduce implant failures and non-unions in fragility fractures.

Effects of cast-mediated immobilization on bone mineral mass at various sites in adolescents with lower-extremity fracture.

PubMed

Ceroni, Dimitri; Martin, Xavier; Delhumeau, Cécile; Rizzoli, René; Kaelin, André; Farpour-Lambert, Nathalie

2012-02-01

Leg or ankle fractures occur commonly in the pediatric population and are primarily treated with closed reduction and cast immobilization. The most predictable consequences of immobilization and subsequent weight-bearing restriction are loss of bone mineral mass, substantial muscle atrophy, and functional limitations. The purposes of this study were to determine if lower-limb fractures in adolescents are associated with abnormal bone mineral density or content at the time of fracture, and to quantify bone mineral loss at various sites due to cast-mediated immobilization and limited weight-bearing. We recruited fifty adolescents aged ten to sixteen years who had undergone cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of the total body, lumbar spine, hip, leg, and calcaneus were performed at the time of fracture and at cast removal. Patients with a fracture were paired with healthy controls according to sex and age. Values at baseline and at cast removal, or at equivalent time intervals in the control group, were compared between groups and between the injured and uninjured legs of the adolescents with the fracture. At the time of fracture, there were no observed differences in the bone mineral density or bone mineral content Z-scores of the total body or the lumbar spine, or in the bone mineral density Z-scores of the calcaneus, between the injured and healthy subjects. At cast removal, bone mineral parameters on the injured side were significantly lower than those on the uninjured side in the injured group. Differences ranged from -5.8% to -31.7% for bone mineral density and from -5.2% to -19.4% for bone mineral content. During the cast period, the injured adolescents had a significant decrease of bone mineral density at the hip, greater trochanter, calcaneus, and total lower limb as compared with the healthy controls. Lower-limb fractures are not related to osteopenia in adolescents at the time of fracture. However, osteopenia does develop in the injured limb during cast immobilization for fracture treatment. Further investigation is required to determine if the bone mineral mass will return to normal or if a permanent decrease is to be expected, which may constitute a hypothetical risk of sustaining a second fracture.

Analysis of facial bone fractures: An 11-year study of 2,094 patients

PubMed Central

Hwang, Kun; You, Sun Hye

2010-01-01

Purpose: The medical records of these patients were reviewed and analysed to determine the clinical characteristics and treatment of facial bone fractures. Patients and Methods: This is a retrospective study of 2,094 patients with facial bone fractures from various accidents that were treated at the Inha University Hospital from 1996 to 2007. Results: The most common age group was the third decade of life (29%). Males were more common than females (3.98:1). The most common aetiology was violent assault or nonviolent traumatic injury (49.4%). The most common isolated fracture site was the nasal bone (37.7%), followed by the mandible (30%), orbital bones (7.6%), zygoma (5.7%), maxilla (1.3%) and the frontal bone (0.3%). The largest group with complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (14%). Closed reduction was performed in 46.3% of the cases while 39.7% of the cases required open reduction. For open reductions, the most commonly used soft-tissue approach was the intraoral approach (32.3%). The complication rate was 6.4% and the most common complication was hypoesthesia (68.4%) followed by diplopia (25.6%). Conclusion: Long-term collection of epidemiological data regarding facial fractures and concomitant injuries is important for the evaluation of existing preventive measures and useful in the development of new methods of injury prevention and treatment. PMID:20924449

Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty.

PubMed

Aono, Hiroyuki; Ishii, Keisuke; Tobimatsu, Hidekazu; Nagamoto, Yukitaka; Takenaka, Shota; Furuya, Masayuki; Chiaki, Horii; Iwasaki, Motoki

2017-08-01

Short-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate. The purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty. This is a prospective multicenter comparative study. We studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty. Radiological parameters (Cobb angle on standing lateral radiographs) were used. Implants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively. After surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and reduction of the vertebrae was maintained with and without vertebroplasty, regardless of load-sharing classification. Although no patient required additional anterior reconstruction, kyphotic change was observed at disc level mainly after implant removal with or without vertebroplasty. Temporary short-segment fixation yielded satisfactory results in the reduction and maintenance of fractured vertebrae with or without vertebroplasty. Kyphosis recurrence may be inevitable because adjacent discs can be injured during the original trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultralow-dose computed tomography imaging for surgery of midfacial and orbital fractures using ASIR and MBIR.

PubMed

Widmann, G; Dalla Torre, D; Hoermann, R; Schullian, P; Gassner, E M; Bale, R; Puelacher, W

2015-04-01

The influence of dose reductions on diagnostic quality using a series of high-resolution ultralow-dose computed tomography (CT) scans for computer-assisted planning and surgery including the most recent iterative reconstruction algorithms was evaluated and compared with the fracture detectability of a standard cranial emergency protocol. A human cadaver head including the mandible was artificially prepared with midfacial and orbital fractures and scanned using a 64-multislice CT scanner. The CT dose index volume (CTDIvol) and effective doses were calculated using application software. Noise was evaluated as the standard deviation in Hounsfield units within an identical region of interest in the posterior fossa. Diagnostic quality was assessed by consensus reading of a craniomaxillofacial surgeon and radiologist. Compared with the emergency protocol at CTDIvol 35.3 mGy and effective dose 3.6 mSv, low-dose protocols down to CTDIvol 1.0 mGy and 0.1 mSv (97% dose reduction) may be sufficient for the diagnosis of dislocated craniofacial fractures. Non-dislocated fractures may be detected at CTDIvol 2.6 mGy and 0.3 mSv (93% dose reduction). Adaptive statistical iterative reconstruction (ASIR) 50 and 100 reduced average noise by 30% and 56%, and model-based iterative reconstruction (MBIR) by 93%. However, the detection rate of fractures could not be improved due to smoothing effects. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures.

PubMed

Hsu, Kai-Lan; Chang, Wei-Lun; Yang, Chyun-Yu; Yeh, Ming-Long; Chang, Chih-Wei

2017-12-01

Modified tension band wiring has been widely used to treat transverse patellar fractures. However, few studies have evaluated the clinical outcomes using different methods of Kirschner wire bending, location of the tension band, and depths of Kirschner wires. Thus, we tried to clarify these factors according to our clinical outcomes. This retrospective cohort study recruited consecutive patients underwent surgical fixation for patellar fractures using modified tension band technique between January 2010 and December 2015. Different factors in this procedure, including the bending manner of the Kirschner wires, their depth, and location of the tension band with respect to the superior and inferior border of the patella were recorded and analysed. The primary outcome was early loss of fixation. The secondary outcomes were minor loss of reduction, implant breakage, deep infection, and the need for implant removal. This study included 170 patients with patellar fractures. Regarding the bending method, similar results were obtained with bilaterally or proximally bent Kirschner wires. Regarding length, the tension band was placed closely (within 25% of the patella length) in 124 patients and distantly in 46 patients. The rates of loss of reduction and implant breakage were significantly higher in the distantly placed tension bands. Regarding depth, 37 patellar fractures were fixed with the Kirschner wires at the superficial one third of the patellae while the K- wires at the middle layer of patella were used in the remaining 133 patellar fractures. A significantly higher rate of minor loss of reduction was obtained using the superficial Kirschner wires. The modified tension band technique for transverse patella fractures provides favourable clinical outcomes, with low failure (5%) and infection (2%) rates. Implant irritation is the major complication, and almost half of cases require implant removal. The location of the tension band with respect to the superior and inferior border of the patella plays an important role in clinical outcomes. Placing the wire close to the patella may prevent major loss of reduction and implant breakage. Superficially placed Kirschner wires also affect clinical outcomes by increasing the rate of minor loss of reduction. Copyright © 2017 Elsevier Ltd. All rights reserved.

Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014.

PubMed

Chua, Ivan S Y; Chong, S L; Ong, Gene Y K

2017-12-01

To evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures. This is a retrospective cohort study of pediatric patients in KKWomen's and Children's Hospital Children's Emergency Department with forearm fractures between Jan 2003 and Dec 2014 who underwent manipulation and reduction using Bier's block. Demographic data, time from registration to discharge, major complications and success rate were collated in a standardized data collection form. A subanalysis of the Bier's block group from 2009 to 2014 was performed and compared to a corresponding data set of paediatric patients who underwent manipulation and reduction of forearm fractures using ketamine for procedural sedation from 2009 to 2014. 1781 cases of paediatric forearm fractures were analysed. The mean age of patients in the Bier's block group was 12.0 years (range 5.5-17.8 years old). Of all patients undergoing Bier's block, 1471 out of 1781 patients were male (82.7%). The mean length of stay (LOS) in the department was 168±72min, measured from time of registration till departure. From our subanalysis of data from 2009 to 2014, the mean LOS for the Bier's block group was shorter - 170min compared to 238min for the ketamine group (P <0.0001). 2 patients had failed Bier's block which required a repeat procedural sedation using ketamine. 96% of patients who underwent Bier's block were discharged with an outpatient orthopaedic appointment. There were no deaths or major complications identified in our study. Bier's block is a safe technique for reduction of fractures when used in the appropriate population and fracture types, with a low failure rate and no major complications including death. Compared to the ketamine group, it has a shorter length of stay in the emergency department. We recommend the adoption of this practice for manipulation and reduction of pediatric forearm fractures in the Emergency Department with a formalised protocol to reduce and prevent any human errors that can potentially result in complications. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity.

PubMed

Morin, Vincent; Pailhé, Régis; Sharma, Akash; Rouchy, René-Christopher; Cognault, Jérémy; Rubens-Duval, Brice; Saragaglia, Dominique

2016-06-01

Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers. We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up. Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement. In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by isolated antero-posterior screwing provides excellent clinical and radiological results. The anteromedial incision has a dual advantage of anatomical reduction, tibial spine fixation (in 80% of our cases) and posteromedial fragment reduction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi-center trial.

PubMed

Bartl, Christoph; Stengel, Dirk; Bruckner, Thomas; Rossion, Inga; Luntz, Steffen; Seiler, Christoph; Gebhard, Florian

2011-03-22

Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation.Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius) is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool.The primary objective is to determine differences in the Short Form 36 (SF-36) Physical Component Score (PCS) between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH) instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery), as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture involves a central statistical unit, an independent monitoring institute, and a data safety monitoring board. Following approval by the institutional review boards of all participating centers, conduct and reporting will strictly adhere to national and international rules, regulations, and recommendations (e.g., Good Clinical Practice, data safety laws, and EQUATOR/CONSORT proposals). To our knowledge, ORCHID is the first multicenter RCT designed to assess quality of life and functional outcomes following operative treatment compared to conservative treatment of complex, intra-articular fractures of the distal radius in elderly patients. The results are expected to influence future treatment recommendations and policies on an international level. ISRCTN: ISRCTN76120052 Registration date: 31.07.2008; Randomization of first patient: 15.09.2008.

Micromechanics Modeling of Fracture in Nanocrystalline Metals

NASA Technical Reports Server (NTRS)

Glaessgen, E. H.; Piascik, R. S.; Raju, I. S.; Harris, C. E.

2002-01-01

Nanocrystalline metals have very high theoretical strength, but suffer from a lack of ductility and toughness. Therefore, it is critical to understand the mechanisms of deformation and fracture of these materials before their full potential can be achieved. Because classical fracture mechanics is based on the comparison of computed fracture parameters, such as stress intlmsity factors, to their empirically determined critical values, it does not adequately describe the fundamental physics of fracture required to predict the behavior of nanocrystalline metals. Thus, micromechanics-based techniques must be considered to quanti@ the physical processes of deformation and fracture within nanocrystalline metals. This paper discusses hndamental physicsbased modeling strategies that may be useful for the prediction Iof deformation, crack formation and crack growth within nanocrystalline metals.

A statistical model of brittle fracture by transgranular cleavage

NASA Astrophysics Data System (ADS)

Lin, Tsann; Evans, A. G.; Ritchie, R. O.

A MODEL for brittle fracture by transgranular cleavage cracking is presented based on the application of weakest link statistics to the critical microstructural fracture mechanisms. The model permits prediction of the macroscopic fracture toughness, KI c, in single phase microstructures containing a known distribution of particles, and defines the critical distance from the crack tip at which the initial cracking event is most probable. The model is developed for unstable fracture ahead of a sharp crack considering both linear elastic and nonlinear elastic ("elastic/plastic") crack tip stress fields. Predictions are evaluated by comparison with experimental results on the low temperature flow and fracture behavior of a low carbon mild steel with a simple ferrite/grain boundary carbide microstructure.

Patterns of Maxillofacial Fractures in Uttar Pradesh, India

PubMed Central

Agarwal, Padmanidhi; Mehrotra, Divya; Agarwal, Rajul; Kumar, Sumit; Pandey, Rahul

2016-01-01

This study aimed to obtain dependable epidemiologic data of the variation in cause and characteristics of maxillofacial fractures by identifying, describing, and quantifying trauma. This retrospective study was conducted in the state of Uttar Pradesh, India, over 1 year, based on a systematic computer-assisted database search from March 2015 to March 2016 for maxillofacial fractures. The demographics, etiology, geographic distribution, date of injury, site and number of fractures, and type of intervention were recorded for each. The study population consisted of 1,000 patients with 1,543 fractures. The male:female ratio was 8:1. A peak incidence of fractures was seen in the third decade (mean age: 30.3) with maximum patients younger than 40 years (80.8%). The incidence of fractures was highest in spring (42.9%). Road traffic accidents were the most common cause of trauma (64.4%) and mainly involved two wheelers (60.2%). Single-site fractures were most common. Mostly zygomatic (45.1%) and mandibular fractures (44.4%) were encountered, accounting for approximately 90% of all fractures. The main site of mandibular fractures was the body (34.4%); 46.2% of fractures underwent open reduction and internal fixation (ORIF) while 53.8% were treated by closed methods. The study provides important data to contrive future plans for injury prevention. The trend of most traffic-related injuries continues with the increasing traffic on roads. Zygomatic complex and mandibular fractures remain the most frequent. The major populations at risk are young men and those driving two wheelers. The use of helmets could achieve a large reduction in maxillofacial fractures. Awareness for preventive measures and safety guidelines should be propagated and legislation on traffic rules strictly reinforced. PMID:28210408

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients.

PubMed

Gupta, Rakesh K; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

2010-12-01

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

Common fractures and dislocations of the hand.

PubMed

Jones, Neil F; Jupiter, Jesse B; Lalonde, Donald H

2012-11-01

After reading this article, the participant should be able to: 1. Describe the concept of early protected movement with Kirschner-wired finger fractures to the hand therapist. 2. Choose the most appropriate method of fracture fixation to achieve the goal of a full range of motion. 3. Describe the methods of treatment available for the most common fractures and dislocations of the hand. The main goal of treatment of hand and finger fractures and dislocations is to attain a full range of wrist and nonscissoring finger motion after the treatment is accomplished. This CME article consists of literature review, illustrations, movies, and an online CME examination to bring the participant recent available information on the topic. The authors reviewed literature regarding the most current treatment strategies for common hand and finger fractures and dislocations. Films were created to illustrate operative and rehabilitation methods used to treat these problems. A series of multiple-choice questions, answers, discussions, and references were written and are provided online so that the participant can receive the full benefit of this review. Many treatment options are available, from buddy and Coban taping to closed reduction with immobilization; percutaneous pins or screws; and open reduction with pins, screws, or plates. Knowledge of all available options is important because all can be used to achieve the goal of treatment in the shortest time possible. The commonly used methods of treatment are reviewed and illustrated. Management of common hand and finger fractures and dislocations includes the need to focus on achieving a full range of motion after treatment. A balance of fracture reduction with minimal dissection and early protected movement will achieve the goal.

A Case Report of Sleeve Fracture of the Patella in a Shield.

PubMed

Tsubosaka, Masanori; Makino, Takeshi; Kishimoto, Shin-Ichiro; Yamaura, Kohei

2016-01-01

Sleeve fractures of the patella are rare fractures that only occur in children. The diagnosis is difficult both clinically and radiologically since the distal bony fragment may be too small to be detectable by radiography. A high-riding patella and hemarthrosis are important signs of sleeve fractures. A 12-year-old boy was admitted to the emergency room after having felt a severe pain in his left knee on kicking the ground while skateboarding earlier that day. Knee swelling, tense hemarthrosis, and periarticular tenderness were noted. On physical examination, an extension lag of 15 was observed. The active range of motion of the injured knee was 45-90° of flexion. Radiography showed an avulsion fracture of the lower pole of the patella and a high-riding patella. At the next day after the injury, we performed open reduction and internal fixation surgery. Open reduction with transosseous tunneling and cerclage wiring was performed because the distal bony fragment was too small for tension band wiring to be used. At 9 months after surgery, there was no extension lag, and the active range of motion of the injured knee was 0-140° of flexion. Callus formation over the fracture site and bone union was confirmed, and the cerclage wire was removed. To date, he had no further symptoms and has been able to carry out all types of physical activities, including skateboarding. Although sleeve fractures in children are uncommon, it should be considered a possibility in children with a chief complaint of pain around the knee. Open reduction and internal fixation was effective in the treatment of sleeve fracture of the patella.

[Medial versus lateral plating in distal tibial fractures: a prospective study of 40 fractures].

PubMed

Encinas-Ullán, C A; Fernandez-Fernandez, R; Rubio-Suárez, J C; Gil-Garay, E

2013-01-01

Tibial plafond fractures are one of the most challenging injuries in orthopaedic surgery. Their results could be improved by following the new guidelines for the management, and modern plating techniques. The results and complication rate between anteromedial and anterolateral approach for open reduction and internal fixation of these fractures were compared. A study was conducted on 40 patients treated by open reduction an internal fixation between 2007 and 2008. The surgical approach was selected by the surgeon in charge, depending on fracture pattern and skin situation. Patients were evaluated clinically and radiographically by an independent orthopaedic surgeon, not involved in the surgical procedure, using clinical (American Orthopaedic Foot and Ankle Society score) and radiological criteria at a minimum of two years. The appearance of complications after both approaches was recorded. Forty patients were included. The mean age was 53 years, with 24 males and 16 females. Seventeen of the injuries were of high energy, and there were 8 open fractures (3 of type i, 4 type ii and one type iii), and 12 of the closed injuries were grade ii or iii in the Tscherne classification. Six patients (15%) had associated injuries. At final follow-up there were 33 (82%) excellent or good results. No statistical differences were found between either surgical approach regarding time to bone union, rate of delayed union and infection rate. Three plates of the anteromedial group and none of the anterolateral group needed to be removed. Open reduction and internal fixation of distal tibia fractures produced reliable results, with no statistical differences found between anteromedial and anterolateral surgical approaches. Clinical and radiological results and complication rate were mainly related to the fracture type. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Surgical treatment of open pilon fractures.

PubMed

Zeng, Xian-tie; Pang, Gui-gen; Ma, Bao-tong; Mei, Xiao-long; Sun, Xiang; Wang, Jia; Jia, Peng

2011-02-01

To discuss the methods, timing and clinical outcomes of surgical treatment for open pilon fractures. From April 2003 to July 2008, 28 patients with open pilon fractures were treated. All had type C fractures according to the Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation (AO/ASIF) classification. Three operative methods were applied, the methods being determined by the types of fracture, soft tissue damage and time interval after injury. Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated by the Burwell-Charnley score. All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1. The healing time was from 2.5 to 11 months (average 4.7 months). Two cases had delayed union. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases, good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis. It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications. © 2011 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models.

PubMed

Middleton, Mark; Wan, Bettina; da Assunçao, Ruy

2017-05-01

our orthopaedic trauma unit serves a large elderly population, admitting 400-500 hip fractures annually. A higher than expected mortality was detected amongst these patients, prompting a change in the hip fracture pathway. The aim of this study was to assess the impact of a change in orthogeriatric provision on hip fracture outcomes and care quality indicators. the hip fracture pathway was changed from a geriatric consultation service to a completely integrated service on a dedicated orthogeriatric ward. A total of 1,894 consecutive patients with hip fractures treated in the 2 years before and after this intervention were analysed. despite an increase in case complexity, the intervention resulted in a significant reduction in mean length of stay from 27.5 to 21 days (P < 0.001), a significant reduction in mean time to surgery from 41.8 to 27.2 h (P < 0.001) and a significant 22% reduction in 30-day mortality (13.2-10.3%, P = 0.04). After controlling for the effects of age, gender, American Society of Anesthesiology (ASA) Grade and abbreviated mental test score (AMTS), the effect of integrating orthogeriatric services into the hip fracture pathway significantly reduced the risk of mortality (odds ratio 0.68, P = 0.03). changing our hip fracture service from a geriatric consultation model of care to an integrated orthogeriatric model significantly improved mortality and performance indicators. This is the first study to directly compare two accepted models of orthogeriatric care in the same hospital. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com

[Operative treatment of sacroiliac joint fracture and dislocation in Tile C pelvic fracture with Colorado 2 system].

PubMed

Liu, Shuping; Zhou, Qing; Liu, Yuehong; Chen, Xi; Zhou, Yu; Zhang, Desheng; Fang, Zhi; Xu, Wei

2011-12-01

To explore the effectiveness of Colorado 2 system in the stability reconstruction of sacroiliac joint fracture and dislocation in Tile C pelvic fracture. Between February 2009 and January 2011, 8 cases of Tile C pelvic fracture were treated with Colorado 2 system. There were 3 males and 5 females with an average age of 34.4 years (range, 22-52 years). Fractures were caused by traffic accident in 3 cases, by falling from height in 3 cases, and by crash of heavy object in 2 cases. According to Tile classification, 5 cases were classified as C1-2, 2 cases as C1-3, and 1 case as C2. The time between injury and operation was 5-10 days (mean, 7 days). After skeletal traction reduction, Colorado 2 system was used to fix sacroiliac joint, and reconstruction plate or external fixation was selectively adopted. The postoperative X-ray films showed that the reduction of vertical and rotatory dislocation was satisfactory, posterior pelvic ring achieved effective stability. All the incisions healed by first intention, and no blood vessel or nerve injury occurred. Eight patients were followed up 6-24 months (mean, 12 months). No loosening or breakage of internal fixation was observed and no re-dislocation of sacroiliac joint occurred. The bone healing time was 6-12 months (mean, 9 months). According to Majeed's functional criterion, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case at last follow-up. Colorado 2 system could provide immediate stability of pelvic posterior ring and good maintenance of reduction effect, which is an effective method in the therapy of sacroiliac joint fracture and dislocation in Tile C pelvic fracture.

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.

Prediction of skull fracture risk for children 0-9 months old through validated parametric finite element model and cadaver test reconstruction.

PubMed

Li, Zhigang; Liu, Weiguo; Zhang, Jinhuan; Hu, Jingwen

2015-09-01

Skull fracture is one of the most common pediatric traumas. However, injury assessment tools for predicting pediatric skull fracture risk is not well established mainly due to the lack of cadaver tests. Weber conducted 50 pediatric cadaver drop tests for forensic research on child abuse in the mid-1980s (Experimental studies of skull fractures in infants, Z Rechtsmed. 92: 87-94, 1984; Biomechanical fragility of the infant skull, Z Rechtsmed. 94: 93-101, 1985). To our knowledge, these studies contained the largest sample size among pediatric cadaver tests in the literature. However, the lack of injury measurements limited their direct application in investigating pediatric skull fracture risks. In this study, 50 pediatric cadaver tests from Weber's studies were reconstructed using a parametric pediatric head finite element (FE) model which were morphed into subjects with ages, head sizes/shapes, and skull thickness values that reported in the tests. The skull fracture risk curves for infants from 0 to 9 months old were developed based on the model-predicted head injury measures through logistic regression analysis. It was found that the model-predicted stress responses in the skull (maximal von Mises stress, maximal shear stress, and maximal first principal stress) were better predictors than global kinematic-based injury measures (peak head acceleration and head injury criterion (HIC)) in predicting pediatric skull fracture. This study demonstrated the feasibility of using age- and size/shape-appropriate head FE models to predict pediatric head injuries. Such models can account for the morphological variations among the subjects, which cannot be considered by a single FE human model.

Complications and Reoperations in Mandibular Angle Fractures.

PubMed

Chen, Collin L; Zenga, Joseph; Patel, Ruchin; Branham, Gregory

2018-05-01

Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates. To analyze patient, injury, and surgical factors, including approach to the angle and plating technique, associated with postoperative complications, as well as the rate of reoperation with regard to mandible angle fractures. Retrospective cohort study analyzing the surgical outcomes of patients with mandible angle fractures between January 1, 2000, and December 31, 2015, who underwent open reduction and internal fixation. Patients were eligible if they were aged 18 years or older, had 3 or less mandible fractures with 1 involving the mandibular angle, and had adequate follow-up data. Patients with comminuted angle fractures, bilateral angle fractures, and multiple surgical approaches were excluded. A total of 135 patients were included in the study. All procedures were conducted at a single, large academic hospital located in an urban setting. Major complications and reoperation rates. Major complications included in this study were nonunion, malunion, severe malocclusion, severe infection, and exposed hardware. Of 135 patients 113 (83.7%) were men; median age was 29 years (range, 18-82 years). Eighty-seven patients (64.4%) underwent the transcervical approach and 48 patients (35.6%) received the transoral approach. Fifteen (17.2%) patients in the transcervical group and 9 (18.8%) patients in the transoral group experienced major complications (difference, 1%; 95% CI, -8% to 10%). Thirteen (14.9%) patients in the transcervical group and 8 (16.7%) patients in the transoral group underwent reoperations (difference, 2%; 95% CI, -13% to 17%). Active smoking had a significant effect on the rate of major complications (odds ratio, 4.04; 95% CI, 1.07 to 15.34; P = .04). During repair of noncomminuted mandibular angle fractures, both of the commonly used approaches-transcervical and transoral-can be used during treatment with equal rates of complication and risk of reoperation. For a patient undergoing surgery for mandibular angle fracture, smoking status is more likely to predict surgical outcomes rather than how the surgeon chooses to approach and fixate the fracture. 3.

Thermal analysis of fractures at Cerberus Fossae, Mars: Detection of air convection in the porous debris apron

NASA Astrophysics Data System (ADS)

Antoine, R.; Lopez, T.; Baratoux, D.; Rabinowicz, M.; Kurita, K.

2011-08-01

This study investigates the cause of high nighttime temperatures within Cerberus Fossae, a system of fractures affecting the Central Elysium Planitia. The inner parts (walls and floor) of the fractures are up to 40 K warmer than the surrounding plains. However, several temperature profiles exhibit a local temperature minima occurring in the central part of the fractures. We examined first the influence of cooling efficiency at night in the case of a strong reduction of the sky proportion induced by the fracture's geometry. However, the lack of correlation between temperature and sky proportion, calculated from extracted Mars Orbiter Laser Altimeter (MOLA) profiles argues against this hypothesis. Albedo variations were considered but appear to be limited within the fractures, and are generally not correlated with the temperatures. Variations of the thermal properties of bedrocks exposures, debris aprons and sand dunes inferred from high-resolution images do not either correlate with temperature variations within the fractures. As none of these factors taken alone, or combined, can satisfactorily explain the temperature variations within and near the fracture, we suggest that geothermal heat transported by air convection within the porous debris aprons may contribute to explain high temperatures at night and the local minima on the fracture floor. The conditions for the occurrence of the suggested phenomenon and the consequences on the surface temperature are numerically explored. A conservative geothermal gradient of 20 mW/m 2 was used in the simulations, this value being consistent with either inferred lithosphere elastic thicknesses below the shield volcanoes of the Tharsis dome or values predicted from numerical simulations of the thermal evolution of Mars. The model results indicate that temperature differences of 10-20 K between the central and upper parts of the fracture are explained in the case of high Darcy velocities which require high permeability values (5 × 10 -6 m 2). The presence of coarse material composing the debris aprons may explain why this key criteria was met in the context of Cerberus Fossae.

Temporomandibular joint dysfunction after mandibular fracture in children: a 10-year review.

PubMed

Leuin, Shelby C; Frydendall, Emily; Gao, Dexiang; Chan, Kenny H

2011-01-01

To collect demographic and clinical data on pediatric mandibular fractures and to assess temporomandibular joint (TMJ) dysfunction in patients with condylar and subcondylar (C/SC) fractures. Retrospective case series of pediatric mandibular fractures (1999-2009) with follow-up telephone questionnaire of patients with C/SC fractures. Collected data included age, gender, unilateral vs bilateral C/SC fracture, presence of concomitant fracture, velocity of injury, and treatment modality. Tertiary care children's hospital. Of 164 patients with mandibular fractures, 83 (50.6%) had C/SC fractures, of which 45 (54.2%) completed the questionnaire. Helkimo Anamnestic Dysfunction Index (A(i)) quantification of TMJ dysfunction after C/SC fracture and treatment modality of C/SC fractures. Of the 164 patients, 122 (74.4%) were male (median age, 10.4 years; age range, 0.6-19.0 years). Of the 83 patients with C/SC fractures, 61 (73.5%) were male (median age, 9.1 years; age range, 1.1-18.7 years); 66 (79.5%) had unilateral fractures and 17 (20.5%) had bilateral fractures. The A(i) distribution of the 45 patients who completed the questionnaire was as follows: 15 (33.3%) none, 6 (13.3%) mild, and 24 (53.3%) severe. Females have more severe dysfunction than do males (95% confidence interval, 1.6-140.0; P = .02). No other significant predictors of treatment modality or TMJ dysfunction were identified. Patients with bilateral fracture are 8.1 times (95% confidence interval, 1.0-66.1 times; P = .05) more likely to have closed reduction than are those with unilateral fracture. This is one of the largest series of pediatric C/SC fractures reported in the recent literature. Findings are significant for increased severity of TMJ dysfunction in females and higher incidence of closed reduction in patients with bilateral C/SC 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.

The effects of shot-peening residual stresses on the fracture and crack growth properties of D6AC steel

NASA Technical Reports Server (NTRS)

Elber, W.

1973-01-01

The fracture strength and cyclic crack-growth properties of surface-flawed, shot-peened D6AC steel plate were investigated. For short crack lengths (up to 1.5mm) simple linear elastic fracture mechanics - based only on applied loading - did not predict the fracture strengths. Also, Paris' Law for cyclic crack growth did not correlate the crack-growth behavior. To investigate the effect of shot-peening, additional fracture and crack-growth tests were performed on material which was precompressed to remove the residual stresses left by the shot-peening. Both tests and analysis show that the shot-peening residual stresses influence the fracture and crack-growth properties of the material. The analytical method of compensating for residual stresses and the fracture and cyclic crack-growth test results and predictions are presented.

Effects of shot-peening residual stresses on the fracture and crack-growth properties of D6AC steel

NASA Technical Reports Server (NTRS)

Elber, W.

1974-01-01

The fracture strength and cyclic crack-growth properties of surface-flawed, shot-peened D6AC steel plate were investigated. For short crack lengths (up to 1.5 mm) simple linear elastic fracture mechanics - based only on applied loading - did not predict the fracture strengths. Also, Paris' Law for cyclic crack growth did not correlate the crack-growth behavior. To investigate the effect of shot-peening, additional fracture and crack-growth tests were performed on material which was precompressed to remove the residual stresses left by the shot-peening. Both tests and analysis show that shot-peening residual stresses influence the fracture and crack-growth properties of the material. This report presents the analytical method of compensating for residual stresses and the fracture and cyclic crack-growth test results and predictions.

Effects of footwear and stride length on metatarsal strains and failure in running.

PubMed

Firminger, Colin R; Fung, Anita; Loundagin, Lindsay L; Edwards, W Brent

2017-11-01

The metatarsal bones of the foot are particularly susceptible to stress fracture owing to the high strains they experience during the stance phase of running. Shoe cushioning and stride length reduction represent two potential interventions to decrease metatarsal strain and thus stress fracture risk. Fourteen male recreational runners ran overground at a 5-km pace while motion capture and plantar pressure data were collected during four experimental conditions: traditional shoe at preferred and 90% preferred stride length, and minimalist shoe at preferred and 90% preferred stride length. Combined musculoskeletal - finite element modeling based on motion analysis and computed tomography data were used to quantify metatarsal strains and the probability of failure was determined using stress-life predictions. No significant interactions between footwear and stride length were observed. Running in minimalist shoes increased strains for all metatarsals by 28.7% (SD 6.4%; p<0.001) and probability of failure for metatarsals 2-4 by 17.3% (SD 14.3%; p≤0.005). Running at 90% preferred stride length decreased strains for metatarsal 4 by 4.2% (SD 2.0%; p≤0.007), and no differences in probability of failure were observed. Significant increases in metatarsal strains and the probability of failure were observed for recreational runners acutely transitioning to minimalist shoes. Running with a 10% reduction in stride length did not appear to be a beneficial technique for reducing the risk of metatarsal stress fracture, however the increased number of loading cycles for a given distance was not detrimental either. Copyright © 2017 Elsevier Ltd. All rights reserved.

Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures.

PubMed

Jawad, Z; Odumala, A; Jones, M

2012-06-01

Hip injuries are becoming a more common problem as the elderly population increases and their management represents a significant proportion of health care costs. Diagnosis of a fracture based on clinical assessment and plain films is not always conclusive and further investigations for such occult fractures, such as magnetic resonance imaging (MRI), are sometimes required which are expensive and may be difficult to access. Disruption to the conduction of a sound wave travelling through a fractured bone is a concept that has been used to diagnose fractures. In our study we used a tuning fork with frequency of 128 Hz to objectively measure the reduction in sound amplitude in fractured and non-fractured hips. We looked at the feasibility of using this test as a diagnostic tool for neck of femur fractures. A total of 20 patients was included in the study, using MRI scan as the standard for comparison of diagnostic findings. Informed consent was obtained from the patients. There was a significant difference in the amplitude reduction of the sound waves when comparing normal to fractured hips. This was 0.9 in normal hips, compared to 0.31 and 0.18 in intra-capsular and extra-capsular fractures, respectively. Our test was 80% accurate at diagnosing neck of femur fractures. In conclusion this test may be used as a diagnostic test or screening tool in the assessment of occult hip fractures. Copyright © 2011 Elsevier Ltd. All rights reserved.

Talocrural Dislocation With Associated Weber Type C Fibular Fracture in a Collegiate Football Player: A Case Report

PubMed Central

Ricci, R Daniel; Cerullo, James; Blanc, Robert O; McMahon, Patrick J; Buoncritiani, Anthony M; Stone, David A; Fu, Freddie H

2008-01-01

Objective: To present the case of a talocrural dislocation with a Weber type C fibular fracture in a National Collegiate Athletic Association Division I football athlete. Background: The athlete, while attempting to make a tackle during a game, collided with an opponent, who in turn stepped on the lateral aspect of the athlete's ankle, resulting in forced ankle eversion and external rotation. On-field evaluation showed a laterally displaced talocrural dislocation. Immediate reduction was performed in the athletic training room to maintain skin integrity. Post-reduction radiographs revealed a Weber type C fibular fracture and increased medial joint clear space. A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Differential Diagnosis: Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption. Treatment: The sports medicine staff immediately splinted and transported the athlete to the athletic training room to reduce the dislocation. The athlete then underwent an open reduction and internal fixation procedure to stabilize the injury: 2 syndesmosis screws and a fibular plate were placed to keep the ankle joint in an anatomically reduced position. With the guidance of the athletic training staff, the athlete underwent an accelerated physical rehabilitation protocol in an effort to return to sport as quickly and safely as possible. Uniqueness: Most talocrural dislocations and associated Weber type C fibular fractures are due to motor vehicle accidents or falls. We are the first to describe this injury in a Division I football player and to present a general rehabilitation protocol for a high-level athlete. Conclusions: Sports medicine practitioners must recognize that this injury can occur in the athletic environment. Prompt reduction, early surgical intervention, sufficient resources, and an accelerated rehabilitation protocol all contributed to a successful outcome in the patient. PMID:18523569

Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures.

PubMed

Jensen, Courtney D; Stark, Jamie T; Jacobson, Lewis L; Powers, Jan M; Joseph, Michael F; Kinsella-Shaw, Jeffrey M; Denegar, Craig R

2017-09-01

Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated. We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated. Mortality was assessed with binary logistic regressions. Across the total population, mortality was 6.7%; incidence of pneumonia was 11.1%; mechanical ventilation was required in 23.8% of patients, for an average duration of 10.0 days; average stay in the hospital was 7.7 nights; and 49.7% of patients were admitted to the ICU for an average of 7.2 nights. Epidural analgesia was administered to 18.4% of patients. After matching samples for candidacy, patients who received epidurals were 3.7 years older, fractured 2.6 more ribs, had higher injury severity scores, and were more likely to present with bilateral fractures, flail segments, pulmonary contusions, hemothoraces, and pneumothoraces. Despite greater injury severity, mortality among these patients was lower (0.5%) than those who received alternative care (1.9%). Controlling for age, injury severity, and use of mechanical ventilation, epidural analgesia predicted a 97% reduction in mortality. Thoracic epidural analgesia associates with reduced mortality in rib fracture patients. Better care of this population is likely to be facilitated by more frequent reliance on this treatment. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Multi-scale Fracture Patterns Associated with a Complex Anticline Structure: Insights from Field Outcrop Analogues of the Jebel Hafit Pericline, Al Ain-UAE

NASA Astrophysics Data System (ADS)

Kokkalas, S.; Jones, R. R.; Long, J. J.; Zampos, M.; Wilkinson, M. W.; Gilment, S.

2017-12-01

The formation of folds and their associated fracture patterns plays an important role in controlling the migration and concentration of fluids within the upper crust. Prediction of fracture patterns from various fold shapes and kinematics still remains poorly understood in terms of spatial and temporal distribution of fracture sets. Thus, a more detailed field-based multi scale approach is required to better constrain 3D models of fold-fracture relationships, which are critical for reservoir characterization studies. In order to generate reservoir-scale fracture models representative fracture properties across a wider range of scales are needed. For this reason we applied modern geospatial technologies, including terrestrial LiDAR, photogrammetry and satellite images in the asymmetric, east verging, four-way closure Jebel Hafit anticline, in the eastern part of the United Arab Emirates. The excellent surface outcrops allowed the rapid acquisition of extensive areas of fracture data from both limbs and fold hinge area of the anticline, even from large areas of steep exposure that are practically inaccessible on foot. The digital outcrops provide longer 1D transects, and 2D or 3D surface datasets and give more robust data, particularly for fracture heights, lengths, spacing, clustering, termination and connectivity. The fracture patterns across the folded structure are more complex than those predicted from conceptual models and geomechanical fracture modeling. Mechanical layering, pre-existing structures and sedimentation during fold growth seem to exert a critical influence in the development of fracture systems within Jebel Hafit anticline and directly affect fracture orientations, spacing/intensity, segmentation and connectivity. Seismic and borehole data provide additional constraints on the sub-surface fold geometry and existence of large-scale thrusting in the core of the anticline. The complexity of the relationship between fold geometry and fracture intensity is presented and the implications for prediction of fracture networks in naturally fractured reservoirs are discussed.

Accuracy of three-dimensional facial soft tissue simulation in post-traumatic zygoma reconstruction.

PubMed

Li, P; Zhou, Z W; Ren, J Y; Zhang, Y; Tian, W D; Tang, W

2016-12-01

The aim of this study was to evaluate the accuracy of novel software-CMF-preCADS-for the prediction of soft tissue changes following repositioning surgery for zygomatic fractures. Twenty patients who had sustained an isolated zygomatic fracture accompanied by facial deformity and who were treated with repositioning surgery participated in this study. Cone beam computed tomography (CBCT) scans and three-dimensional (3D) stereophotographs were acquired preoperatively and postoperatively. The 3D skeletal model from the preoperative CBCT data was matched with the postoperative one, and the fractured zygomatic fragments were segmented and aligned to the postoperative position for prediction. Then, the predicted model was matched with the postoperative 3D stereophotograph for quantification of the simulation error. The mean absolute error in the zygomatic soft tissue region between the predicted model and the real one was 1.42±1.56mm for all cases. The accuracy of the prediction (mean absolute error ≤2mm) was 87%. In the subjective assessment it was found that the majority of evaluators considered the predicted model and the postoperative model to be 'very similar'. CMF-preCADS software can provide a realistic, accurate prediction of the facial soft tissue appearance after repositioning surgery for zygomatic fractures. The reliability of this software for other types of repositioning surgery for maxillofacial fractures should be validated in the future. Copyright © 2016. Published by Elsevier Ltd.

Non union of an epiphyseal fibular fracture in a pediatric patient.

PubMed

Mirmiran, Roya; Schuberth, John M

2006-01-01

There are few reports on delayed or nonunion in the pediatric ankle fracture. The authors present a case of a nonunion of a mid-epiphyseal fracture of the distal fibula, described as a type 7 pediatric fracture. Both the occurrence of this injury pattern and a nonunion has not been reported in the same patient. Operative reduction of the nonunion resulted in a satisfactory outcome.

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

Tensile and fracture properties of type 316 stainless steel after creep

NASA Astrophysics Data System (ADS)

Gan, D.

1982-12-01

The effects of creep on the mechanical properties of type 316 stainless steel were studied. Tensile and Charpy specimens were machined from the oversize specimens crept at 750 °C and 103 MPa. The ambient fracture energy was found to deteriorate rapidly after creep. The ambient yield stress was increased moderately, but the tensile ductility was severely reduced. The effects of intergranular carbides alone on mechanical properties were studied with specimens thermal aged without load. These carbides were shown to cause a moderate reduction in fracture energy and tensile ductility but had little effect on yield stress. Extensive grain boundary separations were observed on the fracture surfaces. SEM studies showed that these grain boundaries were covered with micro voids initiated by the dense intergranular carbides. Frequently, large dimples on grain boundary joined up and initiated shear fracture into the grain. In the crept specimens additional microstructural changes in the form of intragranular carbides and subgrain boundaries were observed. Both are responsible for the increase in yield stress and the further reduction in tensile ductility and fracture energy. The intragranular carbides also modified the size and density of the dimples on the fracture surfaces.

Frictional stability-permeability relationships for fractures in shales

NASA Astrophysics Data System (ADS)

Fang, Yi; Elsworth, Derek; Wang, Chaoyi; Ishibashi, Takuya; Fitts, Jeffrey P.

2017-03-01

There is wide concern that fluid injection in the subsurface, such as for the stimulation of shale reservoirs or for geological CO2 sequestration (GCS), has the potential to induce seismicity that may change reservoir permeability due to fault slip. However, the impact of induced seismicity on fracture permeability evolution remains unclear due to the spectrum of modes of fault reactivation (e.g., stable versus unstable). As seismicity is controlled by the frictional response of fractures, we explore friction-stability-permeability relationships through the concurrent measurement of frictional and hydraulic properties of artificial fractures in Green River shale (GRS) and Opalinus shale (OPS). We observe that carbonate-rich GRS shows higher frictional strength but weak neutral frictional stability. The GRS fracture permeability declines during shearing while an increased sliding velocity reduces the rate of permeability decline. By comparison, the phyllosilicate-rich OPS has lower friction and strong stability while the fracture permeability is reduced due to the swelling behavior that dominates over the shearing induced permeability reduction. Hence, we conclude that the friction-stability-permeability relationship of a fracture is largely controlled by mineral composition and that shale mineral compositions with strong frictional stability may be particularly subject to permanent permeability reduction during fluid infiltration.

Multiscale model reduction for shale gas transport in poroelastic fractured media

NASA Astrophysics Data System (ADS)

Akkutlu, I. Yucel; Efendiev, Yalchin; Vasilyeva, Maria; Wang, Yuhe

2018-01-01

Inherently coupled flow and geomechanics processes in fractured shale media have implications for shale gas production. The system involves highly complex geo-textures comprised of a heterogeneous anisotropic fracture network spatially embedded in an ultra-tight matrix. In addition, nonlinearities due to viscous flow, diffusion, and desorption in the matrix and high velocity gas flow in the fractures complicates the transport. In this paper, we develop a multiscale model reduction approach to couple gas flow and geomechanics in fractured shale media. A Discrete Fracture Model (DFM) is used to treat the complex network of fractures on a fine grid. The coupled flow and geomechanics equations are solved using a fixed stress-splitting scheme by solving the pressure equation using a continuous Galerkin method and the displacement equation using an interior penalty discontinuous Galerkin method. We develop a coarse grid approximation and coupling using the Generalized Multiscale Finite Element Method (GMsFEM). GMsFEM constructs the multiscale basis functions in a systematic way to capture the fracture networks and their interactions with the shale matrix. Numerical results and an error analysis is provided showing that the proposed approach accurately captures the coupled process using a few multiscale basis functions, i.e. a small fraction of the degrees of freedom of the fine-scale problem.

Intraoperative CT in the assessment of posterior wall acetabular fracture stability.

PubMed

Cunningham, Brian; Jackson, Kelly; Ortega, Gil

2014-04-01

Posterior wall acetabular fractures that involve 10% to 40% of the posterior wall may or may not require an open reduction and internal fixation. Dynamic stress examination of the acetabular fracture under fluoroscopy has been used as an intraoperative method to assess joint stability. The aim of this study was to demonstrate the value of intraoperative ISO computed tomography (CT) examination using the Siemens ISO-C imaging system (Siemens Corp, Malvern, Pennsylvania) in the assessment of posterior wall acetabular fracture stability during stress examination under anesthesia. In 5 posterior wall acetabular fractures, standard fluoroscopic images (including anteroposterior pelvis and Judet radiographs) with dynamic stress examinations were compared with the ISO-C CT imaging system to assess posterior wall fracture stability during stress examination. After review of standard intraoperative fluoroscopic images under dynamic stress examination, all 5 cases appeared to demonstrate posterior wall stability; however, when the intraoperative images from the ISO-C CT imaging system demonstrated that 1 case showed fracture instability of the posterior wall segment during stress examination, open reduction and internal fixation was performed. The use of intraoperative ISO CT imaging has shown an initial improvement in the surgeon's ability to assess the intraoperative stability of posterior wall acetabular fractures during stress examination when compared with standard fluoroscopic images. Copyright 2014, SLACK Incorporated.

Complementary hydro-mechanical coupled finite/discrete element and microseismic modelling to predict hydraulic fracture propagation in tight shale reservoirs

NASA Astrophysics Data System (ADS)

Profit, Matthew; Dutko, Martin; Yu, Jianguo; Cole, Sarah; Angus, Doug; Baird, Alan

2016-04-01

This paper presents a novel approach to predict the propagation of hydraulic fractures in tight shale reservoirs. Many hydraulic fracture modelling schemes assume that the fracture direction is pre-seeded in the problem domain discretisation. This is a severe limitation as the reservoir often contains large numbers of pre-existing fractures that strongly influence the direction of the propagating fracture. To circumvent these shortcomings, a new fracture modelling treatment is proposed where the introduction of discrete fracture surfaces is based on new and dynamically updated geometrical entities rather than the topology of the underlying spatial discretisation. Hydraulic fracturing is an inherently coupled engineering problem with interactions between fluid flow and fracturing when the stress state of the reservoir rock attains a failure criterion. This work follows a staggered hydro-mechanical coupled finite/discrete element approach to capture the key interplay between fluid pressure and fracture growth. In field practice, the fracture growth is hidden from the design engineer and microseismicity is often used to infer hydraulic fracture lengths and directions. Microseismic output can also be computed from changes of the effective stress in the geomechanical model and compared against field microseismicity. A number of hydraulic fracture numerical examples are presented to illustrate the new technology.

Surrogate Modeling of High-Fidelity Fracture Simulations for Real-Time Residual Strength Predictions

NASA Technical Reports Server (NTRS)

Spear, Ashley D.; Priest, Amanda R.; Veilleux, Michael G.; Ingraffea, Anthony R.; Hochhalter, Jacob D.

2011-01-01

A surrogate model methodology is described for predicting in real time the residual strength of flight structures with discrete-source damage. Starting with design of experiment, an artificial neural network is developed that takes as input discrete-source damage parameters and outputs a prediction of the structural residual strength. Target residual strength values used to train the artificial neural network are derived from 3D finite element-based fracture simulations. A residual strength test of a metallic, integrally-stiffened panel is simulated to show that crack growth and residual strength are determined more accurately in discrete-source damage cases by using an elastic-plastic fracture framework rather than a linear-elastic fracture mechanics-based method. Improving accuracy of the residual strength training data would, in turn, improve accuracy of the surrogate model. When combined, the surrogate model methodology and high-fidelity fracture simulation framework provide useful tools for adaptive flight technology.

Acoustic Emission Based Surveillance System for Prediction of Stress Fractures

DTIC Science & Technology

2007-09-01

aging are susceptible to such fractures in contexts of osteoporosis, diabetes, cerebral palsy, fibrous dysplasia and osteogenesis imperfecta . This...disease, or, healthy people who have excessive exercise regimes (soldiers and athletes) experience these fractures [2]. Stress fractures interrupt

Height Loss Predicts Subsequent Hip Fracture in Men and Women of the Framingham Study

PubMed Central

Hannan, Marian T.; Broe, Kerry E.; Cupples, L. Adrienne; Dufour, Alyssa B.; Rockwell, Margo; Kiel, Douglas P.

2013-01-01

Background Although height is a risk factor for osteoporotic fracture, current risk assessments do not consider height loss. Height loss may be a simple measurement that clinicians could use to predict fracture or need for further testing. Objective To examine height loss and subsequent hip fracture, evaluating both long-term adult height loss and recent height loss. Methods Prospective cohort of 3,081 adults from the Framingham Heart Study. Height was measured biennially since 1948, and cohort followed for hip fracture through 2005. Adult height loss from middle-age years across 24 years and recent height loss in elderly years were considered. Cox proportional hazard regression was used to estimate association between height loss and risk of hip fracture. Results Of 1,297 men and 1,784 women, mean baseline age was 66y (SD7.8). Average height loss for men was 1.06 inches (0.76), and for women was 1.12 inches (0.84). 11% of men and 15% of women lost ≤ 2 inches of height. Mean follow-up was 17y during which 71 men and 278 women had incident hip fractures. For each 1-inch of height loss, HR=1.4 in men (95%CI: 1.00, 1.99), and 1.04 in women (95%CI: 0.88, 1.23). Men and women who lost ≤ 2 inches of height had increased fracture risk (compared to 0 to <2 inches) of borderline significance: men HR=1.8, 95%CI: 0.86, 3.61; women HR=1.3, 95%CI: 0.90, 1.76. Recent height loss in elders significantly increased the risk of hip fracture, 54% in men and 21% in women (95%CI: 1.14, 2.09; 1.03, 1.42, respectively). Conclusions Adult height loss predicted hip fracture risk in men in our study. Recent height loss in elderly men and women predicted risk of hip fracture. PMID:22072590

Quartz c-axis orientation patterns in fracture cement as a measure of fracture opening rate and a validation tool for fracture pattern models

DOE PAGES

Ukar, Estibalitz; Laubach, Stephen E.; Marrett, Randall

2016-03-09

Here, we evaluate a published model for crystal growth patterns in quartz cement in sandstone fractures by comparing crystal fracture-spanning predictions to quartz c-axis orientation distributions measured by electron backscatter diffraction (EBSD) of spanning quartz deposits. Samples from eight subvertical opening-mode fractures in four sandstone formations, the Jurassic– Cretaceous Nikanassin Formation, northwestern Alberta Foothills (Canada), Cretaceous Mesaverde Group (USA; Cozzette Sandstone Member of the Iles Formation), Piceance Basin, Colorado (USA), and upper Jurassic–lower Cretaceous Cotton Valley Group (Taylor sandstone) and overlying Travis Peak Formation, east Texas, have similar quartzose composition and grain size but contain fractures with different temperature historiesmore » and opening rates based on fluid inclusion assemblages and burial history. Spherical statistical analysis shows that, in agreement with model predictions, bridging crystals have a preferred orientation with c-axis orientations at a high angle to fracture walls. The second form of validation is for spanning potential that depends on the size of cut substrate grains. Using measured cut substrate grain sizes and c-axis orientations of spanning bridges, we calculated the required orientation for the smallest cut grain to span the maximum gap size and the required orientation of the crystal with the least spanning potential to form overgrowths that span across maximum measured gap sizes. We find that within a 10° error all spanning crystals conform to model predictions. Using crystals with the lowest spanning potential based on crystallographic orientation (c-axis parallel to fracture wall) and a temperature range for fracture opening measured from fluid inclusion assemblages, we calculate maximum fracture opening rates that allow crystals to span. These rates are comparable to those derived independently from fracture temperature histories based on burial history and multiple sequential fluid inclusion assemblages. Results support the R. Lander and S. Laubach model, which predicts that for quartz deposited synchronously with fracture opening, spanning potential, or likelihood of quartz deposits that are thick enough to span between fracture walls, depends on temperature history, fracture opening rate, size of opening increments, and size, mineralogy, and crystallographic orientation of substrates in the fracture wall (transected grains). Results suggest that EBSD maps, which can be more rapidly acquired than measurement of tens to hundreds of fluid inclusion assemblages, can provide a useful measure of relative opening rates within populations of quartz-filled fractures formed under sedimentary basin conditions. Such data are useful for evaluating fracture pattern development models.« less

Quartz c-axis orientation patterns in fracture cement as a measure of fracture opening rate and a validation tool for fracture pattern models

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

Ukar, Estibalitz; Laubach, Stephen E.; Marrett, Randall

Here, we evaluate a published model for crystal growth patterns in quartz cement in sandstone fractures by comparing crystal fracture-spanning predictions to quartz c-axis orientation distributions measured by electron backscatter diffraction (EBSD) of spanning quartz deposits. Samples from eight subvertical opening-mode fractures in four sandstone formations, the Jurassic– Cretaceous Nikanassin Formation, northwestern Alberta Foothills (Canada), Cretaceous Mesaverde Group (USA; Cozzette Sandstone Member of the Iles Formation), Piceance Basin, Colorado (USA), and upper Jurassic–lower Cretaceous Cotton Valley Group (Taylor sandstone) and overlying Travis Peak Formation, east Texas, have similar quartzose composition and grain size but contain fractures with different temperature historiesmore » and opening rates based on fluid inclusion assemblages and burial history. Spherical statistical analysis shows that, in agreement with model predictions, bridging crystals have a preferred orientation with c-axis orientations at a high angle to fracture walls. The second form of validation is for spanning potential that depends on the size of cut substrate grains. Using measured cut substrate grain sizes and c-axis orientations of spanning bridges, we calculated the required orientation for the smallest cut grain to span the maximum gap size and the required orientation of the crystal with the least spanning potential to form overgrowths that span across maximum measured gap sizes. We find that within a 10° error all spanning crystals conform to model predictions. Using crystals with the lowest spanning potential based on crystallographic orientation (c-axis parallel to fracture wall) and a temperature range for fracture opening measured from fluid inclusion assemblages, we calculate maximum fracture opening rates that allow crystals to span. These rates are comparable to those derived independently from fracture temperature histories based on burial history and multiple sequential fluid inclusion assemblages. Results support the R. Lander and S. Laubach model, which predicts that for quartz deposited synchronously with fracture opening, spanning potential, or likelihood of quartz deposits that are thick enough to span between fracture walls, depends on temperature history, fracture opening rate, size of opening increments, and size, mineralogy, and crystallographic orientation of substrates in the fracture wall (transected grains). Results suggest that EBSD maps, which can be more rapidly acquired than measurement of tens to hundreds of fluid inclusion assemblages, can provide a useful measure of relative opening rates within populations of quartz-filled fractures formed under sedimentary basin conditions. Such data are useful for evaluating fracture pattern development models.« less

Expedited CT-Based Methods for Evaluating Fracture Severity to Assess Risk of Post-Traumatic Osteoarthritis After Articular Fractures.

PubMed

Anderson, Donald D; Kilburg, Anthony T; Thomas, Thaddeus P; Marsh, J Lawrence

2016-01-01

Post-traumatic osteoarthritis (PTOA) is common after intra-articular fractures of the tibial plafond. An objective CT-based measure of fracture severity was previously found to reliably predict whether PTOA developed following surgical treatment of such fractures. However, the extended time required obtaining the fracture energy metric and its reliance upon an intact contralateral limb CT limited its clinical applicability. The objective of this study was to establish an expedited fracture severity metric that provided comparable PTOA predictive ability without the prior limitations. An expedited fracture severity metric was computed from the CT scans of 30 tibial plafond fractures using textural analysis to quantify disorder in CT images. The expedited method utilized an intact surrogate model to enable severity assessment without requiring a contralateral limb CT. Agreement between the expedited fracture severity metric and the Kellgren-Lawrence (KL) radiographic OA score at two-year follow-up was assessed using concordance. The ability of the metric to differentiate between patients that did or did not develop PTOA was assessed using the Wilcoxon Ranked Sum test. The expedited severity metric agreed well (75.2% concordance) with the KL scores. The initial fracture severity of cases that developed PTOA differed significantly (p = 0.004) from those that did not. Receiver operating characteristic analysis showed that the expedited severity metric could accurately predict PTOA outcome in 80% of the cases. The time required to obtain the expedited severity metric averaged 14.9 minutes/ case, and the metric was obtained without using an intact contralateral CT. The expedited CT-based methods for fracture severity assessment present a solution to issues limiting the utility of prior methods. In a relatively short amount of time, the expedited methodology provided a severity score capable of predicting PTOA risk, without needing to have the intact contralateral limb included in the CT scan. The described methods provide surgeons an objective, quantitative representation of the severity of a fracture. Obtained prior to the surgery, it provides a reasonable alternative to current subjective classification systems. The expedited severity metric offers surgeons an objective means for factoring severity of joint insult into treatment decision-making.

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.

High degree of patient satisfaction after percutaneous treatment of lateral tibia plateau fractures.

PubMed

Elsøe, Rasmus; Larsen, Peter; Rasmussen, Sten; Hansen, Hans Ager; Eriksen, Christian Berre

2016-01-01

The outcomes and complications following surgical treatment of tibial plateau fractures have been widely reported. The objective of this study was to evaluate the quality of life (QoL), functional and radiological outcomes after lateral tibial plateau fractures, Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 41-B2 and B3, treated with minimally invasive bone tamp reduction, allograft and percutaneous screw fixation. This study was a cross-sectional study and a retrospective review and clinical evaluation of patients treated with minimally invasive bone tamp reduction, allograft and percutaneous screw fixation after lateral tibial plateau fractures between 2005 and 2010. The patients completed a clinical examination, Knee Injury and Osteoarthritis Outcome Score (KOOS) and a questionnaire for evaluation of QoL (Eq5D-5L). A total of 28 patients agreed to participate (71%). The mean follow-up time was 2.5 years. Maintained anatomical joint reduction and alignment was achieved in 23 cases. The mean Eq5D-5L index was 0.850. The mean KOOS scores were: pain = 79.9, ADL = 80.8, symptoms = 73.0, QoL = 61.3 and sport = 54.4. Compared with Eq5D-5L reference norms, patients did not report significantly lower scores. Compared with a KOOS reference group, patients reported significantly lower KOOS scores in three subscales. Tibial plateau fractures AO type 41-B2 and 41-B3 treated with minimally invasive bone tamp reduction, allograft and percutaneous screw fixation showed a high rate of anatomical reduction (82%), a low rate of complications (3.5%) and a high level of satisfactory patient-reported QoL. none. not relevant.

Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures.

PubMed

Mathew, G; Kowalczuk, M; Hetaimish, B; Bedi, A; Philippon, M J; Bhandari, M; Simunovic, N; Crouch, S; Ayeni, O R

2014-04-01

The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥ 50 years) who have undergone internal fixation for femoral neck fracture. A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head-neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement. Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes. There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.

Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

PubMed

Hinds, Richard M; Garner, Matthew R; Lazaro, Lionel E; Warner, Stephen J; Loftus, Michael L; Birnbaum, Jacqueline F; Burket, Jayme C; Lorich, Dean G

2015-02-01

The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level III, retrospective comparative study. © The Author(s) 2014.

Team physician #5. Salter-Harris type I fracture of the distal radius due to weightlifting.

PubMed

Weiss, A P; Sponseller, P D

1989-02-01

A Salter-Harris Type I distal radius fracture was sustained by a skeletally immature adolescent while performing a supine bench press during weight training. Closed reduction was accomplished without difficulty. Fractures in adolescence due to weightlifting are rare but illustrate the need for proper instruction and supervision.

[Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures].

PubMed

Chuanjun, Chen; Xiaoyang, Chen; Jing, Chen

2016-10-01

This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures.

PubMed

Dong, Wen-Wei; Shi, Zeng-Yuan; Liu, Zheng-Xin; Mao, Hai-Jiao

2016-12-01

To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

Transmasseteric anterior parotid approach for condylar fractures: experience of 129 cases.

PubMed

Narayanan, Vinod; Ramadorai, Ashok; Ravi, Poornima; Nirvikalpa, Natarajan

2012-07-01

We have evaluated the transmasseteric anterior parotid (TMAP) approach in the treatment of 163 condylar fractures in 129 patients. Ninety-five patients presented with unilateral, and 34 with bilateral, fractures. The inclusion criteria were patient's choice for open reduction and internal fixation, displaced unilateral condylar fractures with occlusal derangement, and displaced bilateral condylar fractures with anterior open bite. Mean (SD) maximum interincisal opening after 3 months was 44(5)mm. There were no differences in lateral movements during the reviews 6 weeks and 3 months postoperatively. Protrusive movement at the end of 3 months was 7(2)mm. All patients achieved functional occlusion identical to the pretraumatic occlusion and good reduction of the condyles. No patient developed temporary or permanent facial palsy, sialocele, salivary fistula, or Frey syndrome. The mean (SD) operating time was 46(11)min. The TMAP approach avoids the complications of incision of the parotid gland, minimises the risk of facial nerve palsy, and offers excellent access to the fractured condyle. Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[Manipulative reduction and small splint fixation combined with micromovement exercise for treatment of humeral shaft fractures].

PubMed

Tang, Hao-chen; Xiang, Ming; Chen, Hang; Hu, Xiao-chuan; Yang, Guo-yong

2016-01-01

To investigate the therapeutic efficacy of bone-setting manipulative reduction and small splint fixation combined with micro-movement theory exercise for treatment of humeral shaft fractures. From March 2011 to February 2014, 64 cases of humeral shaft fractures were treated by bone-setting manipulative reduction and small splint fixation including 28 males and 36 females with an average age of 38.1 years old ranging from 22 to 67 years old. According to the classification of AO/OTA, there were 10 cases of type A1, 12 cases of type A2,11 cases of type A3,10 cases of type B1,12 cases of type B2, 7 cases of type B3, 2 cases of type C1, 1 case of type C2, 1 case of type C3. After close reduction early functional exercise performed according to micro-movement theory. All patients had no other parts of the fractures, neurovascular injury, and serious medical problems. Patients were followed up for fracture healing, shoulder and elbow joint function recovery, and curative effect. All patients were followed up from 10 to 12 months with an average of 10.3 months. Of them, 2 cases had a small amount of callus growth at 3 months after close reduction, so instead of operation; 2 cases appeared radial nerve symptoms after close reduction ,so instead of operation. Other patients were osseous healing, the time was 8 to 12 weeks with an average of 10.2 weeks. After osseous healing, according to Constant-Murley score system ,the average score was (93.5 ± 3.2) points, the result was excellent in 29 cases, good in 29 cases, fair in 6 cases, excellent and good rate was 90.3%; according to the Mayo score system, the average score was (93.7 ± 4.2) points, the result was excellent in 35 cases, good in 23 cases, fair in 6 cases, excellent and good rate was 91.9%. Bone-setting manipulative reduction and small splint fixation combined with micromovement theory exercise for treatment of humeral shaft fractures has advantage of positive effect, easy and inexpensive method, the treatment has relevant scientific basis and practical value, it can effectively reduce complications, promote patients early recovery.

The new intra-articular calcaneal fracture classification system in term of sustentacular fragment configurations and incorporation of posterior calcaneal facet fractures with fracture components of the calcaneal body.

PubMed

Harnroongroj, Thossart; Harnroongroj, Thos; Suntharapa, Thongchai; Arunakul, Marut

2016-10-01

The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. The new classification system used sustentacular fragment configuration and relation of posterior calcaneal facet fracture with fracture components of calcaneal body as key aspects of main types and subtypes. Between 2000 and 2014, 126 intraarticular calcaneal fractures were classified according to the new classification system by using computed tomography images. The new classification system was studied in term of reliability, correlation to choices of treatment, implant fixation and quality of fracture reduction. Types of sustentacular fragment comprised type A, B and C. Type A sustentacular fragment included sustentacular tali containing middle calcaneal facet. In Type B and C fractures sustentacular fragment included medial aspect and entire posterior calcaneal facet as a single unit, respectively. The fractures with type A, B and C sustentacular fragments were classified as main type A, B and C intra-articular calcaneal fractures. The main type A and B comprised 4 subtypes. Subtypes A1, A3, B1, and B3 associated with avulsion and bending fragments of calcaneal body. Subtype A2, B2, and B4 associated with burst calcaneal body. Subtype B4 was not found in the study. Main type C had no subtype and associated with burst calcaneal body. The data showed good reliability. The study showed that our new intra-articular calcaneal fracture classification system correlates to choices of treatment, implant fixation and quality of fracture reduction. Level IV, Study of Diagnostic Test. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates.

PubMed

Somasundaram, K; Huber, C P; Babu, V; Zadeh, H

2013-04-01

The aim of our study is to analyse the results of our surgical technique for the treatment of proximal humeral fractures and fracture dislocations using locking plates in conjunction with calcium sulphate bone-substitute augmentation and tuberosity repair using high-strength sutures. We used the extended deltoid-splitting approach for fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations. Optimal surgical management of proximal humeral fractures remains controversial. Locking plates have become a popular method of fixation. However, failure of fixation may occur if they are used as the sole method of fixation in comminuted fractures, especially in osteopenic bone. We retrospectively analysed 22 proximal humeral fractures in 21 patients; 10 were male and 11 female with an average age of 64.6 years (range 37-77). Average follow-up was 24 months. Eleven of these fractures were exposed by the extended deltoid-splitting approach. Fractures were classified according to Neer and Hertel systems. Preoperative radiographs and computed tomography (CT) scans in three- and four-part fractures were done to assess the displacement and medial calcar length for predicting the humeral head vascularity. According to the Neer classification, there were five two-part, six three-part, five four-part fractures and six fracture-dislocations (two anterior and four posterior). Results were assessed clinically with disabilities of the arm, shoulder and hand (DASH) scores, modified Constant and Murley scores and serial postoperative radiographs. The mean DASH score was 16.18 and the modified Constant and Murley score was 64.04 at the last follow-up. Eighteen out of twenty-two cases achieved good clinical outcome. All the fractures united with no evidence of infection, failure of fixation, malunion, tuberosity failure, avascular necrosis or adverse reaction to calcium sulphate bone substitute. There was no evidence of axillary nerve injury. Four patients had a longer recovery period due to stiffness, associated wrist fracture and elbow dislocation. The CaSO4 bone substitute was replaced by normal appearing trabecular bone texture at an average of 6 months in all patients. In our experience, we have found the use of locking plates, calcium sulphate bone substitute and tuberosity repair with high-strength sutures to be a safe and reliable method of internal fixation for complex proximal humeral fractures and fracture-dislocations. Furthermore, we have also found the use of the extended deltoid-splitting approach to be safe and to provide excellent exposure facilitating accurate reduction for fixation of the fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Progressive Damage Methodology for Residual Strength Predictions of Notched Composite Panels

NASA Technical Reports Server (NTRS)

Coats, Timothy W.; Harris, Charles E.

1998-01-01

The translaminate fracture behavior of carbon/epoxy structural laminates with through-penetration notches was investigated to develop a residual strength prediction methodology for composite structures. An experimental characterization of several composite materials systems revealed a fracture resistance behavior that was very similar to the R-curve behavior exhibited by ductile metals. Fractographic examinations led to the postulate that the damage growth resistance was primarily due to fractured fibers in the principal load-carrying plies being bridged by intact fibers of the adjacent plies. The load transfer associated with this bridging mechanism suggests that a progressive damage analysis methodology will be appropriate for predicting the residual strength of laminates with through-penetration notches. A progressive damage methodology developed by the authors was used to predict the initiation and growth of matrix cracks and fiber fracture. Most of the residual strength predictions for different panel widths, notch lengths, and material systems were within about 10% of the experimental failure loads.

[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.

[Curative effect analysis on closed reduction and external fixator under local anesthesia for the treatment of intertrochanteric fracture in elderly patients with high-risk].

PubMed

Wang, Zeng-ping; Liu, Lin; Xue, Wen; Zhou, Hui-ru; Song, Yu-xin; Cai, Li-yang; Cheng, Xian-tang; Qian, Yao-wen

2016-06-01

To explore clinical efficacy of closed reduction and external fixation under local anesthesia for the treatment of high-risk elderly patients with intertrochanteric fracture. From March 2013 to March 2015, 10 patients with intertrochanteric fractures treated with closing reduction and external fixator under local anesthesia were analyszed, including 4 males and 6 females, aged from 69 to 88 years old with an average of 75.2 years old. All fractures were caused by injury and classified to type I (5 cases), II (3 cases), and V (2 cases) according to Evans classification. According to American Society of Anesthesiologists (ASA), 6 cases were type III and 4 cases were type IV. Blood loss,operative time,hospital stays, postoperative complications, ambulation time and fracture healing time were observed, and Harris scoring were used to evaluate hip joint function. All patients were followed up from 3 to 23 months with an average of 13.1 months. One patient with chronic obstructive pulmonary disease died for non-operation reason at 4 months after operation, the other fractures were healed at stage I, the mean fracture healing time was 5.6 months. There were no coxa vara, lower limb venous thrombosis, loosen and remove of needle passage. The average operative time was 46 min, blood loss was (35.00 ± 8.46) ml without blood transfusion. One patient was occurred pulmonary infection and stent-tract infection on the 2 nd and 3 rd day after operation, and improved with active anti-infection and dressing change; the other patients gone to ground activity at 4.2 d after operation. The patients stayed hospital for 10.6 d on average. According to Harris scoring at final following-up, the total score was 83.42 ± 3.27, 3 cases obtained excellent results, 5 cases good and 1 case poor. Closed reduction and external fixation under local anesthesia in treating high-risk elderly patients with intertrochanteric fracture,which has advantages of shorter operative time, less blood loss, good recovery of postoperative function, is a safe, stable and economic method.

[Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].

PubMed

El Attal, R; Hansen, M; Rosenberger, R; Smekal, V; Rommens, P M; Blauth, M

2011-12-01

Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. Between July 2004 and May 2005, 180 patients were included in a multicenter study. The follow-up rate was 81% after 1 year. Of these, 91 fractures (50.6%) were located in the distal third of the tibia. In this segment, the rate of delayed union was 10.6%. Malalignment of > 5° was observed in 5.4%. A secondary malalignment after initial good reduction was detected in only 1.1% of all cases. The implant-specific risk for screw breakage was 3.2%. One patient sustained a deep infection. If additional fibula plating was performed an 8-fold higher risk for delayed bone healing was observed (95%CI: 2.9-21.2, p< 0.001). If the fracture of the fibula was at the same height as on the tibia, the risk for delayed healing was even 14-fold (95% CI: 3.4-62.5, p< 0.001). Biomechanically plating of the fibula does not increase stability in suprasyndesmal distal tibia-fibular fractures treated with an intramedullary nail. Using the ETN with its optimized locking options, fibula plating is not recommended, thus, avoiding soft tissue problems and potentially delayed bone healing.

[Clinical effects of surgical vs manual reduction of ankle fractures].

PubMed

Zhou, Yi-Fei; Yu, Yang; Zhang, Xiao-Lei; Chen, Hua

2012-05-01

To investigate the clinical effects of surgical vs manual reduction of ankle fractures. From March 2006 to April 2010,301 patients with ankle fractures were analyzed retrospectively, of whom 134 patients were treated by manual reduction and plaster fixation, and the other 167 patients underwent surgical treatment. In manual reduction group, there were 86 males and 48 females with a mean age of (38.2 +/- 15.7) years, involving Weber-Denis A in 55 cases,Weber-Denis B in 60 cases, and Weber-Denis C in 19 cases. In surgical reduction group, there were 115 males and 52 females with a mean age of (39.6 +/- 11.9) years, involving Weber-Denis A in 59 cases, Weber-Denis B in 52 cases and Weber-Denis C in 56 cases. The score of the ankle's symptoms and function was calculated according to Mazur,and the difference was analyzed by Chi-squire test. Of the 114 patients with Weber-Denis A, 55 patients were in manual reduction group, with excellent, good, acceptable and poor results in 18, 20, 11 and 6 patients respectively vs 26, 25, 6 and 2 in surgical reduction group of 59 patients. In patients with Weber-Denis B, there were 60 patients in manual reduction group, with excellent, good, acceptable and poor results in 20 , 26, 8 and 6 patients vs 25, 21, 5, and 1 in surgical reduction group of 52 patients. There was no significant difference in clinical effects between the two group of Weber-Denis A and B. The remaining 75 patients belonged to Weber-Denis C, of whom 19 patients were in manual reduction group,with excellent, good, acceptable and poor results in 2, 3, 7 and 7 patients vs 21, 18, 11 and 6 in surgical reduction group of 56 patients. There was no significant difference in clinical effects between the two groups of Weber-Denis C (P=0.007). The clinical effect of surgical reduction group was obviously better than that of manual reduction group for Weber-Denis C, and therefore surgical intervention is recommended for this type of fracture.

Implications of heterogeneous fracture distribution on reservoir quality; an analogue from the Torridon Group sandstone, Moine Thrust Belt, NW Scotland

NASA Astrophysics Data System (ADS)

Watkins, Hannah; Healy, David; Bond, Clare E.; Butler, Robert W. H.

2018-03-01

Understanding fracture network variation is fundamental in characterising fractured reservoirs. Simple relationships between fractures, stress and strain are commonly assumed in fold-thrust structures, inferring relatively homogeneous fracture patterns. In reality fractures are more complex, commonly appearing as heterogeneous networks at outcrop. We use the Achnashellach Culmination (NW Scotland) as an outcrop analogue to a folded tight sandstone reservoir in a thrust belt. We present fracture data is collected from four fold-thrust structures to determine how fracture connectivity, orientation, permeability anisotropy and fill vary at different structural positions. We use a 3D model of the field area, constructed using field observations and bedding data, and geomechanically restored using Move software, to determine how factors such as fold curvature and strain influence fracture variation. Fracture patterns in the Torridon Group are consistent and predictable in high strain forelimbs, however in low strain backlimbs fracture patterns are inconsistent. Heterogeneities in fracture connectivity and orientation in low strain regions do not correspond to fluctuations in strain or fold curvature. We infer that where strain is low, other factors such as lithology have a greater control on fracture formation. Despite unpredictable fracture attributes in low strain regions, fractured reservoir quality would be highest here because fractures in high strain forelimbs are infilled with quartz. Heterogeneities in fracture attribute data on fold backlimbs mean that fractured reservoir quality and reservoir potential is difficult to predict.

Recent developments in analysis of crack propagation and fracture of practical materials. [stress analysis in aircraft structures

NASA Technical Reports Server (NTRS)

Hardrath, H. F.; Newman, J. C., Jr.; Elber, W.; Poe, C. C., Jr.

1978-01-01

The limitations of linear elastic fracture mechanics in aircraft design and in the study of fatigue crack propagation in aircraft structures are discussed. NASA-Langley research to extend the capabilities of fracture mechanics to predict the maximum load that can be carried by a cracked part and to deal with aircraft design problems are reported. Achievements include: (1) improved stress intensity solutions for laboratory specimens; (2) fracture criterion for practical materials; (3) crack propagation predictions that account for mean stress and high maximum stress effects; (4) crack propagation predictions for variable amplitude loading; and (5) the prediction of crack growth and residual stress in built-up structural assemblies. These capabilities are incorporated into a first generation computerized analysis that allows for damage tolerance and tradeoffs with other disciplines to produce efficient designs that meet current airworthiness requirements.

Sialocele: A rare sequlae of transparotid approach in subcondylar fracture management

PubMed Central

Rajeev, R.; Sajesh, S.; Jose, Mathew; Kumar, N. Dhineksh

2016-01-01

Iatrogenic injury and/or damage to the parotid salivary gland during transparotid approach for open reduction and internal fixation of mandibular condyle fracture is a rare event. Accumulation of saliva in the gland leads to formation of a sialocele. Huge sialocele often seeks drain through the most dependent area through an extraoral wound, whereas in the absence of extraoral fistula, saliva can be redirected intraorally using a stent. A case of mangement of sialocele caused by damage to glandular elements during a transparotid approach for a subcondylar fracture reduction is reported. The various conservative methods and surgical management for this condition are discussed. PMID:28356695

Treatment of Peripheral Talus Fractures.

PubMed

Shank, John R; Benirschke, Stephen K; Swords, Michael P

2017-03-01

Peripheral talus fractures include injuries to the lateral process, posteromedial talar body, and talar head. These injuries are rare and are often missed. Nonunion with conservative treatment is high and excision can lead to joint instability, rapid arthrosis, and earlier need for arthrodesis. Open reduction internal fixation of most peripheral talus fractures is critical to achieving a good outcome. Open reduction leads to more rapid union and ability to mobilize the ankle and subtalar joints, quicker revascularization of the talus, and lower rates of arthrosis. Surgical treatment can lead to substantial functional improvement and a slowing of the degenerative process. Copyright © 2016 Elsevier Inc. All rights reserved.

Nonlinear quasi-static finite element simulations predict in vitro strength of human proximal femora assessed in a dynamic sideways fall setup.

PubMed

Varga, Peter; Schwiedrzik, Jakob; Zysset, Philippe K; Fliri-Hofmann, Ladina; Widmer, Daniel; Gueorguiev, Boyko; Blauth, Michael; Windolf, Markus

2016-04-01

Osteoporotic proximal femur fractures are caused by low energy trauma, typically when falling on the hip from standing height. Finite element simulations, widely used to predict the fracture load of femora in fall, usually include neither mass-related inertial effects, nor the viscous part of bone׳s material behavior. The aim of this study was to elucidate if quasi-static non-linear homogenized finite element analyses can predict in vitro mechanical properties of proximal femora assessed in dynamic drop tower experiments. The case-specific numerical models of 13 femora predicted the strength (R(2)=0.84, SEE=540N, 16.2%), stiffness (R(2)=0.82, SEE=233N/mm, 18.0%) and fracture energy (R(2)=0.72, SEE=3.85J, 39.6%); and provided fair qualitative matches with the fracture patterns. The influence of material anisotropy was negligible for all predictions. These results suggest that quasi-static homogenized finite element analysis may be used to predict mechanical properties of proximal femora in the dynamic sideways fall situation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Unstable metacarpal and phalangeal fractures: treatment by internal fixation using AO mini-fragment plates and screws.

PubMed

Mumtaz, Mohammad Umar; Farooq, Muneer Ahmad; Rasool, Altaf Ahmad; Kawoosa, Altaf Ahmad; Badoo, Abdul Rashid; Dhar, Shabir Ahmad

2010-07-01

Accurate open reduction and internal fixation for metacarpal and phalangeal fractures of the hand is required in less than 5% of the patients; otherwise, closed treatment techniques offer satisfactory results in most of these cases as these fractures are stable either before or after closed reduction. AO mini-fragment screws and plates, when used in properly selected cases, can provide rigid fixation, allowing early mobilization of joints and hence good functional results while avoiding problems associated with protruding K-wires and immobilization. The advantages of such internal fixation urged us to undertake such a study in our state where such hand injuries are commonly seen. Forty patients with 42 unstable metacarpal and phalangeal fractures were treated with open reduction and internal fixation using AO mini-fragment screws and plates over a period of three years in a prospective manner. The overall results were good in 78.5% of cases, fair in 19% of cases and poor in 2.5% of cases, as judged according to the criteria of the American Society for Surgery of the Hand. This technique is a reasonable option for treating unstable metacarpal and phalangeal fractures as it provides a highly rigid fixation, which is sufficient to allow early mobilization of the adjacent joints, thus helping to achieve good functional results.

Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture

PubMed Central

Facaros, Zacharia; Ramanujam, Crystal L.; Stapleton, John J.

2010-01-01

The surgical management of ankle fractures among the diabetic population is associated with higher complication rates compared to the general population. Efforts toward development of better methods in prevention and treatment are continuously evolving for these injuries. The presence of peripheral neuropathy and the possible development of Charcot neuroarthropathy in this high risk patient population have stimulated much surgical interest to create more stable osseous constructs when open reduction of an ankle fracture/dislocation is required. The utilization of multiple syndesmotic screws (pro-syndesmotic screws) to further stabilize the ankle mortise has been reported by many foot and ankle surgeons. In addition, transarticular Steinmann pins have been described as an adjunct to traditional open reduction with internal fixation (ORIF) of the ankle to better stabilize the talus, thus minimizing risk of further displacement, malunion, and Charcot neuroarthropathy. The authors present a unique technique of ORIF with pro-syndesmotic screws and the application of a multi-plane circular external fixator for management of a neglected diabetic ankle fracture that prevented further deformity while allowing a weight-bearing status. This techniqu may be utilized for the management of complex diabetic ankle fractures that are prone to future complications and possible limb loss. PMID:22396812

The utility of absolute risk prediction using FRAX® and Garvan Fracture Risk Calculator in daily practice.

PubMed

van Geel, Tineke A C M; Eisman, John A; Geusens, Piet P; van den Bergh, Joop P W; Center, Jacqueline R; Dinant, Geert-Jan

2014-02-01

There are two commonly used fracture risk prediction tools FRAX(®) and Garvan Fracture Risk Calculator (GARVAN-FRC). The objective of this study was to investigate the utility of these tools in daily practice. A prospective population-based 5-year follow-up study was conducted in ten general practice centres in the Netherlands. For the analyses, the FRAX(®) and GARVAN-FRC 10-year absolute risks (FRAX(®) does not have 5-year risk prediction) for all fractures were used. Among 506 postmenopausal women aged ≥60 years (mean age: 67.8±5.8 years), 48 (9.5%) sustained a fracture during follow-up. Both tools, using BMD values, distinguish between women who did and did not fracture (10.2% vs. 6.8%, respectively for FRAX(®) and 32.4% vs. 39.1%, respectively for GARVAN-FRC, p<0.0001) at group level. However, only 8.9% of those who sustained a fracture had an estimated fracture risk ≥20% using FRAX(®) compared with 53.3% using GARVAN-FRC. Although both underestimated the observed fracture risk, the GARVAN-FRC performed significantly better for women who sustained a fracture (higher sensitivity) and FRAX(®) for women who did not sustain a fracture (higher specificity). Similar results were obtained using age related cut off points. The discriminant value of both models is at least as good as models used in other medical conditions; hence they can be used to communicate the fracture risk to patients. However, given differences in the estimated risks between FRAX(®) and GARVAN-FRC, the significance of the absolute risk must be related to country-specific recommended intervention thresholds to inform the patient. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Computational simulation of progressive fracture in fiber composites

NASA Technical Reports Server (NTRS)

Chamis, C. C.

1986-01-01

Computational methods for simulating and predicting progressive fracture in fiber composite structures are presented. These methods are integrated into a computer code of modular form. The modules include composite mechanics, finite element analysis, and fracture criteria. The code is used to computationally simulate progressive fracture in composite laminates with and without defects. The simulation tracks the fracture progression in terms of modes initiating fracture, damage growth, and imminent global (catastrophic) laminate fracture.

Hydraulic fracture height limits and fault interactions in tight oil and gas formations

NASA Astrophysics Data System (ADS)

Flewelling, Samuel A.; Tymchak, Matthew P.; Warpinski, Norm

2013-07-01

widespread use of hydraulic fracturing (HF) has raised concerns about potential upward migration of HF fluid and brine via induced fractures and faults. We developed a relationship that predicts maximum fracture height as a function of HF fluid volume. These predictions generally bound the vertical extent of microseismicity from over 12,000 HF stimulations across North America. All microseismic events were less than 600 m above well perforations, although most were much closer. Areas of shear displacement (including faults) estimated from microseismic data were comparatively small (radii on the order of 10 m or less). These findings suggest that fracture heights are limited by HF fluid volume regardless of whether the fluid interacts with faults. Direct hydraulic communication between tight formations and shallow groundwater via induced fractures and faults is not a realistic expectation based on the limitations on fracture height growth and potential fault slip.

Closed reduction of a fractured bone

MedlinePlus

... C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction . 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 6. Wood GW. General principles of fracture treatment. In: Canale ST, Beaty JH, ...

Predicting Rib Fracture Risk With Whole-Body Finite Element Models: Development and Preliminary Evaluation of a Probabilistic Analytical Framework

PubMed Central

Forman, Jason L.; Kent, Richard W.; Mroz, Krystoffer; Pipkorn, Bengt; Bostrom, Ola; Segui-Gomez, Maria

2012-01-01

This study sought to develop a strain-based probabilistic method to predict rib fracture risk with whole-body finite element (FE) models, and to describe a method to combine the results with collision exposure information to predict injury risk and potential intervention effectiveness in the field. An age-adjusted ultimate strain distribution was used to estimate local rib fracture probabilities within an FE model. These local probabilities were combined to predict injury risk and severity within the whole ribcage. The ultimate strain distribution was developed from a literature dataset of 133 tests. Frontal collision simulations were performed with the THUMS (Total HUman Model for Safety) model with four levels of delta-V and two restraints: a standard 3-point belt and a progressive 3.5–7 kN force-limited, pretensioned (FL+PT) belt. The results of three simulations (29 km/h standard, 48 km/h standard, and 48 km/h FL+PT) were compared to matched cadaver sled tests. The numbers of fractures predicted for the comparison cases were consistent with those observed experimentally. Combining these results with field exposure informantion (ΔV, NASS-CDS 1992–2002) suggests a 8.9% probability of incurring AIS3+ rib fractures for a 60 year-old restrained by a standard belt in a tow-away frontal collision with this restraint, vehicle, and occupant configuration, compared to 4.6% for the FL+PT belt. This is the first study to describe a probabilistic framework to predict rib fracture risk based on strains observed in human-body FE models. Using this analytical framework, future efforts may incorporate additional subject or collision factors for multi-variable probabilistic injury prediction. PMID:23169122