Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines.

PubMed

Chang, Angela C; Phadnis, Joideep; Eardley-Harris, Nathan; Ranawat, Vijai S; Bain, Gregory I

2016-07-01

Inferior angle of scapula (IAS) fractures are rare, with very few cases reported. They typically present with pain, loss of shoulder motion, and scapula winging. Operative and nonoperative treatments have been trialed with varying success. The aim of this study was to gather data relating to IAS fractures to develop evidence-based treatment guidelines as none are currently available. A search was conducted of the PubMed and Google Scholar databases to identify cases of IAS fractures. Data collected about each case included age and gender of the patient, mechanism of injury, fracture displacement, treatment, and outcome. The authors report 2 additional IAS fracture cases. Ten cases were identified for inclusion in this study, 8 from the literature and 2 described by the authors. Of the 10 cases, 7 described displaced IAS fractures and 3 described undisplaced fractures. All displaced fractures treated nonoperatively resulted in a painful nonunion. All that underwent operative fixation, whether acutely or after failed nonoperative treatment, had resolution of pain and a good functional outcome. All undisplaced fractures were treated nonoperatively; 1 had persisting pain. Surgical exploration identified the fracture fragment attached to serratus anterior in 2 cases and attached to both serratus anterior and latissimus dorsi in 2 cases. There are limited data available about IAS factures. From the cases reviewed, treatment recommendations include the following: (1) displaced IAS fractures should undergo operative fixation to prevent the development of a painful nonunion; (2) suture repair provides adequate fixation; and (3) undisplaced fractures have a variable outcome when treated nonoperatively. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Rib fracture - aftercare

MedlinePlus

... Alternative Names Broken rib - aftercare References Browner BD, Jupiter JB, Krettek C, Anderson PA. Scapula and rib fractures. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: ...

[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.

Fractures of the scapula: long-term results after conservative treatment.

PubMed

Schofer, Markus D; Sehrt, Axel C; Timmesfeld, Nina; Störmer, Sabine; Kortmann, Horst R

2009-11-01

The aim of this study was to determine the long-term prognoses for conservatively treated fractures of the scapula. Ascertainment of functional long-term results in 50 patients treated for a total of 51 scapular fractures in a retrospective cohort study with an average follow-up period of 65 months. The breakdown of these scapular fractures was as follows: simple (22%) and fragmented (51%) fractures of the scapular body, fractures through the scapular neck (41%), fractures of the coracoid process, spine and acromion of the scapula (10%) and glenoid fractures (8%). In 17 of these cases of scapular fracture two or more types were present. At the follow-up examination a restricted range of movement was found in all directions. In abduction, flexion and external rotation the range of motion on the affected as against the unaffected side was significantly restricted, but the observed restriction did not substantially affect the functional results. The Constant score on the affected side was 79 points, with 23% very good, 51% good, 20% satisfactory and 6% poor results. Isokinetic testing carried out on both sides for comparison revealed lower peak torque values and lower mean power output in all planes of movement, and lower speeds on the affected side. There was a correlation between extent of restriction on movement and diminution of isokinetic muscular strength. Determination of the external rotation is recommended as a clinical test value, as it highlights significant deficits both in restriction of range of motion and in isokinetic test measurements. The outcome of treatment was not influenced by fracture type, associated injuries or handedness. After conservative treatment, scapular fractures heal with a good functional result despite measurable restrictions.

[Trial manufacture of subsidiary tool and use of technique for shoulder joint of "Scapula Y"].

PubMed

Maejima, Hideyuki; Okamoto, Takahide; Yamazaki, Norihito; Hiyoshi, Kan; Tanaka, Tamotsu; Mori, Takeshi; Ako, Toshitaka; Ogawa, Norihisa

2002-07-01

The technique of "Scapula Y " is effective for capturing forward/backward dislocation of the humeral head and variation in surgical spine fracture. It is also indispensable for describing images of ossification at the tendon plate of the lower lobe of the acrominon and impingement syndrome. However, owing to large individual variations in body shape and position and shape of the scapula, the conventional method does not lend itself to stable reproduction of position or provide adequate diagnostic information. We measured the central angle of entry from scapula m24 pairs of dried bone (Indian) into the spine of the scapula from horizontal and forehead planes to determine the range of variation together with the clinical data referred to in the next paragraph. We then manufactured a trial subsidiary tool to set the angle of the central entering beam base on the acrominon to the spine of the scapula using data on measured angle from 50 clinical radiographs. We identified improvement in radiography of the scapula by using the subsidiary tool designed and manufactured on the basis of the above measured data.

Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

PubMed Central

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

2016-01-01

AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries. MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed. RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema. CONCLUSIONS: The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients. PMID:28028415

Sex estimation from the scapula in a contemporary Chilean population.

PubMed

Peckmann, Tanya R; Logar, Ciara; Meek, Susan

2016-09-01

The scapula is valuable for sex estimation in human skeletons. Muscles provide protection to the scapula making it difficult to fracture, therefore increasing the potential for undamaged scapulae at forensic scenes. The goal of this project is to evaluate the accuracy of discriminant functions, created using an indigenous Guatemalan and contemporary Mexican population, when applied to a contemporary Chilean sample for estimation of sex from the scapula. The length of the glenoid cavity (LGC) and breadth of the glenoid cavity (BGC) were measured. The sample included 114 individuals (58 males and 56 females) with age ranges from 17 to 85years old. When the Guatemalan discriminant functions were applied to the Chilean sample they showed higher accuracy rates for sexing male scapulae (89.6% to 94.8%) than for sexing female scapulae (53.4% to 80.3%). When the Mexican discriminant functions were applied to the Chilean sample they showed higher accuracy rates for sexing female scapulae (82.1% to 96.4%) than for sexing male scapulae (56.9% to 89.6%). Size comparisons were made to a Guatemalan, Mexican, White American, and Greek population. Overall, in males and females of the Chilean population both left and right scapulae were larger than in the Guatemalan population but smaller than in the Mexican, White American, and Greek samples. Population-specific discriminant functions were created for the Chilean population with an overall sex classification accuracy rate of 80.7% to 86.0%. Copyright © 2016 The Chartered Society of Forensic Sciences. Published by Elsevier Ireland Ltd. All rights reserved.

Early history of scapular fractures.

PubMed

Bartoníček, Jan; Kozánek, Michal; Jupiter, Jesse B

2016-01-01

The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

A case report of Cheyletiella infestation on a Whippet dog in Korea.

PubMed

Shin, S S

1996-12-01

A clinical case of Cheyletiella infestation on a dog born and raised in Korea is reported. A three-year old female Whippet was hospitalized due to a multiple fracture and displacement of the left scapula caused by a recent car accident. The mite infestation was not noticed at the time of hospitalization. The dog underwent multiple operations involving internal fixation of the fractured scapula with wire and a plate, followed by extensive chemotherapy with antibiotics and prednisolone. After two months of hospitalization, a pruritic dermatitis near the left scapula developed. Multiple white dandruff-like flakes were seen on the hair coat, especially over the dorsal spine and neck, and the dog expressed increased pruritus by frequently licking and scratching the affected areas. Local dense accumulations of skin debris that became crusty were also observed. Microscopic examination of a skin scraping revealed a heavy infestation of cheyletiella yasguri, as identified by the presence of hoks of the palpi and the heart-shaped sensory organ on genu I. Immunosuppression elicited by the extensive administration of prednisolone was suspected for the initiation of the generalized mite infestation.

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.

Safety screw fixation technique in a case of coracoid base fracture with acromioclavicular dislocation and coracoid base cross-sectional size data from a computed axial tomography study.

PubMed

Kawasaki, Yoshiteru; Hirano, Tetsuya; Miyatake, Katsutoshi; Fujii, Koji; Takeda, Yoshitsugu

2014-07-01

Coracoid base fracture accompanied by acromioclavicular joint dislocation with intact coracoclavicular ligaments is a rare injury. Generally, an open reduction with screw fixation is the first treatment choice, as it protects the important structures around the coracoid process. This report presents a new technique of screw fixation for coracoid base fracture and provides anatomic information on cross-sectional size of the coracoid base obtained by computed tomography (CT). An axial image of the coracoid base was visualized over the neck of the scapula, and a guidewire was inserted into this circle under fluoroscopic guidance. The wire was inserted easily into the neck of scapula across the coracoid base fracture with imaging in only 1 plane. In addition, 25 measurements of the coracoid base were made in 25 subjects on axial CT images. Average length of the long and short axes at the thinnest part of the coracoid base was 13.9 ± 2.0 mm (range 10.6-17.0) and 10.5 ± 2.2 mm (6.6-15.1), respectively. This new screw fixation technique and measurement data on the coracoid base may be beneficial for safety screw fixation of coracoid base fracture.

Classification and Morphological Parameters of the Scapular Spine

PubMed Central

Wang, Hua-Jun; Giambini, Hugo; Hou, Da-Biao; Huan, Song-Wei; Liu, Ning; Yang, Jie; Chen, Chao; Gao, Yan-Ping; Shang, Ru-Guo; Li, Yi-Kai; Zha, Zhen-gang

2015-01-01

Abstract Incidence of scapular spine (SS) fractures as a result of complications of reverse total shoulder arthroplasty is relatively high leading to inferior clinical outcomes and an increased risk of revision and dislocation. Fractures of SS because of trauma, including the acromion, constitute 6% to 23% of scapula fractures. The purpose of this study was to classify the SS and present specific geometrical parameters according to osteologic features. A total of 319 intact dry scapulae were collected and classified based on morphological characteristics and shape of the SS. Nine bony landmarks were also chosen and described for their relevance to regions of interest for scapular fixation. Five specific types of SS were noted and the most prevalent groups were Type 1 (Fusiform shape) (47.17%) and Type 5 (Horizontal S-shape) (19.18%). Overall, Types 3, 4, and 1 showed thicker landmark values compared to Type 5, with Type 2 having smaller values. Our classification into 5 distinct types allowed appreciation of the anatomical variance of SSs. The contours of Types 5 and 1 presented a more complex morphology and may lead to a worse surgical approach due to a fracture. As Types 2 and 5 were much thinner than the other types, these may be more susceptible to fractures. PMID:26559282

Slot-type fractures of the scapula at New Kingdom Tell El-Amarna, Egypt.

PubMed

Dabbs, Gretchen R; Zabecki, Melissa

2015-12-01

Amarna is the archaeological representation of Akhetaten, the short-lived Egyptian capital city of Akhenaten (reign 1352-1336BCE).Five adult males excavated from the South Tombs Cemetery (STC) (total n>400) at Amarna exhibit slot-type fracture lesions of the scapula, and two of these lesions exhibit evidence of active bone remodeling at the time of death.The lesions in question are described and a full differential diagnosis is considered.The differential diagnosis rules out atrophic perforations, scapular foramina, tumors, and occupational and accidental trauma.Given the location, morphology, and surrounding bony changes, these lesions are consistent with sharp force trauma, specifically stabbing.These lesions most likely represent the consequence of corporal punishment in the form of "strokes" accompanied by "open wounds" known from Egyptian literature for punishment of a wide range of civil and criminal activities.Alternatively, several pigs at Amarna show similar wound morphologies of the cranium and scapulae, which have been interpreted by other authors to represent ritualized punishment of the god Seth, who is often represented as a pig.The lesions described here are consistent in morphology and positioning with the swine examples, and may represent further, cross-species, evidence of ritualized punishment at the ancient capital city. Copyright © 2015 Elsevier Inc. All rights reserved.

An Abnormal Bone Lesion of the Scapula in a Collegiate Basketball Player: A Case Report

PubMed Central

O'Brien, Matthew S.; Donnell, Allison; Miller, Jason; Iven, Val Gene; Pascale, Mark

2013-01-01

Objective: To present the case of a bone lesion of the scapula in a collegiate basketball player. Background: A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion. Differential Diagnosis: Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture. Treatment: The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken. Uniqueness: Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex. Conclusions: Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma. PMID:23725460

[Arthroscopically Assisted Minimally Invasive Fixation of a Type D2c Scapular Fracture].

PubMed

Kornherr, Patrick; Konerding, Christiane; Kovacevic, Mark; Wenda, Klaus

2018-06-12

Fractures of the scapula are rare and have an incidence of 1% of all fractures. Publications highlight glenoid rim fractures. Classification by Ideberg and Euler and Rüdi are accepted. Euler and Rüdi describe three extra-articular and two intra-articular fracture patterns. The indications for surgery are displaced glenoid fractures, scapula tilt of more than 40° and injuries to the superior shoulder suspensory complex. We describe a case of a 22 year old man, who while cycling collided with a moving car due to wet roads. After his admission to hospital as a polytraumatised patient, the trauma CT-Scan showed haemothorax with several associated rip fractures, displaced humeral shaft fracture and fractures of the acromion and glenoid, classified as type D2c according to Euler and Rüdi. Following damage control principles, drainage of the haemothorax was already performed in the ER and surgical treatment of the displaced humeral shaft fracture was performed on the day of admission. No peripheral neurological deficits were evident. After pulmonary stabilisation, surgery was performed 6 days later on the glenoid and acromion fracture, which in conjunction may be regarded as an injury to the superior shoulder suspensory complex. We performed an arthroscopically-assisted screw fixation of the glenoid fracture (type D2c according to Euler and Rüdi) and an ORIF procedure at the acromion. Postoperative rehabilitation was performed with passive abduction and elevation up to 90° for the first two weeks and active abduction an elevation up to 90° for weeks 3 to 6. Full ROM was allowed at week 7. Articular fractures of the glenoid are rare and mainly seen as rim fractures. The indications for surgery are displaced articular fractures and injury to the superior shoulder suspensory complex. As demonstrated by this article, type D2c fractures according to Euler and Rüdi can be treated effectively as an arthroscopically-assisted screw fixation procedure. Georg Thieme Verlag KG Stuttgart · New York.

Winged scapula incidence and upper limb morbidity after surgery for breast cancer with axillary dissection.

PubMed

Rizzi, Samantha Karlla Lopes de Almeida; Haddad, Cinira Assad Simão; Giron, Patricia Santolia; Pinheiro, Thaís Lúcia; Nazário, Afonso Celso Pinto; Facina, Gil

2016-06-01

The aim of this study was to determine the incidence of winged scapula after breast cancer surgery, its impact on shoulder morbidity and difference in incidence according to surgery type. Patients with breast cancer and surgical indication for axillary dissection were included. A total of 112 patients were surveyed with one physical evaluation before the surgery and others 15, 30, 90, and 180 days after. Winged scapula was assessed with test proposed by Hoppenfeld. Shoulder range of motion (ROM) was assessed with goniometer for flexion, extension, adduction, abduction, internal rotation, and external rotation. A verbal scale from 0 to 10 was used to assess pain. Winged scapula incidence was 8.0 % 15 days after surgery. Two patients recovered from winged scapula 90 days after surgery and four more 180 days after surgery, while three patients still had winged scapula at this time. The incidence after 15 days from surgery was 20.9 and 22.6 % among patients submitted to sentinel node biopsy or axillary lymphadenectomy (AL), respectively (p < 0.01). There was no statistical difference of incidence according to breast surgery type. Operated side shoulder flexion, adduction, and abduction ROM changes were statistically different in patients with or without winged scapula. The mean reduction was higher in patients with winged scapula. Both groups showed the same pattern over time in pain. Winged scapula incidence was 8.0 % and was higher in AL, and prevalence decreased during 6 months after surgery. Patients who developed winged scapula had more shoulder flexion, adduction, and abduction limitation.

Radionuclide Imaging of Musculoskeletal Injuries in Athletes with Negative Radiographs.

PubMed

Nagle, C E; Freitas, J E

1987-06-01

In brief: Radionuclide bone scans can be useful in the diagnostic evaluation of musculoskeletal injuries in athletes. Bone scans can detect shinsplints, stress fractures, and muscle injuries before they are detectable on radiographs. Prognosis can be accurately assessed, allowing appropriate treatment to proceed without delay. The authors discuss the use of bone scans and identify musculoskeletal injuries that are associated with specific sports, such as stress fracture of the femur (soccer), tibia (running), scapula (gymnastics), and pars interarticularis (football or lacrosse).

Reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap following gunshot injuries: Report of two cases.

PubMed

Ozcan Akcal, Arzu; Ünal, Kerim; Gorgulu, Tahsin; Akif Akcal, Mehmet; Bigat, Zekiye

2016-10-01

In this report we present two cases of gunshot injury related midfoot defects, reconstructed with a chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap. The first case, a 14 years old male, had 10 × 8 cm medial plantar and 6 × 4 cm dorsal foot defects and the second case, a 55 years old female, had only 8 × 6 cm dorsal foot defect. In both cases the defects were associated with fractures, one with lateral cuneiform and cuboid with 90% bone loss and the other with navicular bone, respectively. After 6 months, the patients could walk well without support, and radiographs confirmed bony union. A chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap may be used for the reconstruction of combined bony and soft tissue defects of the midfoot and to promote bone healing. © 2016 Wiley Periodicals, Inc. Microsurgery 36:598-603, 2016. © 2016 Wiley Periodicals, Inc.

Delayed Presentation of Osteochondroma at Superior Angle of Scapula-A Case Report.

PubMed

Jindal, Mohit

2016-01-01

Osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences. Osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third (35-46%) of cases affecting the bone around the knee (lower end femur> upper end tibia), 10% cases involve the small bones of the hand and 5% involve the pelvis and flat bones like scapula (4-6%) are least involved. These tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity. These are usually painless but may become painful due to neurovascular entrapment/compression, fracture at the stalk, bursal inflammation or malignant transformation. This article presents a case of osteochondroma on superior angle of scapula in a 23-year-old male presented with pseudo winging and snapping of scapula, crepitus on scapulothoracic motion and occasional pain since 5 years. However, there was no increase in size of the swelling or local and systemic signs of malignant transformation. X-ray demonstrated a pedunculated exophytic mass on supero medial aspect of the right scapula. The findings were confirmed on CT and excision of the lesion was done. The patient demonstrated full painless range of motion after 1 month and no recurrence was demonstrated during 1 year follow up. Scapular osteochondroma is a relatively rare condition. Usually a patient presents in early to late childhood, however, in some cases it may be presented in adults. Growth after maturity is indicative of a metastatic transformation. So an excision of the same should be accompanied with histopathological examinations.

Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study.

PubMed

Panigrahi, Ranajit; Madharia, Divya; Das, Dibya Singha; Samant, Saswat; Biswal, Manas Ranjan

2016-12-01

Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint. This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate. Between 2012 and 2015, at 2 centers (HMCH & SHCE) of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side. The median score was 88% (mean 65%, range 30 to 100). The median score for strength was 21/25 (mean 19, range 0 to 25) and that for pain 11/15 (mean 11, range 5 to 15). The median functional score was 16/20 (mean 15, range 0 to 20). The mean range of active abduction of the shoulder was 135° (20 to 180), the mean range of flexion 138° (20 to 180) and the mean range of external rotation 38° (0 to 100). Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%. Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.

Regulation of scapula development.

PubMed

Huang, Ruijin; Christ, Bodo; Patel, Ketan

2006-12-01

The scapula is a component of the shoulder girdle. Its structure has changed greatly during evolution. For example, in humans it is a large quite flat triangular bone whereas in chicks it is a long blade like structure. In this review we describe the mechanisms that control the formation of the scapula. To assimilate our understanding regarding the development of the scapula blade we start by addressing the issue concerning the origin of the scapula. Experiments using somite extirpation, chick-quail cell marking system and genetic cell labelling techniques in a variety of species have suggested that the scapula had its origin in the somites. For example we have shown in the chick that the scapula blade originates from the somite, while the cranial part, which articulates with the upper limb, is derived from the somatopleure of the forelimb field. In the second and third part of the review we discuss the compartmental origin of this bone and the signalling molecules that control the scapula development. It is very interesting that the scapula blade originates from the dorsal compartment, dermomyotome, which has been previously been associated as a source of muscle and dermis, but not of cartilage. Thus, the development of the scapula blade can be considered a case of dermomyotomal chondrogenesis. Our results show that the dermomyotomal chondrogenesis differ from the sclerotomal chondrogenesis. Firstly, the scapula precursors are located in the hypaxial domain of the dermomyotome, from which the hypaxial muscles are derived. The fate of the scapula precursors, like the hypaxial muscle, is controlled by ectoderm-derived signals and BMPs from the lateral plate mesoderm. Ectoderm ablation and inhibition of BMP activity interfers the scapula-specific Pax1 expression and scapula blade formation. However, only somite cells in the cervicothoracic transition region appear to be committed to form scapula. This indicates that the intrinsic segment specific information determines the scapula forming competence of the somite cells. Taken together, we conclude that the scapula forming cells located within the hypaxial somitic domain require BMP signals derived from the somatopleure and as yet unidentified signals from ectoderm for activation of their coded intrinsic segment specific chondrogenic programme. In the last part we discuss the new data that provides evidence that neural crest contributes for the development of the scapula.

Association between scapula bony morphology and snapping scapula syndrome.

PubMed

Spiegl, Ulrich J; Petri, Maximilian; Smith, Sean W; Ho, Charles P; Millett, Peter J

2015-08-01

Scapular incongruity has been described as a contributing factor to the development of snapping scapula syndrome (SSS). The purpose of this retrospective case-control study was to determine the association between scapula bony morphology on magnetic resonance imaging (MRI) and the diagnosis of SSS. Bony morphologies of the scapula were evaluated on MRI scans of 26 patients with SSS and 19 patients with non-SSS pathologies. The medial scapula corpus angle (MSCA) was measured on axial MRI sequences. Scapulae were categorized as straight, S shaped, or concave. Two independent observers performed the measurements. Interobserver and intraobserver agreements of MSCA measurements were determined with intraclass correlation coefficients. Axial scapula bony morphology identified 28 scapulae of the straight type, 14 S-shaped scapulae, and 5 concave scapulae. All 5 concave scapulae had confirmed SSS. Measurement of the MSCA showed excellent interobserver agreement of 0.80 (95% confidence interval [CI], 0.67 to 0.89) and intraobserver agreement of 0.70 (95% CI, 0.52 to 0.82). There were significant differences in the mean MSCAs between shoulders with SSS (14.4° ± 19.3°) and non-SSS shoulders (-3.3° ± 15.3°, P = .001). The odds ratio was 8.4 (95% CI, 2.2 to 31.8) for positive MSCA and SSS. The scapulothoracic distance was significantly decreased in the SSS group (14.9 ± 5.8 mm) compared with the non-SSS patients (24.0 ± 6.7 mm, P < .001). Anterior angulation of the medial scapula in the axial plane was associated with SSS. Patients with a concave-shaped scapula and a positive MSCA have a 12-fold increased risk of SSS. The MSCA may prove helpful in determining the location and amount of scapular resection needed for patients with SSS. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Cadaveric and three-dimensional computed tomography study of the morphology of the scapula with reference to reversed shoulder prosthesis

PubMed Central

Torrens, Carlos; Corrales, Monica; Gonzalez, Gemma; Solano, Alberto; Cáceres, Enrique

2008-01-01

Purpose The purpose of this study is to analyze the morphology of the scapula with reference to the glenoid component implantation in reversed shoulder prosthesis, in order to improve primary fixation of the component. Methods Seventy-three 3-dimensional computed tomography of the scapula and 108 scapular dry specimens were analyzed to determine the anterior and posterior length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula and the angle between the major craneo-caudal glenoid axis and the base of the coracoid process and the upper posterior column. Results The anterior and posterior length of glenoid neck was classified into two groups named "short-neck" and "long-neck" with significant differences between them. The angle between the glenoid surface and the upper posterior column of the scapula was also classified into two different types: type I (mean 50°–52°) and type II (mean 62,50°–64°), with significant differences between them (p < 0,001). The angle between the major craneo-caudal glenoid axis and the base of the coracoid process averaged 18,25° while the angle with the upper posterior column of the scapula averaged 8°. Conclusion Scapular morphological variability advices for individual adjustments of glenoid component implantation in reversed total shoulder prosthesis. Three-dimensional computed tomography of the scapula constitutes an important tool when planning reversed prostheses implantation. PMID:18847487

Cadaveric and three-dimensional computed tomography study of the morphology of the scapula with reference to reversed shoulder prosthesis.

PubMed

Torrens, Carlos; Corrales, Monica; Gonzalez, Gemma; Solano, Alberto; Cáceres, Enrique

2008-10-10

The purpose of this study is to analyze the morphology of the scapula with reference to the glenoid component implantation in reversed shoulder prosthesis, in order to improve primary fixation of the component. Seventy-three 3-dimensional computed tomography of the scapula and 108 scapular dry specimens were analyzed to determine the anterior and posterior length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula and the angle between the major craneo-caudal glenoid axis and the base of the coracoid process and the upper posterior column. The anterior and posterior length of glenoid neck was classified into two groups named "short-neck" and "long-neck" with significant differences between them. The angle between the glenoid surface and the upper posterior column of the scapula was also classified into two different types: type I (mean 50 degrees-52 degrees ) and type II (mean 62.50 degrees-64 degrees ), with significant differences between them (p < 0.001). The angle between the major craneo-caudal glenoid axis and the base of the coracoid process averaged 18,25 degrees while the angle with the upper posterior column of the scapula averaged 8 degrees . Scapular morphological variability advices for individual adjustments of glenoid component implantation in reversed total shoulder prosthesis. Three-dimensional computed tomography of the scapula constitutes an important tool when planning reversed prostheses implantation.

Effects of short malunion of the clavicle on in vivo scapular kinematics.

PubMed

Kim, DooSup; Lee, DongWoo; Jang, YoungHwan; Yeom, JunSeop; Banks, Scott A

2017-09-01

Short malunion of the clavicle after fracture can change scapular kinematics and alter clinical outcome. However, the effects of malunion on kinematics and outcomes remains poorly understood because there have been no in vivo studies measuring changes during active motion with malunion. This study aimed to measure and to compare in vivo 3-dimensional (3D) scapular kinematics between normal shoulders and shoulders with short malunion using 3D-2-dimensional model image registration techniques. Fifteen patients with clavicle fracture who had been treated conservatively were enrolled in this study. In these patients, the angle of scapular upward rotation, posterior tilting, and external rotation were compared between shoulders with short malunion and contralateral, normal shoulders. A 3D-2-dimensional model image registration technique was used to determine the 3D orientation of the scapula. Scapular upward rotation increased following increase of the arm elevation angle and also showed a significant difference by arm elevation in both groups (P = .04). Posterior tilting of the scapula gradually increased as the arm abduction angle increased, and this varied significantly between groups (P = .01). Shoulders with short malunion also showed a more internally rotated position than the contralateral, normal shoulders between 100° and the maximum abduction angle (P = .04). Our results suggest that clavicle shortening of >10% greatly affects scapular kinematics in vivo. Further studies will be needed to determine the clinical implications of short malunion of the clavicle. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Use of a 90° drill and screwdriver for rib fracture stabilization.

PubMed

Nickerson, Terry P; Kim, Brian D; Zielinski, Martin D; Jenkins, Donald; Schiller, Henry J

2015-03-01

Rib fracture stabilization has become a more accepted practice although stabilization of the most cephalad ribs presents a unique challenge. We present our experience with use of a 90° drill and screwdriver to bridge these difficult rib fractures. This retrospective review included patients who underwent rib fracture stabilization from August 1, 2009, through September 30, 2012. Patients were divided into two groups: those whose procedure used the 90° device and those that did not. Data were compared using standard statistical analysis and reported as percentages and medians [interquartile ranges]. P values <0.05 were considered significant. We identified 89 patients: 29 (33%) had 90° devices used and 60 (67%) did not. There were no differences between groups in age, sex, Trauma-Related Injury Severity Score, the presence of flail chest, occurrence of pneumonia, and intensive care unit or hospital length of stay. The Injury Severity Score was higher in the 90° group (22 vs. 16; P = 0.03). The highest rib stabilized was different between the 2 groups (3 [2-5] vs. 5 [2-9]; P = 0.001), with more third rib stabilizations in the 90° group (38 vs. 20%; P = 0.04) as well as more total number of ribs fixed (5 vs. 4; P = 0.001). There was no difference in operative time between the 2 groups. The surgical reach for rib fracture stabilization has been extended with use of a 90° drill and screwdriver. High fractures under the scapula where access is technically challenging can be stabilized without prolonging operative times.

3D reconstructions of quail-chick chimeras provide a new fate map of the avian scapula.

PubMed

Shearman, Rebecca M; Tulenko, Frank J; Burke, Ann C

2011-07-01

Limbed vertebrates have functionally integrated postcranial axial and appendicular systems derived from two distinct populations of embryonic mesoderm. The axial skeletal elements arise from the paraxial somites, the appendicular skeleton and sternum arise from the somatic lateral plate mesoderm, and all of the muscles for both systems arise from the somites. Recent studies in amniotes demonstrate that the scapula has a mixed mesodermal origin. Here we determine the relative contribution of somitic and lateral plate mesoderm to the avian scapula from quail-chick chimeras. We generate 3D reconstructions of the grafted tissue in the host revealing a very different distribution of somitic cells in the scapula than previously reported. This novel 3D visualization of the cryptic border between somitic and lateral plate populations reveals the dynamics of musculoskeletal morphogenesis and demonstrates the importance of 3D visualization of chimera data. Reconstructions of chimeras make clear three significant contrasts with existing models of scapular development. First, the majority of the avian scapula is lateral plate derived and the somitic contribution to the scapular blade is significantly smaller than in previous models. Second, the segmentation of the somitic component of the blade is partially lost; and third, there are striking differences in growth rates between different tissues derived from the same somites that contribute to the structures of the cervical thoracic transition, including the scapula. These data call for the reassessment of theories on the development, homology, and evolution of the vertebrate scapula. Copyright © 2011 Elsevier Inc. All rights reserved.

Correlation between morphometry of the suprascapular notch and anthropometric measurements of the scapula.

PubMed

Polguj, M; Jędrzejewski, K S; Podgórski, M; Topol, M

2011-05-01

The concept of the study was to find the correlation between the morphometry of the suprascapular notch and basic anthropometric measurements of the human scapula. The measurements of the human scapulae included: morphological length and width, maximal width and length projection of scapular spine, length of acromion, and maximal length of the coracoid process. The glenoid cavity was measured in two perpendicular directions to evaluate its width and length. The width-length scapular and glenoid cavity indexes were calculated for every bone. In addition to standard anthropometric measurements two other measurements were defined and evaluated for every suprascapular notch: maximal depth (MD) and superior transverse diameter (STD). The superior transverse suprascapular ligament was completely ossified in 7% of cases. Ten (11.6%) scapulae had a discrete notch. In the studied material, in 21 (24.4%) scapulae the MD was longer than the STD. Two (2.3%) scapulae had equal maximal depth and superior transverse diameter. In 47 (57.7%) scapulae the superior transverse diameter was longer than the maximal depth. There was no statistically significant difference between anthropometric measurements in the group with higher MD and the group with higher STD. The maximal depth of the suprascapular notch negatively correlated with the scapular width-length index. The maximal depth of the scapular notch correlated with the morphological length of the scapulae.

Development of a Finite Element Model of the Human Shoulder to Investigate the Mechanical Responses and Injuries in Side Impact

NASA Astrophysics Data System (ADS)

Iwamoto, Masami; Miki, Kazuo; Yang, King H.

Previous studies in both fields of automotive safety and orthopedic surgery have hypothesized that immobilization of the shoulder caused by the shoulder injury could be related to multiple rib fractures, which are frequently life threatening. Therefore, for more effective occupant protection, it is important to understand the relationship between shoulder injury and multiple rib fractures in side impact. The purpose of this study is to develop a finite element model of the human shoulder in order to understand this relationship. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. The model also included approaches to represent bone fractures and joint dislocations. The relationships between shoulder injury and immobilization of the shoulder are discussed using model responses for lateral shoulder impact. It is also discussed how the injury can be related to multiple rib fractures.

Biomechanical Comparison of Superior Versus Anterior Plate Position for Fixation of Distal Clavicular Fractures: A New Model.

PubMed

Wilkerson, James; Paryavi, Ebrahim; Kim, Hyunchul; Murthi, Anand; Pensy, Raymond A

2017-01-01

Although most clavicular fractures are amenable to nonoperative management, metadiaphyseal fractures are considerably more complex, with rates of suboptimal healing as high as 75% when treated nonoperatively. The poor results are ascribed to the deforming forces on the distal clavicle from the surrounding muscles and the weight of the arm. It recently has been noted that some operative fixations of these fractures are also failing when a standard superiorly placed plate is used. We hypothesized that anterior plating, when compared with superior plating, improves the strength and durability of the construct by redirecting the axis of the major deforming force across rather than in line with the screws of the construct. Six pairs of fresh-frozen human cadaveric clavicles with the scapula attached by the coracoclavicular ligaments were osteotomized just medial to the ligaments and plated with a standard 3.5-mm limited-contact dynamic compression plate. Specimens were potted and mounted on a materials testing system machine, preserving the anatomic relationship of the clavicle and scapula. They were then loaded through the coracoclavicular ligaments to mimic the weight of the arm pulling inferiorly. Each specimen was loaded with 375 N at 1 Hz for 2000 cycles. Sequential loading was then applied at 25-N intervals until failure. Statistical analysis was performed using a Wilcoxon signed-rank test. The superiorly plated specimens failed after fewer cycles and with lower force than the anteriorly plated specimens. The median number of cycles to failure was 2082 for anterior plated specimens and 50 for superiorly plated (P = 0.028). The median load to failure was 587.5 N in the anterior group and 375 N in the superior group (P = 0.035). The median stiffness was 46.13 N/mm for anterior and 40.45 N/mm for superior (P = 0.375) plates. Anteriorly plated distal third clavicular fractures have superior strength and durability compared with fractures plated superiorly when using a physician-contoured, 3.5-mm, limited-contact, dynamic compression plate in this cadaver model.

The safe zone for avoiding suprascapular nerve injury during shoulder arthroscopy: an anatomical study on 500 dry scapulae.

PubMed

Gumina, Stefano; Albino, Paolo; Giaracuni, Marco; Vestri, Annarita; Ripani, Maurizio; Postacchini, Franco

2011-12-01

Suprascapular nerve injury may be a complication during shoulder arthroscopy. Our aim was to verify the reliability of the existing data, assess the differences between scapulae in the 2 genders and in the same subject, obtain a safe zone useful to avoid iatrogenic nerve lesions, and analyze the existing correlations between the scapular dimensions and the safe zone. We examined 500 dried scapulae, measuring 6 distances for each one, referring to the scapular body, glenoid, and the course of the suprascapular nerve, also catalogued according to gender and side. Differences due to gender were assessed comparing mean ± sd of each distance in males and females; paired t test was used to compare distances deriving from each couple. Successively, we calculated our safe zone and Pearson's correlation. We found nonsignificant differences between the right and left distances deriving from each couple; differences due to gender were stated. We defined 3 kinds of safe zones referring to: 500 scapulae; males (139 scapulae) and females (147 scapulae). The correlation indexes calculated between the axis of the scapular body and glenoid, and the posterosuperior distance (referring to the suprascapular nerve) were 0.624, 0.694, 0.675, 0.638; while those with the posterior distance were 0.230, 0.294, 0.232, 0.284. Knowledge of the safe zone, for avoiding suprascapular nerve injury, is important; gender and specific scapular dimensions should be evaluated, as they influence the dimensions of the safe zone. The linear predictors should be used to obtain specific values of the posterosuperior limit in each patient. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

[Treatment of complex scapular body fractures by locking reconstructive plates].

PubMed

Zhang, Jun-wei; Hou, Jin-yong; Yang, Mao-qing

2011-03-01

To investigate the method and effect of treatment of complex scapular body fractures by locking reconstructive plate through modified posterior approach. From August 2005 to November 2009, 27 patients with complex scapula body fractures were treated by locking reconstruction bone plate fixation,including 19 males and 8 females with an average age of 36 years old ranging from 16 to 64 years. The time after injury was 0.5 hours to 11 days (averaged 3 days). Of all the patients, 9 cases were associated with ipsilateral clavicle fracture, 2 cases were associated with acromioclavicular joint dislocation,16 cases were associated with multiple rib fractures, 1 case were associated with humeral shaft fractures, 5 cases were associated with pleural effusion, atelectasis, lung contusion etc. After operating,shoulder functional recovery were followed up. Twenty-four patients were followed up from 2 to 35 months with an average of 19 months. According to Hardegger shoulder function,the results were excellent in 15 cases, good in 7 cases, general in 2 cases. This method had the advantage of less trauma and clear exposure, firm and reliable fixation, and early activities.

The formation of the avian scapula blade takes place in the hypaxial domain of the somites and requires somatopleure-derived BMP signals.

PubMed

Wang, Baigang; He, Liwen; Ehehalt, Florian; Geetha-Loganathan, Poongodi; Nimmagadda, Suresh; Christ, Bodo; Scaal, Martin; Huang, Ruijin

2005-11-01

The avian scapula is a long bone located dorsally on the thorax. The cranial part that articulates with the upper limb is derived from the somatopleure of the forelimb field, while the caudal part, the scapula blade, originates from the dermomyotomes of brachial and thoracic somites. In previous studies, we have shown that scapula blade formation is intrinsically controlled by segment-specific information as well as extrinsically by ectoderm-derived signals. Here, we addressed the role of signals derived from the lateral plate mesoderm on scapula development. Chick-quail chimera experiments revealed that scapula precursor cells are located within the hypaxial domain of the dermomyotome adjacent to somatopleural cells. Barrier implantation between these two cell populations inhibited scapula blade formation. Furthermore, we identified BMPs as scapula-inducing signals from the somatopleure using injection of Noggin-producing cells into the hypaxial domain of scapula-forming dermomyotomes. We found that inhibition of BMP activity interfered with scapula-specific Pax1 expression and scapula blade formation. Taken together, we demonstrate that the scapula-forming cells located within the hypaxial somitic domain require BMP signals derived from the somatopleure for their specification and differentiation.

High-energy roller injuries to the upper extremity.

PubMed

Askins, G; Finley, R; Parenti, J; Bush, D; Brotman, S

1986-12-01

Eleven cases of high-energy industrial roller injuries treated between 1980 and 1984 were retrospectively reviewed. The dominant extremity was affected in nine. Six patients sustained fractures and/or dislocations, and three of these patients required fasciotomies for clinical signs of impending compartment syndromes. All fracture/dislocations, with the exception of a scapula fracture, anterior dislocation of a thumb interphalangeal joint, and a fractured coronoid process of the ulna, required open reduction with internal fixation. Three patients required split-thickness skin grafting for extensive skin degloving. Two patients required immediate amputation. Late sequelae included prolonged edema, nutritional depletion, neuroma formation of the superficial branch of the radial nerve, late carpal tunnel syndrome, and partial brachial plexus palsy. Industrial roller injuries continue to be an occupational hazard associated with more severe crushing trauma than the low-energy wringer washer injuries first described by MacCollum (11). Attention must be paid to the treatment of crushed skin, muscle, and nerves, fracture stabilization, nutritional support, and occupational therapy. Concurrent monitoring for signs of a developing compartment syndrome and complications of rhabdomyolysis is essential.

A Case of Acromioclavicular Joint Dislocation Associated with Coracoid Process Fracture.

PubMed

Nakamura, Yosuke; Gotoh, Masafumi; Mitsui, Yasuhiro; Shirachi, Isao; Yoshikawa, Eiichiro; Uryu, Takuya; Murakami, Hidetaka; Okawa, Takahiro; Higuchi, Fujio; Shiba, Naoto

2015-01-01

Rupture of any two or more parts of the superior shoulder suspensory complex (SSSC) including the distal clavicle, acromion, coracoid process, glenoid cavity of the scapula, acromioclavicular ligament, and coracoclavicular ligament is associated with shoulder girdle instability and is an indication for surgery. Here we report a case of acromioclavicular joint dislocation associated with coracoid process fracture. A 48-year-old man sustained a hard blow to the left shoulder from a fall, and simple radiography detected a coracoid process fracture and acromioclavicular joint dislocation. The injury consisted of a rupture of two parts of the SSSC. For the coracoid process fracture, osteosynthesis was performed using hollow cancellous bone screws. For the acromioclavicular joint dislocation, hook plate fixation and the modified Neviaser's procedure were performed. The bone healed well 5 months after surgery, at which time the screws were removed. At 18 months after initial surgery, the coracoid process fracture had healed with a 10% rate of dislocation on radiography, and the patient currently has no problem performing daily activities, no range of motion limitations, and a Japanese Orthopaedic Association scale score of 93.

Ambulatory measurement of the scapulohumeral rhythm: intra- and inter-operator agreement of a protocol based on inertial and magnetic sensors.

PubMed

Parel, I; Cutti, A G; Fiumana, G; Porcellini, G; Verni, G; Accardo, A P

2012-04-01

To measure the scapulohumeral rhythm (SHR) in outpatient settings, the motion analysis protocol named ISEO (INAIL Shoulder and Elbow Outpatient protocol) was developed, based on inertial and magnetic sensors. To complete the sensor-to-segment calibration, ISEO requires the involvement of an operator for sensor placement and for positioning the patient's arm in a predefined posture. Since this can affect the measure, this study aimed at quantifying ISEO intra- and inter-operator agreement. Forty subjects were considered, together with two operators, A and B. Three measurement sessions were completed for each subject: two by A and one by B. In each session, the humerus and scapula rotations were measured during sagittal and scapular plane elevation movements. ISEO intra- and inter-operator agreement were assessed by computing, between sessions, the: (1) similarity of the scapulohumeral patterns through the Coefficient of Multiple Correlation (CMC(2)), both considering and excluding the difference of the initial value of the scapula rotations between two sessions (inter-session offset); (2) 95% Smallest Detectable Difference (SDD(95)) in scapula range of motion. Results for CMC(2) showed that the intra- and inter-operator agreement is acceptable (median≥0.85, lower-whisker ≥ 0.75) for most of the scapula rotations, independently from the movement and the inter-session offset. The only exception is the agreement for scapula protraction-retraction and for scapula medio-lateral rotation during abduction (inter-operator), which is acceptable only if the inter-session offset is removed. SDD(95) values ranged from 4.4° to 8.6° for the inter-operator and between 4.9° and 8.5° for the intra-operator agreement. In conclusion, ISEO presents a high intra- and inter-operator agreement, particularly with the scapula inter-session offset removed. Copyright © 2011 Elsevier B.V. All rights reserved.

Intra-protocol repeatability and inter-protocol agreement for the analysis of scapulo-humeral coordination.

PubMed

Parel, I; Cutti, A G; Kraszewski, A; Verni, G; Hillstrom, H; Kontaxis, A

2014-03-01

Multi-center clinical trials incorporating shoulder kinematics are currently uncommon. The absence of repeatability and limits of agreement (LoA) studies between different centers employing different motion analysis protocols has led to a lack dataset compatibility. Therefore, the aim of this work was to determine the repeatability and LoA between two shoulder kinematic protocols. The first one uses a scapula tracker (ST), the International Society of Biomechanics anatomical frames and an optoelectronic measurement system, and the second uses a spine tracker, the INAIL Shoulder and Elbow Outpatient protocol (ISEO) and an inertial and magnetic measurement system. First within-protocol repeatability for each approach was assessed on a group of 23 healthy subjects and compared with the literature. Then, the between-protocol agreement was evaluated. The within-protocol repeatability was similar for the ST ([Formula: see text] = 2.35°, [Formula: see text] = 0.97°, SEM = 2.5°) and ISEO ([Formula: see text] = 2.24°, [Formula: see text] = 0.97°, SEM = 2.3°) protocols and comparable with data from published literature. The between-protocol agreement analysis showed comparable scapula medio-lateral rotation measurements for up to 120° of flexion-extension and up to 100° of scapula plane ab-adduction. Scapula protraction-retraction measurements were in agreement for a smaller range of humeral elevation. The results of this study suggest comparable repeatability for the ST and ISEO protocols and between-protocol agreement for two scapula rotations. Different thresholds for repeatability and LoA may be adapted to suit different clinical hypotheses.

Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review

PubMed Central

Chamata, Edward; Mahabir, Raman; Jupiter, Daniel; Weber, Robert A

2014-01-01

BACKGROUND: Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience. OBJECTIVE: To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved. METHODS: The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011). RESULTS: Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve. CONCLUSION: The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve. PMID:25535462

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.

Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade.

PubMed

Valasek, Petr; Theis, Susanne; Krejci, Eliska; Grim, Milos; Maina, Flavio; Shwartz, Yulia; Otto, Anthony; Huang, Ruijin; Patel, Ketan

2010-04-01

The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage-tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin.

Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade

PubMed Central

Valasek, Petr; Theis, Susanne; Krejci, Eliska; Grim, Milos; Maina, Flavio; Shwartz, Yulia; Otto, Anthony; Huang, Ruijin; Patel, Ketan

2010-01-01

The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage-tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin. PMID:20136669

A geometric morphometric study into the sexual dimorphism of the human scapula.

PubMed

Scholtz, Y; Steyn, M; Pretorius, E

2010-08-01

Sex determination is vital when attempting to establish identity from skeletal remains. Two approaches to sex determination exists: morphological and metrical. The aim of this paper was to use geometric morphometrics to study the shape of the scapula and its sexual dimorphism. The sample comprised 45 adult black male and 45 adult black female scapulae of known sex. The scapulae were photographed and 21 homologous landmarks were plotted to use for geometric morphometric analysis with the 'tps' series of programs, as well as the IMP package. Consensus thin-plate splines and vector plots for males and females were compared. The CVA and TwoGroup analyses indicated that significant differences exist between males and females. The lateral and medial borders of females are straighter while the supraspinous fossa is more convexly curved than that of males. More than 91% of the females and 95% of the males were correctly assigned. Hotelling's T(2)-test yielded a significant p-value of 0.00039. In addition, 100 equidistant landmarks representing the curve only were also assigned. These, however, yielded considerably poorer results. It is concluded that it is better to use homologous landmarks rather than curve data only, as it is most probable that the shape of the outline relative to the fixed homologous points on the scapula is sexually dimorphic.

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.

Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

USGS Publications Warehouse

Moore, M.P.; Stauber, E.; Thomas, N.J.

1989-01-01

Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

Winged Scapula: A Comprehensive Review of Surgical Treatment

PubMed Central

Charran, Ordessia; Yilmaz, Emre; Edwards, Bryan; Muhleman, Mitchel A; Oskouian, Rod J; Tubbs, R. Shane; Loukas, Marios

2017-01-01

Winged scapula is caused by paralysis of the serratus anterior or trapezius muscles due to damage to the long thoracic or accessory nerves, resulting in loss of strength and range of motion of the shoulder. Because this nerve damage can happen in a variety of ways, initial diagnosis may be overlooked. This paper discusses the anatomical structures involved in several variations of winged scapula, the pathogenesis of winged scapula, and several historical and contemporary surgical procedures used to treat this condition. Additionally, this review builds upon the conclusions of several studies in order to suggest areas for continued research regarding the treatment of winged scapula. PMID:29456903

Subchondral architecture in bones of the canine shoulder.

PubMed Central

Simkin, P A; Heston, T F; Downey, D J; Benedict, R S; Choi, H S

1991-01-01

The distal scapula and proximal humerus from each shoulder of nine adult dogs were slab-sectioned, cleaned of soft tissues, embedded in white plastic and stained black with a silver stain. These preparations were then photographed for automated, digital, morphometric analysis of subchondral bone structure. Comparison of transverse and coronal sections through the left and right shoulders demonstrated essential isometry of trabecular patterns within each bone. Comparison of the scapula and humerus revealed significant differences in bony architecture. The subchondral plate was an average of 5.6 times thicker under the glenoid fossa than in the opposing humeral head. Deeper trabecular structure also differed with the trabecular bone volume (density) in the humerus being greater than that in the scapula. This difference reflects a greater trabecular density in the humerus with comparable trabecular thickness in both bones. These structural differences are consistent with previous functional studies of the same two bones that revealed greater mechanical stiffness beneath the glenoid fossa and greater hydraulic resistance within the humeral head. Images Fig. 1 Fig. 2 (cont.) Fig. 2 Fig. 3 PMID:2050567

Posttraumatic Intracranial Tuberculous Subdural Empyema in a Patient with Skull Fracture

PubMed Central

Kim, Jiha; Kim, Choonghyo; Ryu, Young-Joon

2016-01-01

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M. tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema. PMID:27226867

Biomechanical loading test on reconstructed mandibles with fibular, iliac crest or scapula graft: a comparative study.

PubMed

Grohmann, Isabella; Raith, Stefan; Mücke, Thomas; Stimmer, Herbert; Rohleder, Nils; Kesting, Marco R; Hölzle, Frank; Steiner, Timm

2015-10-01

Advantages and disadavantages of the three most commonly-used bone grafts for mandibular reconstruction are widely known, but biomechanical experimental studies are rare. We have done loading tests on cadaveric mandibles reconstructed with fibular, iliac crest, and scapular grafts using 3 different osteosynthesis systems to detect and compare their primary stability. Loading tests were done on mandibles with grafts from the fibula and iliac crest and published previously. A 4.5cm paramedian L-type defect was reconstructed with scapula using 2 monocortical non-locking plates, 2 monocortical locking plates, or a single bicortical locking plate/fracture gap in 18 human cadaveric mandibles. These were loaded on to the "Mandibulator" test bench and the movement of fragments in 3 dimensions was assessed and quantified by a PONTOS® optical measurement system. Comparison of the osteosynthesis groups showed that the miniplate was significantly superior to the 6-hole TriLock® plate for both fibular and iliac crest grafts. The fibular graft gave greater stability than the iliac crest and scapular grafts for all 3 osteosynthesis systems. All bony specimens offered sufficient resistance to mechanical stress within the recognised range of biting forces after mandibular reconstruction, independently of the choice of bone graft and osteosynthesis system used. Anatomical and surgical advantages need to be taken into account when choosing a graft. Stability can be maximised with a fibular graft, and further optimised by enlarging the binding area by using the "double barrel" method. Computer simulated experiments could segregate factors that biased results, such as morphological differences among cadavers. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Scaling and kinematics optimisation of the scapula and thorax in upper limb musculoskeletal models

PubMed Central

Prinold, Joe A.I.; Bull, Anthony M.J.

2014-01-01

Accurate representation of individual scapula kinematics and subject geometries is vital in musculoskeletal models applied to upper limb pathology and performance. In applying individual kinematics to a model׳s cadaveric geometry, model constraints are commonly prescriptive. These rely on thorax scaling to effectively define the scapula׳s path but do not consider the area underneath the scapula in scaling, and assume a fixed conoid ligament length. These constraints may not allow continuous solutions or close agreement with directly measured kinematics. A novel method is presented to scale the thorax based on palpated scapula landmarks. The scapula and clavicle kinematics are optimised with the constraint that the scapula medial border does not penetrate the thorax. Conoid ligament length is not used as a constraint. This method is simulated in the UK National Shoulder Model and compared to four other methods, including the standard technique, during three pull-up techniques (n=11). These are high-performance activities covering a large range of motion. Model solutions without substantial jumps in the joint kinematics data were improved from 23% of trials with the standard method, to 100% of trials with the new method. Agreement with measured kinematics was significantly improved (more than 10° closer at p<0.001) when compared to standard methods. The removal of the conoid ligament constraint and the novel thorax scaling correction factor were shown to be key. Separation of the medial border of the scapula from the thorax was large, although this may be physiologically correct due to the high loads and high arm elevation angles. PMID:25011621

Scapula kinematics of pull-up techniques: Avoiding impingement risk with training changes.

PubMed

Prinold, Joe A I; Bull, Anthony M J

2016-08-01

Overhead athletic activities and scapula dyskinesia are linked with shoulder pathology; pull-ups are a common training method for some overhead sports. Different pull-up techniques exist: anecdotally some are easier to perform, and others linked to greater incidences of pathology. This study aims to quantify scapular kinematics and external forces for three pull-up techniques, thus discussing potential injury implications. An observational study was performed with eleven participants (age=26.8±2.4 years) who regularly perform pull-ups. The upward motions of three pull-up techniques were analysed: palms facing anterior, palms facing posterior and wide-grip. A skin-fixed scapula tracking technique with attached retro-reflective markers was used. High intra-participant repeatability was observed: mean coefficients of multiple correlations of 0.87-1.00 in humerothoracic rotations and 0.77-0.90 for scapulothoracic rotations. Standard deviations of hand force was low: <5% body weight. Significantly different patterns of humerothoracic, scapulothoracic and glenohumeral kinematics were observed between the pull-up techniques. The reverse technique has extreme glenohumeral internal-external rotation and large deviation from the scapula plane. The wide technique has a reduced range of pro/retraction in the same HT plane of elevation and 90° of arm abduction with 45° external rotation was observed. All these factors suggest increased sub-acromial impingement risk. The scapula tracking technique showed high repeatability. High arm elevation during pull-ups reduces sub-acromial space and increases pressure, increasing the risk of impingement injury. Wide and reverse pull-ups demonstrate kinematics patterns linked with increased impingement risk. Weight-assisted front pull-ups require further investigation and could be recommended for weaker participants. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Assessment of anterior shoulder instability by CT arthrography.

PubMed

Yang, S O; Cho, K J; Kim, M J; Ro, I W

1987-09-01

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.

Achieving fixation in glenoids with superior wear using reverse shoulder arthroplasty.

PubMed

Roche, Christopher P; Stroud, Nicholas J; Martin, Brian L; Steiler, Cindy A; Flurin, Pierre-Henri; Wright, Thomas W; Zuckerman, Joseph D; Dipaola, Matthew J

2013-12-01

Superior glenoid wear is a common challenge with reverse shoulder arthroplasty and, if left uncorrected, can result in superior glenoid tilt, which increases the risk of aseptic glenoid loosening. This study evaluates the impact of an E2 superior defect on reverse shoulder glenoid fixation in composite scapulae after correction of glenoid tilt by use of 2 different glenoid reaming techniques: eccentric reaming and off-axis reaming. A superior glenoid defect was created in 14 composite scapulae. The superior defect was corrected by 2 different glenoid reaming techniques: (1) eccentric reaming with implantation of a standard glenoid baseplate and (2) off-axis reaming with implantation of a superior-augment glenoid baseplate. Each corrected superior-defect scapula was then cyclically loaded (along with a control group consisting of 7 non-worn scapulae) for 10,000 cycles at 750 N; glenoid baseplate displacement was measured for each group to quantify fixation before and after cyclic loading. Regardless of the glenoid reaming technique or the glenoid baseplate type, each standard and superior-augment glenoid baseplate remained well fixed in this superior-defect model scenario after cyclic loading. No differences in baseplate displacement were observed either before or after cyclic loading between groups. Our results suggest that either glenoid reaming technique may be used to achieve fixation in the clinically challenging situation of superior wear with reverse shoulder arthroplasty. Basic science, biomechanical study. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Intraoperative reduction of the scapular body--a technical trick.

PubMed

Bartonícek, Jan; Fric, Vladimír; Tucek, Michal

2009-04-01

When internal fixation of the scapular neck and body fractures is performed, a problem may occur with reduction and retention of position of the lateral border of the scapula during surgery. For this purpose, the authors have developed their own technique of stabilization using a K-wire in a novel way. The technique is indicated in a 2-part shear unstable fracture of the lateral border. It cannot be used in fractures with an intercalated segment. A 2.5-mm drill bit is used to drill a 1.5-cm deep hole into the "medullary cavity" of each of the 2 fragments of the lateral border. A K-wire, 1.5 mm in diameter and 2.5-cm long, is inserted into the distal fragment. The protruding end of the K-wire is inserted into the hole in the proximal fragment. This intramedullary peg helps to maintain reduction and keeps both fragments stable. Subsequently, the lateral border is stabilized with a 3.5-mm reconstruction plate. This technique is quite simple and allows for a temporary stabilization of fragments without compromising the subsequent fixation by plate screws.

Evaluation of regression-based 3-D shoulder rhythms.

PubMed

Xu, Xu; Dickerson, Clark R; Lin, Jia-Hua; McGorry, Raymond W

2016-08-01

The movements of the humerus, the clavicle, and the scapula are not completely independent. The coupled pattern of movement of these bones is called the shoulder rhythm. To date, multiple studies have focused on providing regression-based 3-D shoulder rhythms, in which the orientations of the clavicle and the scapula are estimated by the orientation of the humerus. In this study, six existing regression-based shoulder rhythms were evaluated by an independent dataset in terms of their predictability. The datasets include the measured orientations of the humerus, the clavicle, and the scapula of 14 participants over 118 different upper arm postures. The predicted orientations of the clavicle and the scapula were derived from applying those regression-based shoulder rhythms to the humerus orientation. The results indicated that none of those regression-based shoulder rhythms provides consistently more accurate results than the others. For all the joint angles and all the shoulder rhythms, the RMSE are all greater than 5°. Among those shoulder rhythms, the scapula lateral/medial rotation has the strongest correlation between the predicted and the measured angles, while the other thoracoclavicular and thoracoscapular bone orientation angles only showed a weak to moderate correlation. Since the regression-based shoulder rhythm has been adopted for shoulder biomechanical models to estimate shoulder muscle activities and structure loads, there needs to be further investigation on how the predicted error from the shoulder rhythm affects the output of the biomechanical model. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Computed tomography analysis of guinea pig bone: architecture, bone thickness and dimensions throughout development

PubMed Central

Witkowska, Agata; Alibhai, Aziza; Hughes, Chloe; Price, Jennifer; Klisch, Karl; Sturrock, Craig J.

2014-01-01

The domestic guinea pig, Cavia aperea f. porcellus, belongs to the Caviidae family of rodents. It is an important species as a pet, a source of food and in medical research. Adult weight is achieved at 8–12 months and life expectancy is ∼5–6 years. Our aim was to map bone local thickness, structure and dimensions across developmental stages in the normal animal. Guinea pigs (n = 23) that had died of natural causes were collected and the bones manually extracted and cleaned. Institutional ethical permission was given under the UK Home Office guidelines and the Veterinary Surgeons Act. X-ray Micro Computed Tomography (microCT) was undertaken on the left and right scapula, humerus and femur from each animal to ascertain bone local thickness. Images were also used to undertake manual and automated bone measurements, volumes and surface areas, identify and describe nutrient, supratrochlear and supracondylar foramina. Statistical analysis between groups was carried out using ANOVA with post-hoc testing. Our data mapped a number of dimensions, and mean and maximum bone thickness of the scapula, humerus and femur in guinea pigs aged 0–1 month, 1–3 months, 3–6 months, 6 months–1 year and 1–4 years. Bone dimensions, growth rates and local bone thicknesses differed between ages and between the scapula, humerus and femur. The microCT and imaging software technology showed very distinct differences between the relative local bone thickness across the structure of the bones. Only one bone showed a singular nutrient foramen, every other bone had between 2 and 5, and every nutrient canal ran in an oblique direction. In contrast to other species, a supratrochlear foramen was observed in every humerus whereas the supracondylar foramen was always absent. Our data showed the bone local thickness, bone structure and measurements of guinea pig bones from birth to 4 years old. Importantly it showed that bone development continued after 1 year, the point at which most guinea pigs have reached full weight. This study is the first to show the high abundance (100% in this study) of the supratrochlear foramen within the guinea pig humerus and the complete absence of a supracondylar foramen, which is different to many other species and may also affect potential fracture points and frequencies. Understanding bone morphology and growth is essential in not only understanding the requirements of the healthy guinea pig, but also necessary in order to investigate disease states. PMID:25289194

Computed tomography analysis of guinea pig bone: architecture, bone thickness and dimensions throughout development.

PubMed

Witkowska, Agata; Alibhai, Aziza; Hughes, Chloe; Price, Jennifer; Klisch, Karl; Sturrock, Craig J; Rutland, Catrin S

2014-01-01

The domestic guinea pig, Cavia aperea f. porcellus, belongs to the Caviidae family of rodents. It is an important species as a pet, a source of food and in medical research. Adult weight is achieved at 8-12 months and life expectancy is ∼5-6 years. Our aim was to map bone local thickness, structure and dimensions across developmental stages in the normal animal. Guinea pigs (n = 23) that had died of natural causes were collected and the bones manually extracted and cleaned. Institutional ethical permission was given under the UK Home Office guidelines and the Veterinary Surgeons Act. X-ray Micro Computed Tomography (microCT) was undertaken on the left and right scapula, humerus and femur from each animal to ascertain bone local thickness. Images were also used to undertake manual and automated bone measurements, volumes and surface areas, identify and describe nutrient, supratrochlear and supracondylar foramina. Statistical analysis between groups was carried out using ANOVA with post-hoc testing. Our data mapped a number of dimensions, and mean and maximum bone thickness of the scapula, humerus and femur in guinea pigs aged 0-1 month, 1-3 months, 3-6 months, 6 months-1 year and 1-4 years. Bone dimensions, growth rates and local bone thicknesses differed between ages and between the scapula, humerus and femur. The microCT and imaging software technology showed very distinct differences between the relative local bone thickness across the structure of the bones. Only one bone showed a singular nutrient foramen, every other bone had between 2 and 5, and every nutrient canal ran in an oblique direction. In contrast to other species, a supratrochlear foramen was observed in every humerus whereas the supracondylar foramen was always absent. Our data showed the bone local thickness, bone structure and measurements of guinea pig bones from birth to 4 years old. Importantly it showed that bone development continued after 1 year, the point at which most guinea pigs have reached full weight. This study is the first to show the high abundance (100% in this study) of the supratrochlear foramen within the guinea pig humerus and the complete absence of a supracondylar foramen, which is different to many other species and may also affect potential fracture points and frequencies. Understanding bone morphology and growth is essential in not only understanding the requirements of the healthy guinea pig, but also necessary in order to investigate disease states.

Shoulder Acromioclavicular and Coracoclavicular Ligament Injuries: Common Problems and Solutions.

PubMed

Wylie, James D; Johnson, Jeremiah D; DiVenere, Jessica; Mazzocca, Augustus D

2018-04-01

Injuries to the acromioclavicular joint and coracoclavicular ligaments are common. Many of these injuries heal with nonoperative management. However, more severe injuries may lead to continued pain and shoulder dysfunction. In these patients, surgical techniques have been described to reconstruct the function of the coracoclavicular ligaments to provide stable relationship between the clavicle and scapula. These surgeries have been fraught with high complication rates including clavicle and coracoid fractures, infection, loss of reduction and fixation, hardware migration, and osteolysis. This article reviews common acromioclavicular and coracoclavicular repair and reconstruction techniques and associated complications, and provides recommendations for prevention and management. Copyright © 2018 Elsevier Inc. All rights reserved.

Shoulder injuries from alpine skiing and snowboarding. Aetiology, treatment and prevention.

PubMed

Kocher, M S; Dupré, M M; Feagin, J A

1998-03-01

There has been a decrease in the overall injury rate and the rate of lower extremity injuries for alpine skiing, with a resultant increase in the ratio of upper extremity to lower extremity injuries. Upper extremity injuries account for 20 to 35% of all injuries during alpine skiing and nearly 50% of all injuries during snowboarding. The most common upper extremity injuries during skiing are sprain of the thumb metacarpal-phalangeal joint ulnar collateral ligament, and the most common in snowboarding is wrist fracture. Shoulder injuries from skiing and snowboarding have been less well characterised. With the increased ratio of upper to lower extremity injuries during alpine skiing and the boom in popularity of snowboarding, shoulder injuries will be seen with increasing frequency by those who care for alpine sport injuries. Shoulder injuries account for 4 to 11% of all alpine skiing injuries and 22 to 41% of upper extremity injuries. The rate of shoulder injuries during alpine skiing is 0.2 to 0.5 injuries per thousand skier-days. During snowboarding, shoulder injuries account for 8 to 16% of all injuries and 20 to 34% of upper extremity injuries. Falls are the most common mechanism of shoulder injury, in addition to pole planting during skiing and aerial manoeuvres during snowboarding. Common shoulder injuries during skiing and snowboarding are glenohumeral instability, rotator cuff strains, acromioclavicular separations and clavicle fractures. Less common shoulder injuries include greater tuberosity fractures, trapezius strains, proximal humerus fractures, biceps strains, glenoid fractures, scapula fractures, humeral head fractures, sterno-clavicular separations, acromion fractures and biceps tendon dislocation. Prevention of shoulder injuries during skiing and snowboarding may be possible through interventions in education and technique, conditioning and equipment and environment.

Fixation of Winged Scapula in Facioscapulohumeral Muscular Dystrophy

PubMed Central

Giannini, Sandro; Faldini, Cesare; Pagkrati, Stavroula; Grandi, Gianluca; Digennaro, Vitantonio; Luciani, Deianira; Merlini, Luciano

2007-01-01

Objective: To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications. Design: A retrospective study. Participants: Thirteen patients with bilateral winged scapula affected by facioscapulohumeral muscular dystrophy. Nine of these patients had been analyzed in our previous study. Methods: Patients were operated on by bilateral fixing of the scapula to the rib cage using metal wires without arthrodesis (scapulopexy). Results: All patients experienced improvement in active range of motion of the shoulder and all of them had clinical improvement with complete resolution of the winged scapula. In all twenty-six surgical interventions of scapulopexy, a stable and long-lasting fixation of the scapula to the rib cage was achieved.The complications strictly associated to the surgical technique encountered were one pneumothorax, which was resolved spontaneously, and one wire breakage without trauma. Average follow-up was 10 years (range, 3 to 18 years). Conclusion: The scapulopexy used in this extended series of patients consisted of repositioning the scapula and fixing it to four ribs by using metal wires without performing arthrodesis.This technique has a low rate of complications, is reproducible, safe and effective, resulting in clinical and functional improvement. PMID:18056023

Finite Element Model to Reduce Fire and Blast Vulnerability

DTIC Science & Technology

2013-01-01

4 Figure 4. Scapula, Clavicle and Arm Models Attached to the Larger Model .............................. 5 Figure 5. The Full Body...Finite Element Model of the Lower Limbs UNCLASSIFIED 4 UNCLASSIFIED Anatomical surfaces of the scapula and clavicle were obtained and...ulna and hand bones. For the arms, hands, scapula and clavicle , the materials were made to be rigid and joints created using computational constraints

Morphometric study of suprascapular notch in Indian dry scapulae with specific reference to the incidence of completely ossified superior transverse scapular ligament.

PubMed

Kannan, Usha; Kannan, N S; Anbalagan, J; Rao, Sudha

2014-03-01

The suprascapular notch, a depression on the lateral part of the superior border of the scapula, medial to the coracoid process, is bridged by the superior transverse scapular ligament, which is sometimes ossified and the foramen which is thus completed, transmits the suprascapular nerve to the supraspinatus fossa. Variations in the morphology of suprascapular notch have been identified as one of the causes of suprascapular nerve entrapment. Rengachary et al. classified this notch into six types, based on its shape. To study morphological variations of suprascapular notch in Indian dry scapulae and to analyze the incidence of completely ossified superior transverse scapular ligament with other ethnic populations which have been cited earlier. A total of 400 human dry scapulae which were obtained from the Department of Anatomy of selected eight medical colleges were analyzed. The type of suprascapular notch was noted and it was recorded as per the description given by Rengachary et al. The results of the present study were compared with the results of previous authors in different populations. In our study, out of 400 scapulae, 40 (10%), were identified to have completely ossified superior transverse scapular ligaments. The frequencies of various types of suprascapular notches were: Type I -20%, Type II -10%, Type III -52%, Type IV -4%, Type V -4%, Type VI -10%. Since the suprascapular nerve entrapment syndrome might be caused by complete ossification of superior transverse scapular ligament with formation of suprascapular foramen and other morphometric variations of suprascapular notch, the knowledge on such variations is essential for clinicians, for making a proper diagnosis and for planning the most suitable surgical intervention.

Altered scapula position in elite young cricketers with shoulder problems.

PubMed

Green, Rodney A; Taylor, Nicholas F; Watson, Lyn; Ardern, Clare

2013-01-01

Shoulder injuries associated with the throwing and fielding demands of the game are common in elite cricketers. This study aimed to identify the factors associated with shoulder injuries in an elite junior squad. Cross-sectional study. Sixty players aged 15-19 years, from the Cricket Victoria elite junior male squads completed questionnaires and 46 completed clinical assessments conducted by a physiotherapist that included shoulder strength, range of movement and scapula position. Participants were classified into two groups; players currently reporting shoulder problems (SP) and those not reporting shoulder problems (NSP) on the basis of their response to the question 'Have you had any problems with your shoulder in the last 12 months that have affected you training for or playing cricket?'. Fifteen percent (9 of 60) of participants reported shoulder problems (SP). The level of shoulder disability in participants with SP, classified on standard self-report scales, was mild to moderate. The major difference between groups was that the SP group displayed a significant downward rotation of the scapula in almost all shoulder positions. There were no differences between the two groups for training factors, range of motion, or in clinical test results. However, contrary to expectations the SP group exhibited greater strength than the NSP group on some variables. A consistently downwardly rotated scapula associated with young cricketers with SP may predispose these cricketers to ongoing injury through impingement and also through increased load on the rotator cuff muscles acting at the glenohumeral joint during throwing. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A rare case of pure primary hemangioma of the scapula: A case report

PubMed Central

LI, WEI; ZOU, FAN; DAI, MIN; ZHANG, BIN; NIE, TAO

2015-01-01

Hemangioma is a benign vascular tumor, which may occur in any bone of the body. The most common locations are the spine and craniofacial bone; however, occurrence is extremely rare in the scapula. The current study presented the case of a 58-year-old female, with scapula hemangioma in the left shoulder who presented with joint ache that had lasted for ~1 year. The main clinical manifestations included local tenderness, an osseous lump and limited shoulder movement with a little pain, which was alleviated by rest. Roentgenogram, computed tomography and magnetic resonance imaging of the left acromion revealed a mass along the inner surface of the scapula of the left shoulder with polycystic expansion and bone destruction. The results of computed tomography and magnetic resonance imaging indicated a pure primary tumor and the lesion was subsequently resected. Notably, the postoperative pathological diagnosis was capillary hemangioma. The aim of the present study was to analyze the clinical and imaging features of scapula hemangioma, which must be considered for the differential diagnosis of scapula tumors. In the present case, no recurrence was identified by X-ray examination 1 year after surgery. The long-term efficacy of surgical treatment requires continuous observation of the patient. PMID:26622831

A new method for motion capture of the scapula using an optoelectronic tracking device: a feasibility study.

PubMed

Šenk, Miroslav; Chèze, Laurence

2010-06-01

Optoelectronic tracking systems are rarely used in 3D studies examining shoulder movements including the scapula. Among the reasons is the important slippage of skin markers with respect to scapula. Methods using electromagnetic tracking devices are validated and frequently applied. Thus, the aim of this study was to develop a new method for in vivo optoelectronic scapular capture dealing with the accepted accuracy issues of validated methods. Eleven arm positions in three anatomical planes were examined using five subjects in static mode. The method was based on local optimisation, and recalculation procedures were made using a set of five scapular surface markers. The scapular rotations derived from the recalculation-based method yielded RMS errors comparable with the frequently used electromagnetic scapular methods (RMS up to 12.6° for 150° arm elevation). The results indicate that the present method can be used under careful considerations for 3D kinematical studies examining different shoulder movements.

The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions.

PubMed

Sewell, M D; Higgs, D S; Al-Hadithy, N; Falworth, M; Bayley, I; Lambert, S M

2012-09-01

Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement.

Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence.

PubMed

Warth, Ryan J; Spiegl, Ulrich J; Millett, Peter J

2015-01-01

Symptomatic scapulothoracic disorders, such as painful scapular crepitus and/or bursitis, are uncommon; however, they can produce significant pain and disability in many patients. To review the current knowledge pertaining to snapping scapula syndrome and to identify areas of further research that may be helpful to improve clinical outcomes and patient satisfaction. Systematic review. We performed a preliminary search of the PubMed and Embase databases using the search terms "snapping scapula," "scapulothoracic bursitis," "partial scapulectomy," and "superomedial angle resection" in September 2013. All nonreview articles related to the topic of snapping scapula syndrome were included. The search identified a total of 167 unique articles, 81 of which were relevant to the topic of snapping scapula syndrome. There were 36 case series of fewer than 10 patients, 16 technique papers, 11 imaging studies, 9 anatomic studies, and 9 level IV outcomes studies. The level of evidence obtained from this literature search was inadequate to perform a formal systematic review or meta-analysis. Therefore, a critical review of current evidence is presented. Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction. © 2014 The Author(s).

A 3D finite element model of an implanted scapula: importance of a multiparametric validation using experimental data.

PubMed

Maurel, N; Diop, A; Grimberg, J

2005-09-01

In order to help to understand the loosening phenomenon around glenoïd prostheses, a 3D finite element model of a previously tested implanted scapula has been developed. The construction of the model was done using CT scans of the tested scapula. Different bone material properties were tested and shell elements or 8 nodes hexaedric elements were used to model the cortical bone. Surface contact elements were introduced on one hand between the bone and the lower part of the plate of the implant, and on the other, between the loading metallic ball and the upper surface of the implant. The results of the model were compared with those issued from in vitro experiments carried out on the same scapula. The evaluation of the model was done for nine cases of loading of 500 N distributed on the implant, in terms of strains (principal strains of six spots around peripheral cortex of the glenoïd) and displacement of four points positioned on the implant. The best configuration of the model presented here, fits with experiments for most of the strains (difference lower than 150microdef) but it seems to be still too stiff (mainly in the lower part). Nevertheless, we want, in this paper, to underline the importance of doing a multiparametric validation for such a model. Indeed, some models can give correct results for one case of loading but bad results for another kind of loading, some others can give good results for one kind of compared parameters (like strains for instance) but bad results for the other one (like displacements).

Incidence of the coracoclavicular joint in South African populations.

PubMed Central

Nalla, S; Asvat, R

1995-01-01

The presence of a diarthrotic coracoclavicular joint, as represented by an articular facet on the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula, was investigated. The sample consisted of 60 white and 180 black South African (60 Sotho, 60 Xhosa and 60 Zulu) skeletons. Each group consisted of 30 male and 30 female skeletons. The presence of the articular facet was recorded as either bilateral, unilateral left or unilateral right. The effect of clavicular length, scapular size and first rib angle on the presence of the coracoclavicular joint was also investigated. The presence of the articular facet was noted in 23 (9.6%) of the 240 individuals studied. Of these 23 individuals, 6 (26.1%) were white and 17 (73.9%) were black. Males (56.5%) presented a higher incidence of this anomaly than females (43.5%). The articular facet occurred bilaterally in 47.9% (11/23), unilaterally on the left in 30.4% (7/23) and unilaterally on the right in 21.7% (5/23). Sexual, racial and tribal differences were not statistically significant. Individuals possessing the joint showed statistically significantly (P < 0.01) larger scapulae (increased border lengths and superior angles), longer clavicles and longer first ribs. No statistically significant differences in the first rib angles were observed between individuals who possessed the joint and those who did not, thus implying similar thoracic inlet size. It is proposed that the aforementioned morphometry of the scapulae, clavicles and first ribs may restrict associated movements of the scapulae, resulting in the development of the coracoclavicular joint. Images Fig. 4 Fig. 5 PMID:7559137

Aneurysmal bone cyst of the scapula. A case report.

PubMed

Megas, Panagiotis; Papathanassiou, Zafiria G; Kasimatis, George; Papachristou, Dionysios J

2009-10-01

Aneurysmal bone cyst (ABC) is an uncommon, benign but locally destructive bone lesion of unknown origin. Differential diagnosis can be challenging as it shares common radiological and pathological features with other benign and malignant bone lesions. The degree of diagnostic difficulty grows even more when an unusual location has to be taken into account. We report a rare and challenging case of a large primary ABC located at the scapula of a young male, who was surgically treated with subtotal removal of the scapula.

Scapula development is governed by genetic interactions of Pbx1 with its family members and with Emx2 via their cooperative control of Alx1

PubMed Central

Capellini, Terence D.; Vaccari, Giulia; Ferretti, Elisabetta; Fantini, Sebastian; He, Mu; Pellegrini, Massimo; Quintana, Laura; Di Giacomo, Giuseppina; Sharpe, James; Selleri, Licia; Zappavigna, Vincenzo

2010-01-01

The genetic pathways underlying shoulder blade development are largely unknown, as gene networks controlling limb morphogenesis have limited influence on scapula formation. Analysis of mouse mutants for Pbx and Emx2 genes has suggested their potential roles in girdle development. In this study, by generating compound mutant mice, we examined the genetic control of scapula development by Pbx genes and their functional relationship with Emx2. Analyses of Pbx and Pbx1;Emx2 compound mutants revealed that Pbx genes share overlapping functions in shoulder development and that Pbx1 genetically interacts with Emx2 in this process. Here, we provide a biochemical basis for Pbx1;Emx2 genetic interaction by showing that Pbx1 and Emx2 can bind specific DNA sequences as heterodimers. Moreover, the expression of genes crucial for scapula development is altered in these mutants, indicating that Pbx genes act upstream of essential pathways for scapula formation. In particular, expression of Alx1, an effector of scapula blade patterning, is absent in all compound mutants. We demonstrate that Pbx1 and Emx2 bind in vivo to a conserved sequence upstream of Alx1 and cooperatively activate its transcription via this potential regulatory element. Our results establish an essential role for Pbx1 in genetic interactions with its family members and with Emx2 and delineate novel regulatory networks in shoulder girdle development. PMID:20627960

Scapular Contribution for the End-Range of Shoulder Axial Rotation in Overhead Athletes

PubMed Central

Ribeiro, Andrea; Pascoal, Augusto Gil

2012-01-01

The aim of this study was to analyze the relative contribution of the scapular motion on the extreme range-of-motion of shoulder external and internal rotation, in overhead athletes. An electromagnetic tracking device (Flock of Birds) was used to record humeral and scapular kinematics. The dominant arm of 26 male subjects (13 athletes and 13 non-athletes) was studied while subjects actively reached end-range of internal and external rotation. Humeral and scapular angles were calculated and compared across groups by means of a t-test for independent samples. A bivariate correlation approach was used to describe the relationship between humeral angles and scapular variables. The range-of-motion of the thoracohumeral angles, during shoulder external rotation was significantly less (p < 0.05) on the athletes group, athletes also positioned their dominant scapula more retracted and posteriorly tilted. A positive correlation was found between glenohumeral angles and scapular tilt (r = 0.6777; p < 0.05). Concerning internal rotation; athletes showed significantly greater (highest) thoracohumeral angles (p < 0.05). Scapula assumed a position more in retraction and anterior tilt. Based on these findings, it is suggested that differences found in athletes seem to reveal an eventual shoulder adaptation to the throwing mechanics. Key points In external rotation end-range, athletes positioned their scapula more in retraction and posterior tilt. In internal rotation end-range, athletes positioned their scapula more in retraction and anterior tilt. Results seem to reveal a sport-related shoulder adaptation. PMID:24150078

Scapulothoracic Dissociation: Evaluation and Management.

PubMed

Choo, Andrew M; Schottel, Patrick C; Burgess, Andrew R

2017-05-01

Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Radiographic evaluation includes measurement of the scapular index on a nonrotated chest radiograph and assessment for either a distracted clavicle fracture or a disrupted acromioclavicular or sternoclavicular joint. Although vascular injury occurs in most patients, emergent surgery is performed only in patients with either limb-threatening ischemia or active arterial hemorrhage. Management of neurologic injury can be delayed if necessary. The location and severity of neurologic injury determine whether observation, nerve grafting, nerve transfer, or above-elbow amputation is performed. Skeletal stabilization procedures include plate fixation of clavicle fractures and reduction of distracted acromioclavicular or sternoclavicular joints. The extent of neurologic injury determines clinical outcomes. Medical Outcomes Study 36-Item Short Form scores are significantly lower in patients with complete brachial plexus avulsion injury than in patients with postganglionic injury.

Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review.

PubMed

Wright, Alexis A; Wassinger, Craig A; Frank, Mason; Michener, Lori A; Hegedus, Eric J

2013-09-01

To systematically review and critique the evidence regarding the diagnostic accuracy of physical examination tests for the scapula in patients with shoulder disorders. A systematic, computerised literature search of PubMED, EMBASE, CINAHL and the Cochrane Library databases (from database inception through January 2012) using keywords related to diagnostic accuracy of physical examination tests of the scapula. The Quality Assessment of Diagnostic Accuracy Studies tool was used to critique the quality of each paper. Eight articles met the inclusion criteria; three were considered to be of high quality. Of the three high-quality studies, two were in reference to a 'diagnosis' of shoulder pain. Only one high-quality article referenced specific shoulder pathology of acromioclavicular dislocation with reported sensitivity of 71% and 41% for the scapular dyskinesis and SICK scapula test, respectively. Overall, no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.

[Treatment of proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring].

PubMed

Teng, Lin; Zhong, Gang; Xiao, Cong; Liu, Gang; Xiang, Zhou; Cen, Shiqiang; Huang, Fuguo

2011-01-01

OBJECTIVE To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and 4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by falling from height, 2 by tumbling, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of oblique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture healing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension are of the elbow averaged 92.8 degrees (range, 23-130 degrees), and the arc of forearm rotation averaged 124.4 degrees (range, 42-175 degrees). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid complications.

Commitment of chondrogenic precursors of the avian scapula takes place after epithelial-mesenchymal transition of the dermomyotome

PubMed Central

2010-01-01

Background Cells of the epithelially organised dermomyotome are traditionally believed to give rise to skeletal muscle and dermis. We have previously shown that the dermomyotome can undergo epithelial-mesenchymal transition (EMT) and give rise to chondrogenic cells, which go on to form the scapula blade in birds. At present we have little understanding regarding the issue of when the chondrogenic fate of dermomyotomal cells is determined. Using quail-chick grafting experiments, we investigated whether scapula precursor cells are committed to a chondrogenic fate while in an epithelial state or whether commitment is established after EMT. Results We show that the hypaxial dermomyotome, which normally forms the scapula, does not generate cartilaginous tissue after it is grafted to the epaxial domain. In contrast engraftment of the epaxial dermomyotome to the hypaxial domain gives rise to scapula-like cartilage. However, the hypaxial sub-ectodermal mesenchyme (SEM), which originates from the hypaxial dermomyotome after EMT, generates cartilaginous elements in the epaxial domain, whereas in reciprocal grafting experiments, the epaxial SEM cannot form cartilage in the hypaxial domain. Conclusions We suggest that the epithelial cells of the dermomyotome are not committed to the chondrogenic lineage. Commitment to this lineage occurs after it has undergone EMT to form the sub-ectodermal mesenchyme. PMID:20807426

A morphometric study on the cross-sections of the scapular spine in dogs.

PubMed

Ocal, M K; Toros, G

2007-01-01

In cases of unstable scapular body fractures, the base of the scapular spine is one of the sites where there is adequate bone for the application of plate fixation in dogs. In this type of fixation, the amount of bone is an important factor with regard to the holding power of the screw from the biomechanical viewpoint. Therefore, the aim of this paper is to present the detailed quantitative features of the sectional area of the scapular spine in dogs. A total of 28 scapulas from 14 dogs were used, and each was divided into 10 equal slices The height of the scapular spine, depths of the supra-spinous and infraspinus fossae were measured from the scanned images with the aid of a computer program. The results showed that the depth of the supraspinous fossa was greater in the ventral half of the spine, while the depth of the infraspinous was greater in the dorsal half. The differences between the depths of the two fossae were noticeable in the ventral half of the scapular spine.

Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

PubMed

Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

2015-08-01

This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (p<0.01). The order of volume was the same in females and males (femur>hip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (p<0.01). An interesting finding of this study was that the ulna is the bone with the highest accuracy for sex determination (94%). When using the surface area of multiple bones, the maximum accuracy (99.4%) was achieved. The equation was as follows: (discriminant equation of surface area; female<0

Functional morphology of the douc langur (Pygathrix spp.) scapula.

PubMed

Bailey, Katie E; Lad, Susan E; Pampush, James D

2017-06-01

Most colobine monkeys primarily move through their arboreal environment quadrupedally. Douc langurs (Pygathrix spp.), however, are regularly observed to use suspensory behaviors at the Endangered Primate Rescue Center (EPRC) in Northern Vietnam. Previous work has linked variation in scapular morphology to different modes of primate arboreal locomotion. Here we investigate whether the shape of the Pygathrix scapula resembles obligate brachiators (gibbons) or obligate arboreal quadrupeds (other cercopithecoids). Using a MicroScribe G2X 3D digitizer, the positions of 17 landmarks were recorded on 15 different species of nonhuman primates (n = 100) from three categories of locomotor behavior: brachiator, arboreal quadruped, and unknown (Pygathrix). All analyses were conducted in the R package geomorph. A Procrustes analysis uniformly scaled the shape data and placed specimens into the same morphospace. A Principal Component Analysis was used to examine scapular shape and a Procrustes ANOVA was conducted to test for shape difference in the scapulae. A pairwise analysis was used to compare the means of the locomotor categories and identify any statistically significant differences. A phylogenetically controlled Procrustes ANOVA was also conducted using a phylogeny from 10kTrees. Results show Pygathrix scapular morphology is significantly different from both arboreal colobine quadrupeds (p < 0.01) and hylobatid brachiators (p < 0.01). It does, however, share some features with each including a long vertebral border, like other cercopithecoids, and a more laterally projecting acromion process, like the hylobatids. The principal difference segregating Pygathrix from both the arboreal quadrupeds and the brachiators is the more medially placed superior angle. These nuanced morphological characteristics associated with suspensory behaviors may be useful for inferring suspensory locomotion in the primate fossil record. © 2017 Wiley Periodicals, Inc.

A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements

PubMed Central

Seth, Ajay; Matias, Ricardo; Veloso, António P.; Delp, Scott L.

2016-01-01

The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual’s anthropometry. We compared the model to “gold standard” bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models. PMID:26734761

A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements.

PubMed

Seth, Ajay; Matias, Ricardo; Veloso, António P; Delp, Scott L

2016-01-01

The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual's anthropometry. We compared the model to "gold standard" bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2 mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models.

Outcome of triple-tendon transfer, an Eden-Lange variant, to reconstruct trapezius paralysis.

PubMed

Elhassan, Bassem T; Wagner, Eric R

2015-08-01

This study describes the technique and evaluates the outcome of the triple-tendon (T3) transfer, an Eden-Lange variant, to the scapula to stabilize the scapulothoracic articulation in the treatment of symptomatic trapezius paralysis. T3 transfers were performed in 22 patients with a history of persistent trapezius paralysis secondary to spinal accessory nerve injury. The indications for surgery included shoulder pain and weakness and limited range of motion of the shoulder. The T3 transfer included transfer of the levator scapulae to the lateral aspect of the spine of the scapula, the rhomboid minor to the spine of the scapula just medial to the levator scapulae insertion, and the rhomboid major to the medial spine of the scapula, including all muscles bony insertions. At an average follow-up of 35 months, winging was corrected in all patients, with improvement of shoulder asymmetry. All patients had significant improvement of pain (P < .01) and range of motion, including active shoulder abduction that improved from an average of 71° preoperatively to 118° postoperatively (P < .02) and shoulder flexion from an average of 102° to 150° (P < .01). There were also significant improvements in aggregate Constant Shoulder Score (P < .01), subjective shoulder value (P < .01), and Disabilities of the Arm, Shoulder and Hand score (P < .01). All patients were very satisfied with the outcome of surgery. This study shows that the T3 transfer is effective in stabilizing the scapulothoracic articulation and restoring the function of the trapezius, and thus, in improving pain and shoulder function in patients with symptomatic trapezius paralysis. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Three-dimensional scapular kinematics during the throwing motion.

PubMed

Meyer, Kristin E; Saether, Erin E; Soiney, Emily K; Shebeck, Meegan S; Paddock, Keith L; Ludewig, Paula M

2008-02-01

Proper scapular motion is crucial for normal shoulder mechanics. Scapular motion affects glenohumeral joint function during throwing, yet little is known about this dynamic activity. Asymptomatic subjects (10 male and 10 female), ages 21 to 45, were analyzed. Electromagnetic surface sensors on the sternum, acromion, and humerus were used to collect 3-D motion data during three trials of low-velocity throwing. Scapular angular position data were described or five predetermined events throughout the throw corresponding with classic descriptions of throwing phases, and trial-to-trial reliability was determined. ANOVA compared scapular angles across events. Subjects demonstrated good to excellent reliability between trials of the throw (ICC 0.74-0.98). The scapula demonstrated a pattern of external rotation, upward rotation (peak of approx. 40 degrees), and poster humeral horizontal abduction. During the arm acceleration phase, the scapula moved toward greater internal rotation and began anteriorly tilting. At maximum humeral internal rotation, the scapula ended in internal rotation (55 degrees), upward rotation (20 degrees), and anterior tilting (3 degrees). Significant differences in scapular position (p<0.05) were identified across the throwing motion. Scapular data identify events in the throwing motion in which throwers may be more susceptible to shoulder pathologies related to abnormal scapular kinematics.

Does scapula stabilizing t-shirt help over-head athletes in shoulder discomfort? A randomized control study.

PubMed

Pellegrini, Andrea; Pogliacomi, Francesco; Costantino, Cosimo; Desimoni, Stefano; Giovanelli, Margherita; Golz, Andrew; Tonino, Pietro; Ceccarelli, Francesco

2016-04-15

Scapular dyskinesis in pitchers can potentially lead to impairments in the optimal performance of muscles of the shoulder complex. The purpose of this prospective study was to evaluate whether the use of a scapula stabilizing t-shirt can decrease stress and discomfort in over-head baseball pitchers. Thirty-two semi-professional baseball pitchers were divided into 2 groups. Group A dressed the scapula stabilizing t-shirt during the weekly practice while group B (control group) continued to follow their training program without the t-shirt. All pitchers underwent a clinical examination at the beginning of the study (T0), 4 weeks (T1) and 8 weeks after (T2). Data collected showed a better clinical outcome at T1 which increased in T2 for pitchers in Group A, while in Group B athletes these positive results were not observed. This study underlines that scapula-stabilizing t-shirt can have positive effects on shoulder discomfort in over-head athletes.

Comparing Blast Effects on Human Torso Finite Element Model against Existing Lethality Curves

DTIC Science & Technology

2010-07-15

vertebrae, intervertebral discs, ribs, cartilage, sternum, scapula, and clavicle . The internal organs include the heart and aorta, lungs and trachea...Thoracic Vertebrae  Intervertebral Disc  Scapula  Clavicle Heritage Style Viewgraphs6 HTFEM Development Internal Organs Ten-noded tetrahedral

Optimal Normalization Tests for Muscle Activation of the Levator Scapulae, Pectoralis Minor, and Rhomboid Major: An Electromyography Study Using Maximum Voluntary Isometric Contractions.

PubMed

Castelein, Birgit; Cagnie, Barbara; Parlevliet, Thierry; Danneels, Lieven; Cools, Ann

2015-10-01

To identify maximum voluntary isometric contraction (MVIC) test positions for the deeper-lying scapulothoracic muscles (ie, levator scapulae, pectoralis minor, rhomboid major), and to provide a standard set of a limited number of test positions that generate an MVIC in all scapulothoracic muscles. Cross-sectional study. Physical and rehabilitation medicine department. Healthy subjects (N=21). Not applicable. Mean peak electromyographic activity from levator scapulae, pectoralis minor, and rhomboid major (investigated with fine-wire electromyography) and from upper trapezius, middle trapezius, lower trapezius, and serratus anterior (investigated with surface electromyography) during the performance of 12 different MVICs. The results indicated that various test positions generated similar high mean electromyographic activity and that no single test generated maximum activity for a specific muscle in all subjects. The results of this study support using a series of test positions for normalization procedures rather than a single exercise to increase the likelihood of recruiting the highest activity in the scapulothoracic muscles. A standard set of 5 test positions was identified as being sufficient for generating an MVIC of all scapulothoracic muscles: seated T, seated U 135°, prone T-thumbs up, prone V-thumbs up, and supine V-thumbs up. A standard set of test positions for normalization of scapulothoracic electromyographic data that also incorporates the levator scapulae, pectoralis minor, and rhomboid major muscles is 1 step toward a more comprehensive understanding of normal and abnormal muscle function of these muscles and will help to standardize the presentation of scapulothoracic electromyographic muscle activity. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography.

PubMed

Kim, Yoon Sang; Yoo, Yon-Sik; Jang, Seong Wook; Nair, Ayyappan Vijayachandran; Jin, Hyonki; Song, Hyun-Seok

2015-07-01

The clavicle hook plate can be used to treat acromioclavicular and coracoclavicular ligament injury or distal clavicular fracture with comminution. However, the hook plate can induce subacromial impingement, resulting in discomfort from the hardware. Our inclusion criteria were (1) men and women aged older than 20 years and (2) the presence of comminuted distal clavicular fractures (Neer type IIB) fixed with a hook plate (Synthes, Oberdorf, Switzerland). Three-dimensional computed tomography was obtained before removal of the hook plate. Seven patients were enrolled prospectively. The mean age was 42 years (range, 24-60 years). Zero degree images and abduction images were obtained. The sagittal cut surface was obtained 5 mm medial from the distal clavicle. The equator of the cut surface of the clavicle was compared with the full abduction model to analyze rotation. The center of the cut surface of the clavicle was compared with the full abduction model to analyze translation. The average difference in rotation of the distal clavicle between both shoulders was 16° (range, 3°-22°; P = .001). The mean difference in anterior translation of the distal clavicle was 2.2 mm (range, -0.7 to 5.6 mm; P = .030). Hook plate fixation at the acromioclavicular joint causes decreased internal rotation and increased anterior translation of the distal clavicle with respect to the medial acromion, indicating that the scapula relative to the thorax has decreased posterior tilting and increased external rotation in shoulders fixed using a hook plate. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

THE ROLE OF THE SCAPULA

PubMed Central

Voight, Michael L.

2013-01-01

Previously, the scapular musculature was often neglected in designing a rehabilitation protocol for the shoulder. In the past two decades a significant amount of research has been performed in order to help identify the role of the scapula in upper extremity function. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased shoulder complex neuromuscular performance. This clinical commentary presents facts about the anatomy and biomechanics of the scapula and surrounding musculature, and describes the pathomechanics of scapular dysfunction. The focus is upon the assessment of dysfunction and retraining of the scapular musculature. Level of Evidence: 5 PMID:24175141

Orientation and position of head posture, scapula and thoracic spine in mouth-breathing children.

PubMed

Neiva, Patrícia Dayrell; Kirkwood, Renata Noce; Godinho, Ricardo

2009-02-01

Mouth-breathing is a common clinical condition among school-age children and some studies have correlated this condition with quality of life and postural alterations. Therefore, the objective of this study was to investigate the orientation and position of the scapula, thoracic spine and head posture among mouth-breathing (MB) children and nasal-breathing (NB) children. Twenty-one male MB children and 21 male NB children between 8 and 12 years of age participated in the study. Data were obtained through a stereophotogrammetry system that uses passive markers over anatomical landmarks to capture the position of the segments. Internal rotation, upward rotation, anterior tilt, scapular elevation and abduction were measured bilaterally as well as thoracic kyphosis, forward head position and shoulder protrusion. The MB children showed increased scapular superior position in relation to the NB group. No statistically significant differences were found between groups regarding the angular and linear measurements of the scapula. To verify reliability, three measurements were taken for each variable in the study. The intraclass correlation coefficient (ICC) showed results above 0.8 for all the variables except for the internal rotation angle (I-Rot), below 0.5, probably due to uncertainty in the palpation of the inferior angle of the scapula. Ninety-five percent of the NB children and 58% among the MB children had been breastfed, this difference was statistically significant. There were statistically significant differences between groups regarding the domains of the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI) scale and body mass index, which was higher among the NB children. MB children increased scapular superior position in comparison to NB children due probably to the position of forward head, leading to an alteration in the positioning of the mandible. The absence of significantly difference in posture pattern between groups in the present study could attributed to height-weight development in this age, as the posture of children changes in order to adapt to new body proportions, regardless of health status. The results observed in this study demonstrate the importance of using reliable measurements in the postural assessment of MB and NB children helping physical therapists to focus their strategies during rehabilitation in more specific conditions.

Dual origin and segmental organisation of the avian scapula.

PubMed

Huang, R; Zhi, Q; Patel, K; Wilting, J; Christ, B

2000-09-01

Bones of the postcranial skeleton of higher vertebrates originate from either somitic mesoderm or somatopleural layer of the lateral plate mesoderm. Controversy surrounds the origin of the scapula, a major component of the shoulder girdle, with both somitic and lateral plate origins being proposed. Abnormal scapular development has been described in the naturally occurring undulated series of mouse mutants, which has implicated Pax1 in the formation of this bone. Here we addressed the development of the scapula, firstly, by analysing the relationship between Pax1 expression and chondrogenesis and, secondly, by determining the developmental origin of the scapula using chick quail chimeric analysis. We show the following. (1) The scapula develops in a rostral-to-caudal direction and overt chondrification is preceded by an accumulation of Pax1-expressing cells. (2) The scapular head and neck are of lateral plate mesodermal origin. (3) In contrast, the scapular blade is composed of somitic cells. (4) Unlike the Pax1-positive cells of the vertebral column, which are of sclerotomal origin, the Pax1-positive cells of the scapular blade originate from the dermomyotome. (5) Finally, we show that cells of the scapular blade are organised into spatially restricted domains along its rostrocaudal axis in the same order as the somites from which they originated. Our results imply that the scapular blade is an ossifying muscular insertion rather than an original skeletal element, and that the scapular head and neck are homologous to the 'true coracoid' of higher vertebrates.

Sex estimation from the scapula in a contemporary Thai population: Applications for forensic anthropology.

PubMed

Peckmann, Tanya R; Scott, Shelby; Meek, Susan; Mahakkanukrauh, Pasuk

2017-07-01

The impact of climate change is estimated to be particularly severe in Thailand. Overall, the country faces an increase in surface temperatures, severe storms and floods, and a possible increase in the number of mass disasters in the region. It is extremely important that forensic scientists have access to sex estimation methods developed for use on a Thai population. The goal of this project is to evaluate the accuracy of sex estimation discriminant functions, created using contemporary Mexican and Greek populations, when applied to a contemporary Thai sample. The length of the glenoid cavity (LGC) and breadth of the glenoid cavity (BGC) were measured. The sample included 191 individuals (95 males and 96 females) with age ranges from 19 to 96years old. Overall, when the Mexican and Greek discriminant functions were applied to the Thai sample they showed higher accuracy rates for sexing female scapulae (83% to 99%) than for sexing male scapulae (53% to 92%). Size comparisons were made to Chilean, Mexican, Guatemalan, White American, and Greek populations. Overall, in males and females of the Thai sample, the scapulae were smaller than in the Chilean, Mexican, White American, and Greek populations. However, the male and female Thai scapulae were larger than in the Guatemalan sample. Population-specific discriminant functions were created for the Thai population with an overall sex classification accuracy rate of 83% to 88%. Copyright © 2017 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.

[Bony injuries of the thoracic cage in multiple trauma : Incidence, concomitant injuries, course and outcome].

PubMed

Schulz-Drost, S; Oppel, P; Grupp, S; Krinner, S; Langenbach, A; Lefering, R; Mauerer, A

2016-12-01

Thoracic trauma is considered to be responsible for 25 % of fatalities in multiple trauma and is a frequent injury with an incidence of 50 %. In addition to organ injuries, severe injuries to the bony parts of the thorax also occur and these injuries are described very differently mostly based on single center data. The focus of this study was on a holistic presentation of the prevalence and the incidence of thoracic trauma in patients with multiple trauma from the data of the large collective of the TraumaRegister DGU® (TR-DGU) with the objective of an analysis of concomitant injuries, therapy options and outcome parameters. A retrospective analysis was carried out based on the data set of the TR-DGU from the years 2009-2013. Inclusion criteria were an injury severity scale (ISS) score ≥ 16 and primary admission to a trauma center but isolated craniocerebral injury was an exclusion criterium. Patients were separated into two groups: those with rib fractures (RF) and those with flail chest (FC). A total of 21,741 patients met the inclusion criteria including 10,474 (48.2 %) suffering from either RF or FC. The mean age was 49.8 ± 19.9 years in the RF group and 54.1 ± 18.2 years in the FC group. Approximately 25 % were female in both groups, 98.1 % were blunt force injuries and the median ISS was 28.0 ± 11.2 in RF and 35.1 ± 14.2 in FC. Shock, insertion of a chest tube, (multi) organ failure and fatality rates were significantly higher in the FC group as were concomitant thoracic injuries, such as pneumothorax and hemothorax. Sternal fractures without rib fractures were less common (3.8 %) than concomitant in the RF (10.1 %) and FC (14 %) groups, as were concomitant fractures of the clavicle and the scapula. Out of all patients 32.6 % showed fractures of the thoracolumbar spine, 26.5 % without rib fractures, 36.6-38.6 % with rib fractures or monolateral FC and 48.6 % concomitant to bilateral FC. Thoracotomy was carried out only in isolated cases in RF and in 10.2 % of the FC group. Operative stabilization of the thoracic cage was carried out in 3.9-9.1 % of patients in the RF group and in 17.9-23.9 % in the FC group.

Clavicles, scapulae and humeri from the Sima de los Huesos site (Sierra de Atapuerca, Spain).

PubMed

Carretero, J M; Arsuaga, J L; Lorenzo, C

1997-01-01

The scapulae, clavicles and humeri recovered from the Sima de los Huesos (SH) site between 1976 and 1994 are studied. All elements are briefly described anatomically with metrics and compared with other fossil hominids in order to establish the morphological pattern of the SH hominids. A minimum of 13 individuals are represented by the humeri in the SH sample. Almost all of them can be classified as adolescents and young adults. The morphology of the SH hominid shoulder girdle and humeri indicates that much of the shoulder morphology recognized in the later true Neandertal was present in Europe long before they appeared. Thus, this morphological pattern is not exclusive to Neandertals alone. The SH clavicles, scapulae and humeri share with the Neandertals many traits usually considered to be Neandertal specializations. The comparative analysis of the SH evidence suggests that most of the SH and Neandertal shared traits are either primitive features within the genus Homo or even for all hominids, or display high variability within different hominid samples. These traits must be used with caution, or not used at all, in phylogenetic analysis. There are, however, traits that to date have only been detected in the SH hominids and the Neanderials, which could be exclusive to the European phyletic lineage (clade) of Homo.

Morphological and radiological study of ossified superior transverse scapular ligament as potential risk factor of suprascapular nerve entrapment.

PubMed

Polguj, Michał; Sibiński, Marcin; Grzegorzewski, Andrzej; Waszczykowski, Michał; Majos, Agata; Topol, Mirosław

2014-01-01

The suprascapular notch is covered superiorly by the superior transverse scapular ligament. This region is the most common place of suprascapular nerve entrapment formation. The study was performed on 812 specimens: 86 dry scapulae, 104 formalin-fixed cadaveric shoulders, and 622 computer topography scans of scapulae. In the cases with completely ossified superior transverse scapular ligament, the following measurements were performed: proximal and distal width of the bony bridge, middle transverse and vertical diameter of the suprascapular foramen, and area of the suprascapular foramen. An ossified superior transverse scapular ligament was observed more often in men and in the right scapula. The mean age of the subjects with a completely ossified superior transverse scapular ligament was found to be similar than in those without ossification. The ossified band-shaped type of superior transverse scapular ligament was more common than the fan-shaped type and reduced the space below the ligament to a significantly greater degree. The ossified band-shaped type should be taken into consideration as a potential risk factor in the formation of suprascapular nerve entrapment. It could explain the comparable frequency of neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified superior transverse scapular ligament.

The effect of using different regions of interest on local and mean skin temperature.

PubMed

Maniar, Nirav; Bach, Aaron J E; Stewart, Ian B; Costello, Joseph T

2015-01-01

The dynamic nature of tissue temperature and the subcutaneous properties, such as blood flow, fatness, and metabolic rate, leads to variation in local skin temperature. Therefore, we investigated the effects of using multiple regions of interest when calculating weighted mean skin temperature from four local sites. Twenty-six healthy males completed a single trial in a thermonetural laboratory (mean ± SD): 24.0 (1.2)°C; 56 (8%) relative humidity; <0.1 m/s air speed). Mean skin temperature was calculated from four local sites (neck, scapula, hand and shin) in accordance with International Standards using digital infrared thermography. A 50 mm × 50 mm, defined by strips of aluminium tape, created six unique regions of interest, top left quadrant, top right quadrant, bottom left quadrant, bottom right quadrant, centre quadrant and the entire region of interest, at each of the local sites. The largest potential error in weighted mean skin temperature was calculated using a combination of a) the coolest and b) the warmest regions of interest at each of the local sites. Significant differences between the six regions interest were observed at the neck (P<0.01), scapula (P<0.001) and shin (P<0.05); but not at the hand (P = 0.482). The largest difference (± SEM) at each site was as follows: neck 0.2 (0.1)°C; scapula 0.2 (0.0)°C; shin 0.1 (0.0)°C and hand 0.1 (0.1)°C. The largest potential error (mean ± SD) in weighted mean skin temperature was 0.4 (0.1)°C (P<0.001) and the associated 95% limits of agreement for these differences was 0.2-0.5 °C. Although we observed differences in local and mean skin temperature based on the region of interest employed, these differences were minimal and are not considered physiologically meaningful. Copyright © 2015 Elsevier Ltd. All rights reserved.

Functional and oncological outcome after surgical resection of the scapula and clavicle for primary chondrosarcoma.

PubMed

Nota, S P F T; Russchen, M J A M; Raskin, K A; Mankin, H J; Hornicek, F J; Schwab, J H

2017-04-01

The scapula is a relatively common site for chondrosarcoma to develop in contrary to the clavicle, which is rarely affected by these tumors. The aim of this study is to determine the functional and oncological outcome for patients treated operatively for scapular or clavicular chondrosarcoma. In this single-center retrospective study, we included a sample of 20 patients that received the diagnosis of a primary chondrosarcoma of the scapula or clavicle. Of the surviving patients, the functional function was assessed using the DASH and the PROMIS Physical Function-Upper Extremity. Patients were longitudinally tracked for their oncological outcome. All patients were followed for at least 2 years or until death. The mean age of the cohort was 47 years. Eighteen patients suffered from a chondrosarcoma of the scapula, and in 2 patients, the tumor was located in the clavicle. Metastasis, local recurrence and a higher tumor grade were all associated with a decreased overall survival. For the patients with a chondrosarcoma of the scapula, the average DASH score was 16 ± 16 and the mean PROMIS Physical Function-Upper Extremity score was 48 ± 10. Patients with both an intact rotator cuff and glenoid had a better physical function. Upper extremity function after (partial) scapulectomy varied depending on whether the glenoid was spared and whether a functioning shoulder abductor remained. When the resection spared these structures, then excellent functional outcomes were reported. Oncologic outcomes depended upon the grade of the tumor and whether local recurrence and metastases occurred.

A Study on the Morphology of the Suprascapular Notch and Its Distance from the Glenoid Cavity

PubMed Central

Sangam, Muralidhar Reddy; Sarada Devi, Sattiraju Sri; Krupadanam, Karumanchi; Anasuya, Kolla

2013-01-01

Introduction: A suprascapular nerve entrapment can occur at the suprascapular notch or at the spinoglenoid notch. So, the size and shape of the suprascapular notch are associated with suprascapular entrapment neuropathy as well as with an injury to the suprascapular nerve in arthroscopic procedures. The knowledge on the variations along the course of the nerve is important in understanding the source of the entrapment syndrome. Material and Methods: The present study was carried out on 104 scapulae which were obtained from the Department of Anatomy, NRI Medical College and from other nearby medical colleges. The suprascapular notches in the scapulae were classified, based on the descriptions of Rengachary et al and Ticker et al. The distance between the suprascapular notch and the supraglenoid tubercle, and the distance between the posterior rim of the glenoid cavity and the medial wall of the spinoglenoid notch at the base of the scapular spine, were determined. The data were analyzed statistically. Results: Based on the Rengachary classification, the type III notch was more common. The suprascapular foramen was observed in 2 scapulae. In 56.73% scapulae, the superior transverse diameter was greater than the maximum depth. The U shaped notch (69.23%) was more common. 2.88% and 8.65% scapulae fell short of the mentioned respective safe zone distances from the margin of the glenoid cavity. Conclusion: Such studies may be useful in understanding the role of the notch in causing nerve entrapment and to prevent iatrogenic nerve injuries while posterior approaches are made to the shoulder joint. PMID:23542385

Osteochondrosis of the inferior pole of the scapula (Roca disease).

PubMed

Skaf, Abdalla; Taneja, Atul K

2014-03-01

We report a rare case of osteochondrosis of the inferior pole of the scapula in a 14-year-old boy, an amateur swimmer, that was diagnosed by a combination of clinical and imaging findings. Also known as Roca disease, this is the first article to report this entity in the English literature and demonstrates its computerized tomography and MRI features.

Rhizopus-associated soft tissue infection in an immunocompetent air-conditioning technician after a road traffic accident: a case report and review of the literature.

PubMed

Rabie, Nada B; Althaqafi, Abdulhakeem O

2012-03-01

Rhinocerebral or sinopulmonary mucromycosis is a well-recognized human fungal infection found among immunocompromised and diabetic patients. However, the infection is rare among immunocompetent hosts. We are reporting the case of an adult immunocompetent male patient working as an air-conditioning technician. The patient was a victim of a road traffic accident (RTA) and sustained multiple fractures in the proximal part of the left tibia, distal femur, and scapula. Two weeks postoperatively, Rhizopus microspores were isolated from an infected traumatic wound over the distal femur. Surgical debridement was performed, and the patient was started on amphotericin B. Occupational exposure history and workplace environmental sanitation are crucial for the prevention of this potentially fatal yet preventable infection. Copyright © 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents.

PubMed

Moskała, Artur; Woźniak, Krzysztof; Kluza, Piotr; Romaszko, Karol; Lopatin, Oleksij

2016-01-01

Since traffic accidents are an important problem in forensic medicine, there is a constant search for new solutions to help with an investigation process in such cases. In recent years there was a rapid development of post-mortem imaging techniques, especially post-mortem computed tomography (PMCT). In our work we concentrated on a potential advantage of PMCT in cases of motorcycle accident fatalities. The results of forensic autopsy were compared with combined results of the autopsy and PMCT to check in which areas use of these two techniques gives statistically important increase in number of findings. The hypothesis was confirmed in case of pneumothorax and fractures of skull, spine, clavicle, scapula, lower leg bones. As for majority of other bone fractures locations and brain injures there were single cases with pathologies visible only in PMCT, but too few to reach expected level of p-value. In case of injuries of solid organs and soft tissues statistical analysis did not confirmed any advantage of unenhanced PMCT use. On the whole it has been shown that PMCT used as an adjunct to forensic autopsy can cause an increase in information about vitally important regions in case of motorcycle accident fatalities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.

PubMed

Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Boix, Ricardo; Lopez-Perez, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

2012-09-01

To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4). Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.

Scapular insertion of the rabbit latissimus dorsi muscle: gross anatomy and fibre-type composition.

PubMed

Barron, D J; Etherington, P J; Winlove, C P; Pepper, J R

2001-01-01

This paper defines the characteristics and significance of the scapular insertion of the latissimus dorsi muscle (LDM) of the rabbit. In a study of the New Zealand White species (n = 10) the scapular insertion was found to be a consistent anatomical feature of the LDM that made up 12.3% (+/-2.3) of the total muscle weight. The fibres arise from the medial aspect of the body of the LDM and run in a caudocranial direction to be inserted into a broad, thin tendon beneath the scapula ridge. This is morphologically different from the scapular component of the human LDM which is a well-recognized but inconsistent feature and consists of no more than a small leash of fibres running around the lower pole of the scapula. The scapular insertion was deeper red in colour than the body of the muscle and fibre-typing demonstrated a mean slow-fibre composition of 49% (+/-2.6) compared to 16% (+/-1.7) for the body of the muscle (p < 0.01). Mapping of the fibre types throughout the remainder of the LDM confirmed that the body of the muscle was of fast phenotype but with significantly more slow fibres in the superomedial segment of the muscle than elsewhere. This region of the muscle contributes mainly to the scapular insertion and it is proposed that this part of the muscle takes on a predominantly postural role in stabilising the scapula during movement of the forelimb.

Acromiohumeral Distance Change Relates to Middle Trapezius Muscle Activation During Shoulder Elevation With Scapular Retraction.

PubMed

Guney-Deniz, Hande; Harput, Gulcan; Toprak, Ugur; Duzgun, Irem

2018-05-29

The scapular retraction exercises are widely used among clinicians to balance the activity of the scapular muscles as well as the rotator cuff muscles in different shoulder abduction positions. The aim of this study was to investigate the relationship between scapular (middle and upper trapezius) and shoulder muscles (middle deltoid and infraspinatus) activation level differences and acromiohumeral distance changes during shoulder abduction with scapular retraction. Cross-sectional study. University research laboratory. Nineteen asymptomatic individuals were included (mean ± SD age, 22.4 ± 1.8 years). The acromiohumeral distance was measured at 0° and 90° shoulder abduction when scapula was in non-retracted and retracted position with ultrasound imaging. The relationship between muscle activation level changes and acromiohumeral distance difference was analyzed with Pearson correlation test. Middle trapezius muscle activity change correlated with acromiohumeral distance difference (r=0.55, p=0.018) from 0º to 90º shoulder abduction when scapula was retracted. For both non-retracted and retracted scapular positions, no correlations were found between middle deltoid, infraspinatus and upper trapezius muscle activity changes with acromiohumeral distance differences during shoulder abduction (p>0.05). Active scapular retraction exercise especially focusing on the middle trapezius muscle activation seems to be an effective treatment option to optimize the acromiohumeral distance during shoulder abduction.

Assessment of body parameters' symmetry in child violinists.

PubMed

Cygańska, Anna; Truszczyńska-Baszak, Aleksandra; Drzał-Grabiec, Justyna; Tarnowski, Adam

2017-09-22

Playing violin may lead to overload of the locomotor system. The aim of this study was to assess body parameters for trunk symmetry in child violinists and compare with the control group. We analyzed body posture of 101 children aged 7-12 years, mean age 11.09 ± 9.46, 49 child violinists and control group of 52 children. We found statistically significant differences for the difference in depth of the lower corners of scapulae and upper posterior spina iliaca, though greater asymmetries were found in the clinical control group. The remaining parameter values are close to significance, which may suggest that the process of postural change among the children had just started and that the existing asymmetries were easy to correct. We found positive correlation between body height and the difference in distance of the lower corners of scapulae from the spine: OL (p= 0.029, correlation coefficient value was 0.167) and the Thales triangle height: (p= 0.018, correlation coefficient was 0.214). Position maintained while playing the violin changed some parameters characterizing the curvature of the spine in frontal plane. We found the importance of detailed analysis of children body posture and its critical assessment.

Hydrodynamic Performance of the Minke Whale (Balaenoptera Acutorostrata) Flipper

DTIC Science & Technology

2008-04-01

to be captured by fringes of baleen along the lingual sides of baleen plates . Although the function of the balaenopterid feeding apparatus has been the...020717Ba; Fig.·1) with an attached scapula , obtained from the College of the Atlantic (COA) in Bar Harbor, ME, USA, was rotated through its full range of...motion. The scapula was secured with clamps, and range of positive angles of attack () was determined through manipulation of the flipper to the most

Open reduction and internal fixation of Ideberg IV and V glenoid intra-articular fractures through a Judet approach: a retrospective analysis of 11 cases.

PubMed

Hu, Chuanzhen; Zhang, Weibin; Qin, Hui; Shen, Yuhui; Xue, Zichao; Ding, Haoliang; An, Zhiquan

2015-02-01

To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations. The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively. 11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points. Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach.

3-D scapular kinematics during arm elevation: effect of motion velocity.

PubMed

Fayad, F; Hoffmann, G; Hanneton, S; Yazbeck, C; Lefevre-Colau, M M; Poiraudeau, S; Revel, M; Roby-Brami, A

2006-11-01

No three-dimensional (3-D) data exist on the influence of motion velocity on scapular kinematics. The effect of arm elevation velocity has been studied only in a two-dimensional setting. Thirty healthy subjects performed dominant (right) arm elevation in two planes, sagittal and frontal, and at slow and fast self-selected arm speed. Scapular orientation and humeral elevation were measured at 30 Hz recording frequency with use of a 6-degree-of-freedom electromagnetic system (Polhemus Fastraka). Motion was computed according to the International Society of Biomechanics standards. Scapular orientation was also determined with the arm held in different static positions. We obtained a full 3-D kinematic description of scapula achieving a reliable, complex 3-D motion during humeral elevation and lowering. The maximal sagittal arm elevation showed a characteristic "M"-shape pattern of protraction/retraction curve. Scapular rotations did not differ significantly between slow and fast movements. Moreover, protraction/retraction and tilt angular values did not differ significantly between static and dynamic tasks. However, scapular lateral rotation values differed between static and dynamic measurements during sagittal and frontal arm elevation. Lateral scapular rotation appears to be less in static than in dynamic measurement, particularly in the sagittal plane. Interpolation of statically recorded positions of the bones cannot reflect the kinematics of the scapula.

Unusual localizations of unicameral bone cysts and aneurysmal bone cysts: A retrospective review of 451 cases.

PubMed

Aycan, Osman Emre; Çamurcu, İsmet Yalkın; Özer, Devrim; Arıkan, Yavuz; Kabukçuoğlu, Yavuz Selim

2015-06-01

Unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC) are benign cystic lesions of bone which are easily diagnosed. However, unusual locations may lead to a false diagnosis. Therefore the aim of this retrospective study was to determine the frequency of unusual localizations. The authors studied 451 cases with histopathologically confirmed diagnosis of UBC or ABC, seen between 1981 and 2012. In the UBC group (352 cases) humerus, femur and calcaneus were found to be the most common sites, while acetabulum, scapula, scaphoid, lunatum, metacarpals, metatarsals, toe phalanges and ulna each accounted for less than 1%. In the ABC group (99 cases) the most common sites of involvement were femur, humerus and tibia, while finger phalanges, ilium, acetabulum, pubis, calcaneus, cuboid, and toe phalanges each accounted for only 1%. The differential diagnosis of cystic bone lesions should include both UBC and ABC. Pain complaints plead for the latter, except in case of fracture.

Distal radius fractures result in alterations in scapular kinematics: a three-dimensional motion analysis.

PubMed

Ayhan, Cigdem; Turgut, Elif; Baltaci, Gul

2015-03-01

Scapular motion is closely integrated with arm motion. Injury to a distal segment requires compensatory changes in the proximal segments leading to alterations in scapular motion. Since the effects of distal injuries on scapular kinematics remain unknown, in the present study we investigated the influences on scapular motion in patients with distal injuries. Sixteen subjects with a history of distal radius fracture and 20 asymptomatic healthy subjects (controls) participated in the study. Three-dimensional scapular and humeral kinematic data were collected on all 3 planes of shoulder elevation: frontal, sagittal, and scapular. All testing was performed in a single session; therefore, the sensors remained attached to the participants for all testing. The position and orientation data of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation and 120°, 90°, 60°, and 30° lowering were used for statistical comparisons. Independent samples t-test was used to compare the scapular internal/external rotation, upward/downward rotation, and anterior/posterior tilt between the affected side of subjects with a distal radius fracture and the dominant side of asymptomatic subjects at the same stage of humerothoracic elevation. Scapular internal rotation was significantly increased at 30° elevation (P=0.01), 90° elevation (P=0.03), and 30° lowering (P=0.03), and upward rotation was increased at 30° and 60° elevation (P<0.001) on the affected side during frontal plane elevation. Scapular upward rotation and anterior tilt were significantly increased during 30° lowering on both the scapular (P=0.002 and 0.02, respectively) and sagittal planes (P=0.01 and 0.02. respectively). Patients with distal radius fractures exhibit altered scapular kinematics, which may further contribute to the development of secondary musculoskeletal pathologies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of scapular external rotation on the axillary nerve during the arthroscopic Latarjet procedure: an anatomical investigation.

PubMed

Reinares, Felipe; Werthel, Jean-David; Moraiti, Constantina; Valenti, Philippe

2017-10-01

The first purpose of this study is to measure the distance between the axillary nerve and the exit point of K-wires placed retrograde through the glenoid in the setting of an arthroscopic Latarjet procedure. The second objective is to evaluate whether manual external rotation of the scapula alters that distance. In seven fresh-frozen specimens, two 2.0-mm K-wires were drilled through the glenoid using an arthroscopic Latarjet retrograde glenoid guide. These were drilled into the glenoid at the 7- and 8-o'clock positions (right shoulders) and at the 4- and 5-o'clock positions (left). K-wires were oriented parallel to the glenoid articular surface and perpendicular to the long superoinferior axis of the glenoid, 7 mm medial to the joint surface. Two independent evaluators measured the distances between the axillary nerve and the exit point of the K-wires in the horizontal plane (AKHS for the superior K-wire and AKHI for the inferior K-wire) and in the vertical plane (AKV). Measurements were taken with the scapula left free and were repeated with the scapula placed at 15° and 30° of external rotation. With the scapula left free, scapular external rotation was 34° ± 2.3°. In this position, the AKHS was 2.5 ± 1.6, 6.3 ± 1.2 mm at 15° of external rotation (ER) and 11.4 ± 1.4 mm at 30° ER. The AKHI distance was 0.37 ± 1.6, 3.4 ± 1.4 and 10.6 ± 2.1 mm, respectively, for the scapula left free, at 15° ER and 30° of ER. The AKV distances were, respectively, 0.12 ± 0.2, 4.9 ± 1.6 and 9.9 ± 1.7 mm. The increase in all distances was statistically significant (p < 0.001). Increasing scapular external rotation significantly increases the distance between the axillary nerve and the exit point of the K-wires, increasing the margin of safety during this procedure. Therefore, increased external rotation of the scapula could be an effective tool to decrease the risk of iatrogenic axillary nerve injury. Cadaveric study, Level V.

Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated?: A case-control study with surface and fine-wire EMG.

PubMed

Castelein, Birgit; Cools, Ann; Parlevliet, Thierry; Cagnie, Barbara

2016-12-01

The function of the scapula is important in normal neck function and might be disturbed in patients with neck pain. The surrounding muscular system is important for the function of the scapula. To date, it is not clear if patients with idiopathic neck pain show altered activity of these scapulothoracic muscles. Therefore, the objective of this study was to investigate differences in deeper and superficial lying scapulothoracic muscle activity between patients with idiopathic neck pain and healthy controls during arm elevation, and to identify the influence of scapular dyskinesis on muscle activity. Scapular dyskinesis was rated with the yes/no method. The deeper lying (Levator Scapulae, Pectoralis Minor (Pm) and Rhomboid major) and superficial lying (Trapezius and Serratus Anterior) scapulothoracic muscles' activity was investigated with fine-wire and surface EMG, respectively, in 19 female subjects with idiopathic neck pain (age 28.3±10.1years, average duration of neck pain 45.6±36.3months) and 19 female healthy control subjects (age 29.3±11.7years) while performing scaption and towel wall slide. Possible interactions or differences between subject groups, scapular dyskinesis groups or phases of the task were studied with a linear mixed model. Higher Pm activity during the towel wallslide (p=0.024, mean difference 8.8±3.3% MVIC) was shown in patients with idiopathic neck pain in comparison with healthy controls. For the MT, a significant group∗dyskinesis interaction effect was found during scaption which revealed that patients with neck pain and scapular dyskinesis showed lower Middle Trapezius (MT) activity in comparison with healthy controls with scapular dyskinesis (p=0.029, mean difference 5.1±2.2% MVIC). In the presence of idiopathic neck pain, higher Pm activity during the towel wallslide was found. Patients with neck pain and scapular dyskinesis showed lower MT activity in comparison with healthy controls with scapular dyskinesis during scaption. Scapular dyskinesis did not have a significant influence on scapulothoracic muscle activity. Copyright © 2016 Elsevier Ltd. All rights reserved.

An Investigation of the Five Point Restraint System for Aviators

DTIC Science & Technology

1980-10-01

Crotch strap loo - .Lneb mdc? plate 11. puate noste on belt 07" Al -2" go ditreace in feel the promest Crotch strop Is posit io ls" AV 11* |lodiag a...upper pelvic bone and scapula bones could be used as the aft protuberances. But when the individuals were seated in the AAH seat, portion, of the...inajor trapeziuH muscle on either side of the backbone pro- ruded farther ali than the scapula bones. The back cushion molded the r Aircraft crash surv

Standing on the shoulders of apes: Analyzing the form and function of the hominoid scapula using geometric morphometrics and finite element analysis.

PubMed

Püschel, Thomas A; Sellers, William I

2016-02-01

The aim was to analyze the relationship between scapular form and function in hominoids by using geometric morphometrics (GM) and finite element analysis (FEA). FEA was used to analyze the biomechanical performance of different hominoid scapulae by simulating static postural scenarios. GM was used to quantify scapular shape differences and the relationship between form and function was analyzed by applying both multivariate-multiple regressions and phylogenetic generalized least-squares regressions (PGLS). Although it has been suggested that primate scapular morphology is mainly a product of function rather than phylogeny, our results showed that shape has a significant phylogenetic signal. There was a significant relationship between scapular shape and its biomechanical performance; hence at least part of the scapular shape variation is due to non-phylogenetic factors, probably related to functional demands. This study has shown that a combined approach using GM and FEA was able to cast some light regarding the functional and phylogenetic contributions in hominoid scapular morphology, thus contributing to a better insight of the association between scapular form and function. © 2015 Wiley Periodicals, Inc.

Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula.

PubMed

Pizzari, Tania; Wickham, James; Balster, Simon; Ganderton, Charlotte; Watson, Lyn

2014-02-01

Scapular dyskinesis, characterised by drooping scapulae and reduced upward rotation, has been implicated in the presentation of a number of shoulder disorders. Traditionally, in shoulder rehabilitation programmes, the shrug exercise has been prescribed to facilitate upward rotation of the scapula by strengthening the upper trapezius muscle. The aim of this research was to compare muscle activation levels during the standard shrug and the upward rotation shrug in a normal and pathological population. Surface electrodes recorded electromyographical activity from upper trapezius, middle trapezius, lower trapezius and serratus anterior muscles in 23 normal participants and 14 participants with multi-directional shoulder instability. Participants completed 10 trials of the standard shrug exercise at 0° of shoulder abduction and the upward rotation shrug exercise at 30° of shoulder abduction in the coronal plane. Muscle activity was expressed as a percentage of maximum voluntary isometric contraction. The four muscles tested performed at a higher intensity during the modified shrug than the standard shrug. Upper trapezius and lower trapezius activity was significantly greater (P < 0.05) in both populations. Though for middle trapezius and serratus anterior muscles, the modified shrug was statistically significant only in the normal population, P = 0.031 and P = <0.001 respectively. The upward rotation shrug is a more effective exercise for eliciting muscle activity of the upper and lower trapezius than the standard shrug in a normal and multi-directional instability population. Clinically, the upward rotation shrug might be useful to address scapular dyskinesis involving drooping shoulders and reduced scapula upward rotation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Importance of latissimus dorsi muscle preservation for shoulder function after scapulectomy.

PubMed

Mimata, Yoshikuni; Nishida, Jun; Nagai, Taro; Tada, Hiroshi; Sato, Kotaro; Doita, Minoru

2018-03-01

Scapulectomy is an inevitable treatment for sarcomas of the scapula. This procedure is unavoidable because it reduces the local recurrence rate but can impair shoulder movements and affect the activities of daily living. This study investigated the factors influencing functional outcomes after scapulectomy. The clinical results of 8 patients (5 males, 3 females) who were diagnosed with primary or metastatic sarcomas of the scapula were retrospectively reviewed. The mean age was 49 years (range, 11-86 years). We examined the correlation between the type of excision of the scapula (total, subtotal, or partial) and postoperative functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. In partial excision, the glenohumeral joint was preserved; in subtotal excision, the glenoid was completely resected and some bony components were preserved; and in total excision, the entire bony component of the scapula was resected. The average follow-up period was 55 months (range, 9-142 months). The partial, subtotal, and total excision groups had mean functional scores of 96.7%, 76.7%, and 62.2%, respectively. Although the mean functional scores were lower in patients who underwent total and subtotal excisions, 3 patients in whom the latissimus dorsi muscle was preserved had better function (mean MSTS score, 76.7%) than the 2 patients in whom it was not preserved (mean MSTS score, 55.0%). These results suggest that the latissimus dorsi muscle, along with the deltoid and pectoralis major muscles, is one of the stabilizers of the proximal humerus after scapulectomy. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evolution of the turtle bauplan: the topological relationship of the scapula relative to the ribcage

PubMed Central

Lyson, Tyler R.; Joyce, Walter G.

2012-01-01

The turtle shell and the relationship of the shoulder girdle inside or ‘deep’ to the ribcage have puzzled neontologists and developmental biologists for more than a century. Recent developmental and fossil data indicate that the shoulder girdle indeed lies inside the shell, but anterior to the ribcage. Developmental biologists compare this orientation to that found in the model organisms mice and chickens, whose scapula lies laterally on top of the ribcage. We analyse the topological relationship of the shoulder girdle relative to the ribcage within a broader phylogenetic context and determine that the condition found in turtles is also found in amphibians, monotreme mammals and lepidosaurs. A vertical scapula anterior to the thoracic ribcage is therefore inferred to be the basal amniote condition and indicates that the condition found in therian mammals and archosaurs (which includes both developmental model organisms: chickens and mice) is derived and not appropriate for studying the developmental origin of the turtle shell. Instead, among amniotes, either monotreme mammals or lepidosaurs should be used. PMID:22809725

Congruency of scapula locking plates: implications for implant design.

PubMed

Park, Andrew Y; DiStefano, James G; Nguyen, Thuc-Quyen; Buckley, Jenni M; Montgomery, William H; Grimsrud, Chris D

2012-04-01

We conducted a study to evaluate the congruency of fit of current scapular plate designs. Three-dimensional image-processing and -analysis software, and computed tomography scans of 12 cadaveric scapulae were used to generate 3 measurements: mean distance from plate to bone, maximum distance, and percentage of plate surface within 2 mm of bone. These measurements were used to quantify congruency. The scapular spine plate had the most congruent fit in all 3 measured variables. The lateral border and glenoid plates performed statistically as well as the scapular spine plate in at least 1 of the measured variables. The medial border plate had the least optimal measurements in all 3 variables. With locking-plate technology used in a wide variety of anatomical locations, the locking scapula plate system can allow for a fixed-angle construct in this region. Our study results showed that the scapular spine, glenoid, and lateral border plates are adequate in terms of congruency. However, design improvements may be necessary for the medial border plate. In addition, we describe a novel method for quantifying hardware congruency, a method that can be applied to any anatomical location.

Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain.

PubMed

Kim, Su-Rim; Kang, Mi-Hee; Bahng, Sun-Young; An, Jin-Kyoung; Lee, Ji-Young; Park, Sang-Young; Kim, Seong-Gil

2016-05-01

[Purpose] This study aimed to investigate the correlations among scapular asymmetry, neck pain, and neck disability index in women in their 20s with slight neck pain. [Subjects and Methods] A total of 60 female students at U university in Gyeongsangbuk-do, South Korea, participated in this study. The lateral scapular slide test, which measures the distance between the thorax and scapula, was used to analyze the scapular asymmetry. The lateral scapular slide test was performed in three positions. The visual analogue scale and neck disability index were used to measure neck pain. [Results] In the lateral scapular slide test in position 3 (shoulder abduction at 90 degrees), the scapular left-right asymmetry and VAS showed a moderate positive linear relationship, with r=0.344. The VAS and NDI showed a moderate positive linear relationship, with r = 0.632. [Conclusion] Scapular asymmetry indicates imbalance of surrounding muscles of the scapula and is related to neck pain based on the results of measuring the distance from the thorax to the scapula.

Clavicle length, throwing performance and the reconstruction of the Homo erectus shoulder.

PubMed

Roach, Neil T; Richmond, Brian G

2015-03-01

Powerful, accurate throwing may have been an important mode of early hunting and defense. Previous work has shown that throwing performance is functionally linked to several anatomical shifts in the upper body that occurred during human evolution. The final shift to occur is the inferior reorientation of the shoulder. Fossil scapulae show the earliest evidence of a more inferior glenoid in Homo erectus. However, where the scapula rests on the thorax is uncertain. The relative length of the clavicle, the only skeletal attachment of the scapula to the torso, is quite variable. Depending on which fossils or skeletal measures are used to reconstruct the H. erectus shoulder, either a novel, anteriorly facing shoulder configuration or a modern human-like lateral orientation is possible. These competing hypotheses have led to very different conclusions regarding the throwing ability and hunting behavior of early Homo. Here, we evaluate competing models of H. erectus shoulder morphology and examine how these models relate to throwing performance. To address these questions, we collected skeletal measures from fossil and extant taxa, as well as anthropometric (N = 36) and kinematic (N = 27) data from Daasanach throwers from northwestern Kenya. Our data show that all H. erectus fossil clavicles fall within the normal range of modern human variation. We find that a commonly used metric for normalizing clavicle length, the claviculohumeral ratio, poorly predicts shoulder position on the torso. Furthermore, no significant relationship between clavicle length and any measure of throwing performance was found. These data support reconstructing the H. erectus shoulder as modern human-like, with a laterally facing glenoid, and suggest that the capacity for high speed throwing dates back nearly two million years. Copyright © 2014 Elsevier Ltd. All rights reserved.

An Introductory Characterization of a Combat-Casualty-Care Relevant Swine Model of Closed Head Injury Resulting from Exposure to Explosive Blast

DTIC Science & Technology

2009-07-08

into the crew compartment, the steel top of the frame was bolted to the top of the surrogate and the sling was anchored to the bottom steel plate of...subcutaneously from near the right scapula to the skull surface, where the ends of these leads were attached to the screws, the ends of which rested on...dis- sected near the right scapula , and the positive lead for channel 3 was advanced within this pocket under the skin around the left rib cage to a

Adaptive scapula bone remodeling computational simulation: Relevance to regenerative medicine

NASA Astrophysics Data System (ADS)

Sharma, Gulshan B.; Robertson, Douglas D.

2013-07-01

Shoulder arthroplasty success has been attributed to many factors including, bone quality, soft tissue balancing, surgeon experience, and implant design. Improved long-term success is primarily limited by glenoid implant loosening. Prosthesis design examines materials and shape and determines whether the design should withstand a lifetime of use. Finite element (FE) analyses have been extensively used to study stresses and strains produced in implants and bone. However, these static analyses only measure a moment in time and not the adaptive response to the altered environment produced by the therapeutic intervention. Computational analyses that integrate remodeling rules predict how bone will respond over time. Recent work has shown that subject-specific two- and three dimensional adaptive bone remodeling models are feasible and valid. Feasibility and validation were achieved computationally, simulating bone remodeling using an intact human scapula, initially resetting the scapular bone material properties to be uniform, numerically simulating sequential loading, and comparing the bone remodeling simulation results to the actual scapula's material properties. Three-dimensional scapula FE bone model was created using volumetric computed tomography images. Muscle and joint load and boundary conditions were applied based on values reported in the literature. Internal bone remodeling was based on element strain-energy density. Initially, all bone elements were assigned a homogeneous density. All loads were applied for 10 iterations. After every iteration, each bone element's remodeling stimulus was compared to its corresponding reference stimulus and its material properties modified. The simulation achieved convergence. At the end of the simulation the predicted and actual specimen bone apparent density were plotted and compared. Location of high and low predicted bone density was comparable to the actual specimen. High predicted bone density was greater than actual specimen. Low predicted bone density was lower than actual specimen. Differences were probably due to applied muscle and joint reaction loads, boundary conditions, and values of constants used. Work is underway to study this. Nonetheless, the results demonstrate three dimensional bone remodeling simulation validity and potential. Such adaptive predictions take physiological bone remodeling simulations one step closer to reality. Computational analyses are needed that integrate biological remodeling rules and predict how bone will respond over time. We expect the combination of computational static stress analyses together with adaptive bone remodeling simulations to become effective tools for regenerative medicine research.

Intrapancreatic Splenule in a Pancreas Allograft: Case Report.

PubMed

Yadav, K; Serrano, O K; Kandaswamy, R

2016-11-01

A 16-year-old white man was involved in a motor vehicle collision and suffered head, chest, and abdominal trauma. Despite initial resuscitative efforts, he progressed to brain death and was designated to be an organ donor by his family. He had no earlier medical or surgical history and no high-risk behaviors. Blood work revealed normal creatinine, liver function tests, lipase, and amylase. Viral serologies were negative except for cytomegalovirus IgG and Epstein-Barr virus nucleic acid. Imaging revealed a right kidney contusion, a manubrial fracture, and fractures of right first rib and bilateral scapulae. No other abdominal trauma was identified, specifically to the pancreas, duodenum, or spleen. Our transplant center accepted the pancreas from this donor. During back-table inspection of the pancreas, a 1.5 × 1.5 cm dark purple rubbery mass was identified within the parenchyma of the pancreas in the tail. An incisional biopsy of the lesion was sent for frozen section, which yielded a mixed inflammatory infiltrate consisting of neutrophils and lymphocytes and an overlying fibrous capsule. The diagnosis of lymphoma or another neoplasm could not be definitely ruled out. Owing to uncertainty in diagnosis, the entire lesion was excised along with the distal pancreas with the use of a linear stapler. The staple line was oversewn with running 4-0 polypropylene suture, and the pancreas was transplanted. After surgery, the pancreas allograft functioned well with a small pancreatic leak, which had resolved by the first postoperative outpatient visit. Published by Elsevier Inc.

A regression-based 3-D shoulder rhythm.

PubMed

Xu, Xu; Lin, Jia-hua; McGorry, Raymond W

2014-03-21

In biomechanical modeling of the shoulder, it is important to know the orientation of each bone in the shoulder girdle when estimating the loads on each musculoskeletal element. However, because of the soft tissue overlying the bones, it is difficult to accurately derive the orientation of the clavicle and scapula using surface markers during dynamic movement. The purpose of this study is to develop two regression models which predict the orientation of the clavicle and the scapula. The first regression model uses humerus orientation and individual factors such as age, gender, and anthropometry data as the predictors. The second regression model includes only the humerus orientation as the predictor. Thirty-eight participants performed 118 static postures covering the volume of the right hand reach. The orientation of the thorax, clavicle, scapula and humerus were measured with a motion tracking system. Regression analysis was performed on the Euler angles decomposed from the orientation of each bone from 26 randomly selected participants. The regression models were then validated with the remaining 12 participants. The results indicate that for the first model, the r(2) of the predicted orientation of the clavicle and the scapula ranged between 0.31 and 0.65, and the RMSE obtained from the validation dataset ranged from 6.92° to 10.39°. For the second model, the r(2) ranged between 0.19 and 0.57, and the RMSE obtained from the validation dataset ranged from 6.62° and 11.13°. The derived regression-based shoulder rhythm could be useful in future biomechanical modeling of the shoulder. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Scapular deformity in obstetric brachial plexus palsy and the Hueter-Volkmann law; a retrospective study

PubMed Central

2013-01-01

Background The Hueter-Volkmann law describes growth principles around joints and joint deformation. It states that decreased stress leads to increased growth and that excessive stress leads to growth retardation. Aim of this study was to test the possible results of this principle by measuring the effect of dorsal humeral head subluxation on scapular growth in children with Obstetrical Brachial Plexus Lesions (OBPL). According to the Hueter-Volkmann law, subluxation should result in decrease of growth of the dorsal length of the scapula (by increased dorsal pressure) and increase of the ventral length (decreased pressure). Methods 58 children (mean age 20 months, range 1-88 month) with unilateral OBPL and good quality MRI of both shoulders were included. On MRI, humeral head subluxation, joint deformation, and ventral and dorsal scapular lengths were measured. Data were expressed as a ratio of the normal side. Results In affected scapulas both ventral and dorsal side were smaller compared to the normal side. Reduction of growth on the affected side was more marked on the dorsal side than on the ventral side (6.5 mm respectively 4.5 mm, p < 0.001). The balance of growth reduction as expressed by the ratio of ventral and dorsal length was strongly related to subluxation (R2 = 0.33, p < 0.001) and age (R2 = 0.19, p < 0.001). Conclusions The Hueter-Volkmann law is incompletely active in subluxated shoulders in OBPL. Dorsal subluxation indeed leads to decrease of growth of the dorsal length of the scapula. However, decreased stress did not lead to increased growth of the ventral length of the scapula. PMID:23522350

3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation.

PubMed

Ohl, Xavier; Hagemeister, Nicola; Zhang, Cheng; Billuart, Fabien; Gagey, Olivier; Bureau, Nathalie J; Skalli, Wafa

2015-11-01

Alterations of the scapular kinematics in different pathologic conditions have been widely studied. However, results have shown considerable discrepancies concerning the direction and the amplitude of scapular movement. The lack of consistency in the literature probably has several explanations. The purpose of this study was to analyze scapular orientation with the arm at rest and with 90° lateral elevation in healthy and pathologic subjects by use of stereoradiographs. All participants (n = 65) underwent a clinical examination and magnetic resonance imaging of the shoulder to assess rotator cuff status. Participants were separated into 3 groups: healthy, rotator cuff tear (RCT), and RCT and subacromial impingement syndrome (RCT+ SIS). A 3-dimensional model of the scapula was fitted to each low-dose stereoradiograph acquired with the arm at rest and 90° arm elevation. Orientation of the scapula with the arm at rest was not significantly different between groups. During lateral elevation, scapular orientation was not significantly different between the healthy group and the RCT group. However, upward rotation was significantly reduced in the RCT + SIS group. Alterations of scapular kinematics in symptomatic subjects are multifactorial. We observed a link between clinically assessed subacromial impingement and scapular orientation during lateral elevation of the arm. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Stretching position can affect levator scapular muscle activity, length, and cervical range of motion in people with a shortened levator scapulae.

PubMed

Jeong, Hyo-Jung; Cynn, Heon-Seock; Yi, Chung-Hwi; Yoon, Jang-Whon; Lee, Ji-Hyun; Yoon, Tae-Lim; Kim, Bo-Been

2017-07-01

Levator scapulae (LS) muscle stretching exercises are a common method of lengthening a shortened muscle; however, the appropriate stretching position for lengthening the LS in people with a shortened LS remains unclear. The purpose of this study was to compare the effects of different stretching exercise positions on the LS and introduce effective stretching exercise methods to clinicians. Twenty-four university students (12 men, 12 women) with a shortened LS were recruited. LS muscle activity, LS index (LSI), and cervical range of motion (ROM) were measured pre (baseline) and post three different stretching exercise positions (sitting, quadruped, and prone). The LSI and cervical ROM exceeded the minimal detectable change and had significant changes. The LSI was greater in the sitting position than at the baseline (p = 0.01), quadruped position (p < 0.01); the LSI in the prone position presented a higher increase than the quadruped position (p = 0.01). The cervical ROM increased in the sitting position when compared to the baseline (p < 0.01) and quadruped position (p < 0.01). Stretching the LS in the sitting position was the most effective exercise for improving LS muscle length and cervical ROM. Copyright © 2017 Elsevier Ltd. All rights reserved.

Analysis of Relationship between the Body Mass Composition and Physical Activity with Body Posture in Children

PubMed Central

Baran, Joanna; Czenczek-Lewandowska, Ewelina; Leszczak, Justyna; Mazur, Artur

2016-01-01

Introduction. Excessive body mass in turn may contribute to the development of many health disorders including disorders of musculoskeletal system, which still develops intensively at that time. Aim. The aim of this study was to assess the relationship between children's body mass composition and body posture. The relationship between physical activity level of children and the parameters characterizing their posture was also evaluated. Material and Methods. 120 school age children between 11 and 13 years were enrolled in the study, including 61 girls and 59 boys. Each study participant had the posture evaluated with the photogrammetric method using the projection moiré phenomenon. Moreover, body mass composition and the level of physical activity were evaluated. Results. Children with the lowest content of muscle tissue showed the highest difference in the height of the inferior angles of the scapulas in the coronal plane. Children with excessive body fat had less slope of the thoracic-lumbar spine, greater difference in the depth of the inferior angles of the scapula, and greater angle of the shoulder line. The individuals with higher level of physical activity have a smaller angle of body inclination. Conclusion. The content of muscle tissue, adipose tissue, and physical activity level determines the variability of the parameter characterizing the body posture. PMID:27761467

Comparison of nanoparticular hydroxyapatite pastes of different particle content and size in a novel scapula defect model

PubMed Central

Hruschka, Veronika; Tangl, Stefan; Ryabenkova, Yulia; Heimel, Patrick; Barnewitz, Dirk; Möbus, Günter; Keibl, Claudia; Ferguson, James; Quadros, Paulo; Miller, Cheryl; Goodchild, Rebecca; Austin, Wayne; Redl, Heinz; Nau, Thomas

2017-01-01

Nanocrystalline hydroxyapatite (HA) has good biocompatibility and the potential to support bone formation. It represents a promising alternative to autologous bone grafting, which is considered the current gold standard for the treatment of low weight bearing bone defects. The purpose of this study was to compare three bone substitute pastes of different HA content and particle size with autologous bone and empty defects, at two time points (6 and 12 months) in an ovine scapula drillhole model using micro-CT, histology and histomorphometry evaluation. The nHA-LC (38% HA content) paste supported bone formation with a high defect bridging-rate. Compared to nHA-LC, Ostim® (35% HA content) showed less and smaller particle agglomerates but also a reduced defect bridging-rate due to its fast degradation The highly concentrated nHA-HC paste (48% HA content) formed oversized particle agglomerates which supported the defect bridging but left little space for bone formation in the defect site. Interestingly, the gold standard treatment of the defect site with autologous bone tissue did not improve bone formation or defect bridging compared to the empty control. We concluded that the material resorption and bone formation was highly impacted by the particle-specific agglomeration behaviour in this study. PMID:28233833

Rehabilitation of patient with brachial plexus lesion and break in axillary artery. Case study.

PubMed

Bajuk, S; Jelnikar, T; Ortar, M

1996-01-01

This paper describes the physiotherapy and occupational therapy used in treating a 74-year-old woman with a left brachial plexus lesion, a break in the axillary artery, dislocation of the acromioclavicular joint, a broken scapula and clavicula, serial left rib fractures, and lacerations on the upper and lower arm. After testing the patient, the following goals were set: reduce pain, soften scar tissue, and improve joint motion, muscle strength, and functionality of the hand. A 12-month outpatient program was used. Various analgesics were used to reduce pain, and a special aid was made to unweight the shoulder and elbow joints. Physiotherapy included kinesiotherapy, audiovisual biofeedback, electrical stimulation, friction massage, and lymph drainage. Occupational therapy included active functional exercises and re-education. As a result of this program, the patient no longer had pain, passive range of motion was close to normal, active motion where present was improved, swelling was reduced, and the hand became functional again. Complex physiotherapy, occupational therapy, and the patient's motivation resulted in the rehabilitation of severe trauma of the hand.

Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

PubMed

Senter, Phil; Juengst, Sara L

2016-01-01

Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

Combination of icotinib, surgery, and internal-radiotherapy of a patient with lung cancer severely metastasized to the vertebrae bones with EGFR mutation: a case report.

PubMed

Qu, Li-Li; Qin, Hai-Feng; Gao, Hong-Jun; Liu, Xiao-Qing

2015-01-01

A 48-year-old Chinese female was referred to us regarding EGFR-mutated advanced non-small cell lung cancer, and metastasis to left scapula and vertebrae bones which caused pathological fracture at T8 and T10 thoracic vertebrae. An aggressive combined therapy with icotinib, vertebrae operation, and radioactive particle implantation and immunotherapy was proposed to prevent paraplegia, relieve pain, and control the overall and local tumor lesions. No postoperative symptoms were seen after surgery, and the pain was significantly relieved. Icotinib merited a 31-month partial response with grade 1 diarrhea as its drug-related adverse event. High dose of icotinib was administered after pelvis lesion progression for 3 months with good tolerance. Combination therapy of icotinib, surgery, and internal radiation for metastases of the vertebrae bones from non-small cell lung cancer seems to be a very promising technique both for sufficient pain relief and for local control of the tumor, vertebrae operation can be an encouraging option for patients with EFGR positive mutation and good prognosis indicator.

Scapular dyskinesia: evolution towards a systems-based approach

PubMed Central

Smith, Michael J

2015-01-01

Historically, scapular dyskinesia has been used to describe an isolated clinical entity whereby an abnormality in positioning, movement or function of the scapula is present. Based upon this, treatment approaches have focused on addressing local isolated muscle activity. Recently, however, there has been a progressive move towards viewing the scapula as being part of a wider system of movement that is regulated and controlled by multiple factors, including the wider kinetic chain and individual patient-centred requirements. We therefore propose a paradigm shift whereby scapular dyskinesia is seen not in isolation but is considered within the broader context of patient-centred care and an entire neuromuscular system. PMID:27583003

Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads.

PubMed

de Toledo, Joelly Mahnic; Loss, Jefferson Fagundes; Janssen, Thomas W; van der Scheer, Jan W; Alta, Tjarco D; Willems, W Jaap; Veeger, DirkJan H E J

2012-10-01

Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1 kg and elastic resistance). Shoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. The scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1 kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. Differences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effects of Crossed Brassiere Straps on Pain, Range of Motion, and Electromyographic Activity of Scapular Upward Rotators in Women With Scapular Downward Rotation Syndrome.

PubMed

Kang, Min-Hyeok; Choi, Ji-Young; Oh, Jae-seop

2015-12-01

Scapular downward rotation syndrome manifests as an abnormally downward-rotated scapula at rest or with arm motion and typically results in neck and shoulder pain. The brassiere strap has been suggested as a possible contributing factor to scapula downward rotation and pain in the upper trapezius because of increased downward rotational force on the lateral aspect of the scapula. No study, however, has examined the influences of a modified brassiere strap on pain in and the function of the scapular muscles. To examine the effects of crossed brassiere straps on the pressure pain threshold (PPT) of the upper trapezius, neck rotation range of motion (ROM), and electromyographic activity of the scapular upward rotators in females with scapular downward rotation syndrome. Cross-over design. Laboratory. In total, 15 female subjects with scapular downward rotation syndrome were recruited at hospitals and a local university. All participants performed neck rotation and humeral elevation under 2 different conditions: parallel and crossed brassiere straps. The PPT of the upper trapezius was measured using an analog algometer, whereas neck rotation ROM was quantified with a 3-dimensional ultrasonic motion analysis system. The electromyographic activities of the upper trapezius, serratus anterior, and lower trapezius during humeral elevation were assessed with a surface electromyography system. Outcome measures were assessed under parallel and crossed brassiere strap conditions, and differences in outcomes between the conditions were analyzed using a paired t-test. The PPT and neck rotation ROM were increased when the subject was wearing the brassiere with crossed versus parallel straps (P < .001). Greater electromyographic activities of the serratus anterior, lower trapezius, and lesser upper trapezius muscles during humeral elevation were found under the crossed strap condition than the parallel strap condition (P < .05). These findings provide useful information for clinicians when designing management programs to decrease pain and improve biomechanical function for females with scapular downward rotation syndrome. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion.

PubMed

Lee, Kwang Won; Kim, Yong In; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-09-01

There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

PubMed Central

Lee, Kwang Won; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-01-01

Background There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Methods Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. Results There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). Conclusions The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. PMID:27583116

Osteochondroma of the Scapula with Accessory Nerve (XI) Compression.

PubMed

Beauchamp-Chalifour, Philippe; Pelet, Stéphane

2018-01-01

Osteochondroma is the most common benign bone tumor and is characterized as a cartilage-capped bony stalk. This lesion usually develops from the growth plate of long bones. Most osteochondromas are asymptomatic. Neurovascular compressions or cosmetic issues can occur in specific locations. Malignant transformation is extremely rare, and MRI can help evaluate these lesions. Symptomatic mass and malignancy features are the main surgical indications. Uncommonly, an osteochondroma can develop from flat bones. We present the case of a 25-year-old patient with a right scapula osteochondroma causing an accessory nerve compression. The mass was surgically removed, and the diagnosis was confirmed. The patient fully recovered at the latest 3-year follow-up visit.

[Tumorous space occupying lesions of the scapula. An analysis of preoperative assessment of invasion].

PubMed

Erlemann, R; Davies, A M; Edel, G; Wuisman, P; Peters, P E; Grundmann, E

1988-02-01

The radiographic and histological morphology of 38 tumors lesions of the scapula are analyzed. Osteochondromas (n = 12), chondrosarcomas (n = 7), plasmacytomas (n = 4) and Ewing's sarcomas (n = 3) were the most frequent neoplasms. The radiographically determined growth rates allowed an estimate of the dignity in all cases. Benign lesions were only observed in the first five decades of life, and were mostly located in the scapular blade. Most tumors found in the acromion and in the glenoid region and all lesions diagnosed in the 6th to the 8th decades of life were malignant. In 63.2% of cases correct diagnosis of the type of lesion present was possible on radiographic examination.

Recurrent Scapular Metastasis From Hepatoblastoma Shown on FDG PET/CT and F-DOPA PET/CT.

PubMed

Zhang, Bing; He, Qiao; Shi, Xinchong; Wang, Xiaoyan; Zhang, Xiangsong

2017-10-01

We report the case of a 4-year-old girl with a biochemical relapse (plasma α-fetoprotein of 57,987.6 μg/L) after hepatoblastoma and extrahepatic metastases removal and adjuvant chemotherapy. Abdominal ultrasound, CT, and MRI failed to determine the site of recurrence. F-FDG PET/CT showed increased activity in the region of left scapula and adjacent soft tissue, which was incorrectly interpreted as the postoperative repair or inflammatory change. F-DOPA PET/CT showed increased activity and noticeable progressed lesion in the same place. Finally, the left scapula was identified as the site of recurrent metastasis from hepatoblastoma by pathological examination.

Reproducibility of isometric shoulder protraction and retraction strength measurements in normal subjects and individuals with winged scapula.

PubMed

Oh, Jae-Seop; Kang, Min-Hyeok; Dvir, Zeevi

2016-11-01

The strength of the shoulder protractors and retractors may be compromised in individuals with winged scapula (IwWS). However, no standard approach to measuring the strength of these muscles has been described. The aim of this study was to study the intra-rater and inter-rater reproducibility of a fixed-base isometric dynamometer and to describe cutoff scores for clinically meaningful change for protraction and retraction isometric strength. Twice during a week, 20 normal subjects and 20 IwWS were tested by 2 independent raters. IwWS were significantly weaker (P < .001) than control subjects in their protraction and retraction isometric strength. Excellent intra-rater and inter-rater correlations were obtained in most combinations, leading to low cutoff scores for meaningful change expressed in terms of the smallest real difference. When it is properly used, the technique described in this paper is recommended as an effective clinical tool for the quantitative assessment of protraction and retraction isometric strength, both for status determination and for monitoring of change in IwWS during and after rehabilitation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reliability of levator scapulae index in subjects with and without scapular downward rotation syndrome.

PubMed

Lee, Ji-Hyun; Cynn, Heon-Seock; Choi, Woo-Jeong; Jeong, Hyo-Jung; Yoon, Tae-Lim

2016-05-01

The objective of this study was to introduce levator scapulae (LS) measurement using a caliper and the levator scapulae index (LSI) and to investigate intra- and interrater reliability of the LSI in subjects with and without scapular downward rotation syndrome (SDRS). Two raters measured LS length twice in 38 subjects (19 with SDRS and 19 without SDRS). For reliability testing, intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. Intrarater reliability analysis resulted with ICCs ranging from 0.94 to 0.98 in subjects with SDRS and 0.96 to 0.98 in subjects without SDRS. These results represented that intrarater reliability in both groups were excellent for measuring LS length with the LSI. Interrater reliability was good (ICC: 0.82) in subjects with SDRS; however, interrater reliability was moderate (ICC: 0.75) in subjects without SDRS. Additionally, SEM and MDC were 0.13% and 0.36% in subjects with SDRS and 0.35% and 0.97% in subjects without SDRS. In subjects with SDRS, low dispersion of the measurement errors and MDC were shown. This study suggested that the LSI is a reliable method to measure LS length and is more reliable for subjects with SDRS. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Contribution of Pre-impact Spine Posture on Human Body Model Response in Whole-body Side Impact.

PubMed

Poulard, David; Subit, Damien; Donlon, John-Paul; Lessley, David J; Kim, Taewung; Park, Gwansik; Kent, Richard W

2014-11-01

The objective of the study was to analyze independently the contribution of pre-impact spine posture on impact response by subjecting a finite element human body model (HBM) to whole-body, lateral impacts. Seven postured models were created from the original HBM: one matching the standard driving posture and six matching pre-impact posture measured for each of six subjects tested in previously published experiments. The same measurements as those obtained during the experiments were calculated from the simulations, and biofidelity metrics based on signals correlation were established to compare the response of HBM to that of the cadavers. HBM responses showed good correlation with the subject response for the reaction forces, the rib strain (correlation score=0.8) and the overall kinematics. The pre-impact posture was found to greatly alter the reaction forces, deflections and the strain time histories mainly in terms of time delay. By modifying only the posture of HBM, the variability in the impact response was found to be equivalent to that observed in the experiments performed with cadavers with different anthropometries. The patterns observed in the responses of the postured HBM indicate that the inclination of the spine in the frontal plane plays a major role. The postured HBM sustained from 2 to 5 bone fractures, including the scapula in some cases, confirming that the pre-impact posture influences the injury outcome predicted by the simulation.

Effect of a worktable position on head and shoulder posture and shoulder muscles in manual material handling.

PubMed

Kim, Min-Hee; Yoo, Won-Gyu

2015-06-05

According to a recent research, manual working with high levels of static contraction, repetitive loads, or extreme working postures involving the neck and shoulder muscles causes an increased risk of neck and shoulder musculoskeletal disorders. We investigated the effects of the forwardly worktable position on head and shoulder angles and shoulder muscle activity in manual material handling tasks. The forward head and shoulder angles and the activity of upper trapezius, levator scapulae, and middle deltoid muscle activities of 15 workers were measured during performing of manual material handling in two tasks that required different forward head and shoulder angles. The second manual material task required a significantly increased forward head and shoulder angle. The upper trapezius and levator scapulae muscle activity in second manual material task was increased significantly compared with first manual material task. The middle deltoid muscle activity in second manual material task was not significantly different compared with first manual material task. Based on this result, the forward head and shoulder angles while performing manual work need to be considered in selection of the forward distance of a worktable form the body. The high level contractions of the neck and shoulder muscles correlated with neck and shoulder pain. Therefore, the forward distance of a worktable can be an important factor in preventing neck and shoulder pain in manual material handling workers.

Radiographic sclerotic contour loss in the identification of glenoid bone loss.

PubMed

Bornes, Troy D; Jaremko, Jacob L; Beaupre, Lauren A; Bouliane, Martin J

2016-07-01

Quantification of glenoid bone loss guides surgical management in the setting of anterior shoulder instability. Glenoid defects resulting in ≥20 % articular area loss require bony reconstruction. The objective of this study was to evaluate the utility of sclerotic glenoid contour loss on true anteroposterior radiography in the detection of varying quantities of simulated glenoid bone loss using a cadaveric model. Eight cadaveric scapulae with full radiographic sclerotic contour were osteotomized to produce glenoid surface area reductions of 10-50 %. Radiography was performed initially and following each osteotomy, and assessed by an orthopedic surgeon and radiologist twice. Quantity of glenoid loss was compared using Fisher's exact test. Sensitivity, specificity, and reliability analyses were performed. On the first radiographic review, sclerotic contour loss was detected in 6 out of 8 scapulae with 50 % area loss, but only 1 out of 8 scapulae with 20 % area loss. There was a significantly higher proportion of radiographs containing sclerotic contour loss for defects with 50 % area loss compared to those with 0-25 % loss (p ≤ 0.02). In the detection of ≥20 % area loss, sclerotic contour loss had a sensitivity of 33-43 % and specificity of 88-100 %. Moderate inter-observer reliability (Cohen's kappa value of 0.42-0.53) and intra-observer reliability (kappa value of 0.46-0.58) were found. Radiographic sclerotic contour loss is commonly observed in radiographs of scapulae with 40-50 % glenoid area loss and less often with smaller lesions. However, this finding lacks utility in discerning specific quantifications of glenoid bone loss. In a clinical setting, sclerotic contour loss suggests the presence of a large glenoid defect that may require bony reconstruction. However, an intact sclerotic contour does not rule out significant bone loss.

Congenital Elevation of the Scapula

PubMed Central

2008-01-01

Dr. Robert D. Schrock was born in 1884 in Delaware, Ohio [3]. His father, William A., was a physician, as was his son, Robert D., Jr. The family subsequently moved to Decatur, Indiana. Dr. Robert Schrock obtained his undergraduate work at Wabash College, Crawfordsville, Indiana, in 1908 [2] and his medical degree at Cornell University Medical School in 1912 [2]. He completed postgraduate work at the New York Hospital in New York City. He briefly practiced in Omaha with Dr. John Lord, then served as a surgeon in WW I, working under Lt. Col. Joel Goldthwait in France. After the war he returned to Omaha to again practice with Lord. In 1921 he was appointed to the faculty of the University of Nebraska School of Medicine and became Professor and Chair in 1932, a post he held until 1949, when he became Professor Emeritus. Dr. Schrock became active in many medical organizations and in 1928 was elected President of the Clinical Orthopaedic Society, one of the two major groups that founded the AAOS, and was also active in the other, the American Orthopaedic Association. He was, as a result, involved in the early foundations of the AAOS, and became its President in 1940. He served as a civilian consultant to the Secretary of War from 1943 to 1945. With great prescience he commented in his Presidential Address to the AAOS in 1941 about Board certification, “This is not a hallmark of excellence in perpetuity. Products are frequently certified for a definite period of time if maintained under certain optimum conditions. Some people, like products, improve with advancing years, others deteriorate and some in cold storage remain frigidly good but no better. Orthopaedic surgeons, like human beings, are influenced by environment, necessity, ambition, health and avocational interest in other pursuits of happiness…If the measure of continued merit is to be maintained through our oncoming years, there need be an awareness of change, open mindedness to new concepts, elasticity in viewpoint, with a ready reception and stimulating encouragement to the newer generation whose future is in the making” [3]. The article we reprint describes a seemingly radical approach to a difficult problem: congenital elevation of the scapula (Sprengel’s deformity) [4]. Shrock noted the few previous attempts to address this problem were “…rather indefinite and in too many the results seemed discouraging. Most of the reports indicated considerable conservatism in the operative attack” [4]. He advocated “a far more radical procedure, but based upon the suggestions obtained from previous reports” [4]. As in earlier reports, he recommended sectioning the chondroosseous scapulothoracic bridge, but he then described a radical subperiosteal dissection of the scapula leaving the rhomboids, serratus magnus, and subscapularis muscles with the periosteal sleeve, then distally transplanting the entire scapula within that sleeve. (Interested readers can also see Campbell’s description in 1939 [1]). If this did not allow adequate drop of the scapula, he then performed an osteotomy at the base of the acromion. A postoperative dressing which maintained downward and backward pressure on the scapula was, he insisted, a critical detail. He reported two cases with good results in followup at 15 and 16 months postoperatively [4]. Dr. Robert D. Schrock is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress, 1983. References Campbell WC. Operative Orthopedics. Saint Louis, MO: CV Mosby Co; 1939. Cornell Alumni News. 1912. Cornell College Web site. Available at: http://ecommons.library.cornell.edu/bitstream/1813/3529/5/014_36.pdf. Accessed August 17, 2007. Robert D. Schrock, M.D. 1884–1960. J Bone Joint Surg Am. 1961;43:155–157. Schrock RD. Congenital elevation of the scapula. J Bone Joint Surg Am. 1926;8:207–215. PMID:18196376

Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies.

PubMed

McDonnell, Lisa K; Hume, Patria A; Nolte, Volker

2011-11-01

Rib stress fractures (RSFs) can have serious effects on rowing training and performance and accordingly represent an important topic for sports medicine practitioners. Therefore, the aim of this review is to outline the definition, epidemiology, mechanisms, intrinsic and extrinsic risk factors, injury management and injury prevention strategies for RSF in rowers. To this end, nine relevant books, 140 journal articles, the proceedings of five conferences and two unpublished presentations were reviewed after searches of electronic databases using the keywords 'rowing', 'rib', 'stress fracture', 'injury', 'mechanics' and 'kinetics'. The review showed that RSF is an incomplete fracture occurring from an imbalance between the rate of bone resorption and the rate of bone formation. RSF occurs in 8.1-16.4% of elite rowers, 2% of university rowers and 1% of junior elite rowers. Approximately 86% of rowing RSF cases with known locations occur in ribs four to eight, mostly along the anterolateral/lateral rib cage. Elite rowers are more likely to experience RSF than nonelite rowers. Injury occurrence is equal among sweep rowers and scullers, but the regional location of the injury differs. The mechanism of injury is multifactorial with numerous intrinsic and extrinsic risk factors contributing. Posterior-directed resultant forces arising from the forward directed force vector through the arms to the oar handle in combination with the force vector induced by the scapula retractors during mid-drive, or repetitive stress from the external obliques and rectus abdominis in the 'finish' position, may be responsible for RSF. Joint hypomobility, vertebral malalignment or low bone mineral density may be associated with RSF. Case studies have shown increased risk associated with amenorrhoea, low bone density or poor technique, in combination with increases in training volume. Training volume alone may have less effect on injury than other factors. Large differences in seat and handle velocity, sequential movement patterns, higher elbow-flexion to knee-extension strength ratios, higher seat-to-handle velocity during the initial drive, or higher shoulder angle excursion may result in RSF. Gearing may indirectly affect rib loading. Increased risk may be due to low calcium, low vitamin D, eating disorders, low testosterone or use of depot medroxyprogesterone injections. Injury management involves 1-2 weeks cessation of rowing with analgesic modalities followed by a slow return to rowing with low-impact intensity and modified pain-free training. Some evidence shows injury prevention strategies should focus on strengthening the serratus anterior, strengthening leg extensors, stretching the lumbar spine, increasing hip joint flexibility, reducing excessive protraction, training with ergometers on slides or floating-head ergometers, and calcium and vitamin D supplementation. Future research should focus on the epidemiology of RSF over 4-year Olympic cycles in elite rowers, the aetiology of the condition, and the effectiveness of RSF prevention strategies for injury incidence and performance in rowing.

Directional asymmetry of upper limbs in a medieval population from Poland: A combination of linear and geometric morphometrics.

PubMed

Kubicka, Anna Maria; Lubiatowski, Przemysław; Długosz, Jan Dawid; Romanowski, Leszek; Piontek, Janusz

2016-11-01

Degrees of upper-limb bilateral asymmetry reflect habitual behavior and activity levels throughout life in human populations. The shoulder joint facilitates a wide range of combined motions due to the simultaneous motion of all three bones: clavicle, scapula, and humerus. Accordingly, we used three-dimensional geometric morphometrics to analyze shape differences in the glenoid cavity and linear morphometrics to obtain the degree of directional asymmetry in a medieval population. To calculate directional asymmetry, clavicles, humeri, and scapulae from 100 individuals (50 females, 50 males) were measured. Landmarks and semilandmarks were placed within a three-dimensional reconstruction of the glenoid cavity for analysis of shape differences between sides of the body within sexes. Linear morphometrics showed significant directional asymmetry in both sexes in all bones. Geometric morphometrics revealed significant shape differences of the glenoid cavity between sides of the body in females but not in males. Both indicators of directional asymmetry (%DA and %AA) did not show significant differences between sexes. PLS analysis revealed a significant correlation between glenoid shape and two humeral head diameters only in females on the left side of the body. The studied population, perhaps due to a high level of activity, exhibited slightly greater upper-limb bone bilateral asymmetry than other agricultural populations. Results suggest that the upper limbs were involved in similar activity patterns in both sexes but were characterized by different habitual behaviors. To obtain comprehensive results, studies should be based on sophisticated methods such as geometric morphometrics as well as standard measurements. Am. J. Hum. Biol. 28:817-824, 2016. © 2016Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Allograft reconstruction after resection of malignant tumors of the scapula.

PubMed

Mnaymneh, Walid A; Temple, H Thomas; Malinin, Theodore I

2002-12-01

The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.

Validation of Shoulder Response of Human Body Finite-Element Model (GHBMC) Under Whole Body Lateral Impact Condition.

PubMed

Park, Gwansik; Kim, Taewung; Panzer, Matthew B; Crandall, Jeff R

2016-08-01

In previous shoulder impact studies, the 50th-percentile male GHBMC human body finite-element model was shown to have good biofidelity regarding impact force, but under-predicted shoulder deflection by 80% compared to those observed in the experiment. The goal of this study was to validate the response of the GHBMC M50 model by focusing on three-dimensional shoulder kinematics under a whole-body lateral impact condition. Five modifications, focused on material properties and modeling techniques, were introduced into the model and a supplementary sensitivity analysis was done to determine the influence of each modification to the biomechanical response of the body. The modified model predicted substantially improved shoulder response and peak shoulder deflection within 10% of the observed experimental data, and showed good correlation in the scapula kinematics on sagittal and transverse planes. The improvement in the biofidelity of the shoulder region was mainly due to the modifications of material properties of muscle, the acromioclavicular joint, and the attachment region between the pectoralis major and ribs. Predictions of rib fracture and chest deflection were also improved because of these modifications.

Positioning of the patient during shoulder surgery: an inexpensive, safe and easy technique.

PubMed

Van Tongel, Alexander; Hardeman, François; Karelse, Anne; de Wilde, Lieven

2013-01-01

The knowledge of shoulder pathology has improved tremendously in the last decades, and shoulder surgery is increasingly performed because of new treatment options and better operative results. Nowadays most surgical shoulder procedures are performed in the sitting or semi-sitting (beach chair) position. Stability of the patient and the ability to flex, extend and rotate the shoulder during surgery are crucial to improve exposure of the surgical field and lower the risk of perioperative complications. We developed an easy, safe and inexpensive surgical set-up providing a very good posterior, superior and anterior access to the shoulder in the sitting or semi-sitting position. In this technique, the patient is placed supine with the head at the foot end of the table and the body positioned slightly eccentrically with the back being supported by the leg plate contralateral to the operative side, avoiding any contact with the scapula of the operative side. A neck support is attached on an extra bar at the contralateral side and accommodated to the patient's lordosis. Next, the leg plate on the operative side is removed, and the head and the body are secured to the table with adhesive dressing. This way a stable positioning of the patient is obtained during the whole procedure, and the shoulder girdle is completely free. The set-up can accommodate patients of different stature and weight without the need to adapt the technique. This position also gives the possibility to provide an excellent radiographic view of the shoulder during operative fracture treatment. Our technique further allows a significant reduction in costs. A surgical table, extra bar, additional arm support and neck support are usually available and can be used in different settings, without the need for a specific shoulder table.

Transformation of a vascularised iliac crest or scapula bone to a pedicled osteomuscular transplant for reconstruction of distant defects in the head and neck region: a new method of transforming two island flaps to one longer island flap.

PubMed

Kärcher, Hans; Feichtinger, Matthias

2014-12-01

Bone defects in the maxillofacial region after ablative surgery require reconstructive surgery, usually using microvascular free flaps. This paper presents a new method of reconstructing extensive defects in patients not suitable for microvascular surgery using prefabrication of a vascularised osteomuscular flap from the scapula or iliac crest bone. Three patients who were treated with this new technique are presented. Two patients (one mandibular defect and one defect in the maxillary region) received prefabricated osteomuscular flaps from the iliac crest bone using the latissimus dorsi muscle as a pedicle. One patient also presenting a mandibular defect after tumour surgery received a scapula transplant for reconstruction of the defect using the pectoralis major muscle as pedicle. In all three cases vital bone could be transplanted. The pedicle was strainless in all three cases. Minor bone loss could be seen initially only in one case. The results are stable now and one patient received dental implants for later prosthetic treatment. The presented two-step surgery provides an excellent method for reconstruction of bony defects in the maxillofacial region in patients where microvascular surgery is not possible due to reduced state of health or lack of recipient vessels. Copyright © 2010. Published by Elsevier Ltd.

Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome.

PubMed

Ha, Sung-min; Kwon, Oh-yun; Yi, Chung-hwi; Cynn, Heon-seock; Weon, Jong-hyuck; Kim, Tae-ho

2016-02-01

The purpose of this study was to investigate the effects of a 6-week scapular upward rotation exercise (SURE) on scapular and clavicular alignment and scapular upward rotators strength in subjects with scapular downward rotation syndrome (SDRS). Seventeen volunteer subjects with SDRS were recruited from university populations. The alignment of the scapula and clavicle was measured using radiographic analysis and compared in subjects before and after a 6-week self-SURE program. A hand-held dynamometer was used to measure the strength of the scapular upward rotators. The subjects were instructed how to perform the self-SURE program at home. The 6-week self-SURE program was divided into two sections (the first section with non-resistive SURE during weeks 1-3, and the second section with resistive SURE using thera-band during weeks 4-6). The significance of the difference between pre- and post-program was assessed using a paired t-test, with the level of statistical significance set at p<0.05. Significant differences between pre- and post-program were found for scapular and clavicular alignment (p<0.05). Additionally, the comparison between pre- and post-program measurements of the strength of the scapular upward rotators showed significant differences (p<0.05). The results of this study showed that a 6-week self-SURE program is effective for improving scapular and clavicular alignment and increasing the strength of scapular upward rotator muscles in subjects with SDRS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study.

PubMed

Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Aune, Kyle T; Porterfield, Ron A; Harker, Paul; Evans, Timothy J; Andrews, James R

2014-09-01

Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Cohort study; Level of evidence, 2. For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was assessed with the subject supine and the scapula stabilized per methods previously established. Elbow injuries and days missed because of elbow injuries were assessed and recorded by the medical staff of the team. Throwing and nonthrowing shoulder measurements were compared by using Student t tests; 1-tailed Fisher exact tests were performed to identify significant associations between shoulder motion and elbow injury. Nominal logistic regression was performed to determine the odds of elbow injury. Significant differences were noted during side-to-side comparisons within subjects. There were 49 elbow injuries and 8 surgeries in 38 players, accounting for a total of 2551 days missed. Neither glenohumeral internal rotation deficit nor external rotation insufficiency was correlated with elbow injuries. Pitchers with deficits of >5° in total rotation in their throwing shoulders had a 2.6 times greater risk for injury. Pitchers with deficit of ≥5° in flexion of the throwing shoulder had a 2.8 times greater risk for injury. Bilateral differences in shoulder total rotation and flexion had a significant effect on the risk for elbow injuries in pitchers. Clinicians need to be aware of these findings and plan preventive programs that address these issues in hopes of reducing elbow injuries. © 2014 The Author(s).

Shoulder separation - aftercare

MedlinePlus

... collarbone (clavicle) meets the top of the shoulder blade (acromion of the scapula). It is not the ... connects the collarbone and top of the shoulder blade. These tears can also come from car accidents ...

Genetics Home Reference: facioscapulohumeral muscular dystrophy

MedlinePlus

... those of the face (facio-), around the shoulder blades (scapulo-), and in the upper arms (humeral). The ... Weak shoulder muscles tend to make the shoulder blades (scapulae) protrude from the back, a common sign ...

Scapulothoracic arthrodesis for winged scapula due to facioscapulohumeral dystrophy (a new technique).

PubMed

Ziaee, Majid A; Abolghasemian, Mansoor; Majd, Mohammad E

2006-07-01

We introduced a new scapulothoracic arthrodesis technique in 6 patients (2 bilaterally) with winging of the scapula due to facioscapulohumeral muscular dystrophy from 1984 to 2000. The procedure involved a combination of plating and wiring techniques. The indications were symptomatic winging, limitation of active shoulder motion, pain, and impaired daily living activity. Our objective was to improve motion, strength, and performance of activities of daily living, as well as to provide pain relief. As a result of the technique, active motion improved in all patients, flexion improved from 64 degrees to 104 degrees, and abduction improved from 67.5 degrees to 112.5 degrees. The only complication was a hemothorax in a bilateral case that was easily treated. The length of follow-up averaged 32.5 months (14-55 months), and results did not change with time.

Management of chronic unstable acromioclavicular joint injuries.

PubMed

Cisneros, Luis Natera; Reiriz, Juan Sarasquete

2017-12-01

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Expert opinion, Level V.

Adaptive changes in the dominant shoulders of female professional overhead athletes: mutual association and relation to shoulder injury.

PubMed

Tonin, Katarina; Stražar, Klemen; Burger, Helena; Vidmar, Gaj

2013-09-01

The aim of our study was to evaluate adaptive changes in the dominant shoulders of female professional overhead athletes, their mutual association, and relation between adaptive changes and shoulder injury. Thirty-six female professional volleyball and handball players were divided into two groups: 14 athletes were included in the symptomatic group (positive shoulder injury history and specific shoulder tests) and 22 athletes were included in the asymptomatic group (negative shoulder injury history and specific shoulder tests). Clinical examinations with specific shoulder tests, evaluation of rotational mobility, and symptoms of malposition and dyskinesis of the dominant scapula (SICK scapula syndrome) were performed. Glenohumeral rotators were isokinetically tested at 60 and 150°/s, with evaluation of stability ratios and rotator fatigability. On average, the participants had decreased internal rotation (P<0.001) and increased external rotation (P<0.001), lower spiking (P<0.01 at 60 and 150°/s) and conventional ratios (P≤0.01 at 60 and 150°/s), lower eccentric external rotator peak torques (eER) (P≤0.05 at 60 and 150°/s), and marginally lower eccentric internal rotator peak torques at 60°/s (P=0.061) on the dominant side compared with the nondominant side. The symptomatic group showed decreased ER (P=0.021), higher deficit of dominant eER at 60°/s (P=0.049), and higher fatigability of internal (P=0.013) and external rotators (P=0.028). The athletes with increased ER had more scapular lateralization (ρ=0.340, P=0.042), higher spiking ratios at 60°/s (ρ=0.349, P=0.037) and 150°/s (ρ=0.330, P=0.049), and lower cocking ratios at 60°/s (ρ=-0.477, P=0.003). Decreased dominant ER, higher deficit of dominant eccentric ER peak torques, and higher dominant rotator fatigability correlate with previous shoulder pain/injury. Different adaptive changes (rotational mobility, SICK scapula signs, and glenohumeral muscular imbalance) are inter-related. As a form of both prevention and rehabilitation for the athletes at risk, we recommend individually adjusted shoulder training on the basis of clinical and isokinetic testing.

Rotator cuff muscle function and its relation to scapular morphology in apes.

PubMed

Larson, Susan G; Stern, Jack T

2013-10-01

It is widely held that many differences among primate species in scapular morphology can be functionally related to differing demands on the shoulder associated with particular locomotor habits. This perspective is largely based on broad scale studies, while more narrow comparisons of scapular form often fail to follow predictions based on inferred differences in shoulder function. For example, the ratio of supraspinous fossa/infraspinous fossa size in apes is commonly viewed as an indicator of the importance of overhead use of the forelimb, yet paradoxically, the African apes, the most terrestrial of the great apes, have higher scapular fossa ratios than the more suspensory orangutan. The recent discovery of several nearly complete early hominin scapular specimens, and their apparent morphological affinities to scapulae of orangutans and gorillas rather than chimpanzees, has led to renewed interest in the comparative analysis of human and extant ape scapular form. To facilitate the functional interpretation of differences in ape scapulae, particularly in regard to relative scapular fossa size, we used electromyography (EMG) to document the activity patterns in all four rotator cuff muscles in orangutans and gibbons, comparing the results with previously published data for chimpanzees. The EMG results indicate that the distinctive contributions of each cuff muscle to locomotion are the same in the three ape species, failing to support inferences of differences in rotator cuff function based on relative scapular fossa size comparisons. It is also shown that relative scapular fossa size is not in fact a good predictor of either the relative masses or cross-sectional areas of the rotator cuff muscles in apes, and relative fossa size gives a false impression of the importance of individual cuff muscles to locomotor differences among apes. A possible explanation for the disparity between fossa and muscle size relates to the underappreciated role of the scapular spine in structural reinforcement of the blade. Copyright © 2013 Elsevier Ltd. All rights reserved.

Scapular kinematics and muscle activities during pushing tasks.

PubMed

Huang, Chun-Kai; Siu, Ka-Chun; Lien, Hen-Yu; Lee, Yun-Ju; Lin, Yang-Hua

2013-01-01

Pushing tasks are functional activities of daily living. However, shoulder complaints exist among workers exposed to regular pushing conditions. It is crucial to investigate the control of shoulder girdles during pushing tasks. The objective of the study was to demonstrate scapular muscle activities and motions on the dominant side during pushing tasks and the relationship between scapular kinematics and muscle activities in different pushing conditions. Thirty healthy adults were recruited to push a four-wheel cart in six pushing conditions. The electromyographic signals of the upper trapezius (UT) and serratus anterior (SA) muscles were recorded. A video-based system was used for measuring the movement of the shoulder girdle and scapular kinematics. Differences in scapular kinematics and muscle activities due to the effects of handle heights and weights of the cart were analyzed using two-way ANOVA with repeated measures. The relationships between scapular kinematics and muscle activities were examined by Pearson's correlation coefficients. The changes in upper trapezius and serratus anterior muscle activities increased significantly with increased pushing weights in the one-step pushing phase. The UT/SA ratio on the dominant side decreases significantly with increased handle heights in the one-step pushing phase. The changes in upward rotation, lateral slide and elevation of the scapula decreased with increased pushing loads in the trunk-forward pushing phase. This study indicated that increased pushing loads result in decreased motions of upward rotation, lateral slide and elevation of the scapula; decreased handle heights result in relatively increased activities of the serratus anterior muscles during pushing tasks.

Length of winter coat in horses depending on husbandry conditions.

PubMed

Bocian, Krzysztof; Strzelec, Katarzyna; Janczarek, Iwona; Jabłecki, Zygmunt; Kolstrung, Ryszard

2017-02-01

This paper analyzes changes in the length of coat on selected body areas in horses and ponies kept under different husbandry (stable) conditions during the winter-spring period. The study included 12 Małpolski geldings and 12 geldings of Felin ponies aged 10-15 years. Horses were kept in two stables (six horses and six ponies in each stable). The type of performance, husbandry conditions and feeding of the studied animals were comparable. As of December 1, samples of hair coat from the scapula, sternum, back and abdomen areas of both body sides were collected seven times. The lengths of 20 randomly selected hair fibers were measured. Daily measurements of air temperature in the stables were also taken. An analysis of variance (ANOVA) was performed using the following factors: the body part from where the coat was sampled, the subsequent examination and the stable as well as the interaction between these factors. The significance of differences between means was determined with a t-Tukey test. The relations between air temperature in the stable and hair length were calculated using Pearson's correlation. It was found that air temperature in the stable impacts the length of winter coat in horses and ponies. The effect of this factor is more pronounced in ponies; as in the stables with lower temperatures it produces a longer hair coat which is more evenly distributed over the body in comparison with horses. Keeping horses and ponies in stables with a low air temperature accelerates coat shedding by approximately 25 days. Coat shedding begins from the scapula area. © 2016 Japanese Society of Animal Science.

Finite element modeling for predicting the contact pressure between a foam mattress and the human body in a supine position.

PubMed

Lee, Wookjin; Won, Byeong Hee; Cho, Seong Wook

2017-01-01

In this paper, we generated finite element (FE) models to predict the contact pressure between a foam mattress and the human body in a supine position. Twenty-year-old males were used for three-dimensional scanning to produce the FE human models, which was composed of skin and muscle tissue. A linear elastic isotropic material model was used for the skin, and the Mooney-Rivlin model was used for the muscle tissue because it can effectively represent the nonlinear behavior of muscle. The contact pressure between the human model and the mattress was predicted by numerical simulation. The human models were validated by comparing the body pressure distribution obtained from the same human subject when he was lying on two different mattress types. The experimental results showed that the slope of the lower part of the mattress caused a decrease in the contact pressure at the heels, and the effect of bone structure was most pronounced in the scapula. After inserting a simple structure to function as the scapula, the contact pressure predicted by the FE human models was consistent with the experimental body pressure distribution for all body parts. These results suggest that the models proposed in this paper will be useful to researchers and designers of products related to the prevention of pressure ulcers.

Thoracic outlet syndrome part 2: conservative management of thoracic outlet.

PubMed

Watson, L A; Pizzari, T; Balster, S

2010-08-01

Thoracic outlet syndrome (TOS) is a symptom complex attributed to compression of the nerves and vessels as they exit the thoracic outlet. Classified into several sub-types, conservative management is generally recommended as the first stage treatment in favor of surgical intervention. In cases where postural deviations contribute substantially to compression of the thoracic outlet, the rehabilitation approach outlined in this masterclass will provide the clinician with appropriate management strategies to help decompress the outlet. The main component of the rehabilitation program is the graded restoration of scapula control, movement, and positioning at rest and through movement. Adjunctive strategies include restoration of humeral head control, isolated strengthening of weak shoulder muscles, taping, and other manual therapy techniques. The rehabilitation outlined in this paper also serves as a model for the management of any shoulder condition where scapula dysfunction is a major contributing factor. Copyright 2010 Elsevier Ltd. All rights reserved.

Influence of different peg length in glenoid bone loss: A biomechanical analysis regarding primary stability of the glenoid baseplate in reverse shoulder arthroplasty.

PubMed

Königshausen, M; Jettkant, B; Sverdlova, N; Ehlert, C; Gessmann, J; Schildhauer, T A; Seybold, D

2015-01-01

There is no biomechanical basis to determine the influence of different length of the central peg of the baseplate anchored within the native scapula in glenoid defect reconstruction in cases of degenerative or posttraumatic glenoid bone loss in reversed shoulder arthroplasty. The purpose of this study was to analyse the stability of different peg lengths used in glenoid bone loss in reversed shoulder arthroplasty. Different lengths of metaglene pegs with different depths of peg anchorage performed with or without metaglene screws in sawbone foam blocks were loaded in vertical and horizontal directions for differentiating load capacities. Simulated physiological loadings were then applied to the peg implants to determine the limits of loading in each depth of anchorage. The loading capacity of the implant was reduced as less of the peg was anchored. The vertically loaded implants showed a significantly higher stability, in contrast to those loaded horizontally at a corresponding peg length and depth of anchorage (p < 0.05). The tests revealed that the metaglene screws are more essential for primary stability than is the peg particularly in the vertically directed loadings (2/3 anchored: peg contributed to 28% of the stability, 1/3 anchorage: peg contributed to 12%). Under the second test conditions, the lowest depth of peg anchorage (1/3) resulted in 322 Newtons [N] in the long peg with a vertical loading direction, and in 130 N in the long peg with a horizontal loading direction (p < 0.05). The pegs should be anchored as deeply as possible into the native scapula bone stock. The metaglene screws play a major role in the initial stability, in contrast to the peg, and they become more important when the depth of the peg anchorage is reduced. If possible, four metaglene screws should be used in cases of uncontained bone loss to guarantee the highest stability.

Evaluation of clinical and histopathologic prognostic factors for survival in canine osteosarcoma of the extracranial flat and irregular bones.

PubMed

Kruse, M A; Holmes, E S; Balko, J A; Fernandez, S; Brown, D C; Goldschmidt, M H

2013-07-01

Osteosarcoma is the most common bone tumor in dogs. However, current literature focuses primarily on appendicular osteosarcoma. This study examined the prognostic value of histological and clinical factors in flat and irregular bone osteosarcomas and hypothesized that clinical factors would have a significant association with survival time while histological factors would not. All osteosarcoma biopsy samples of the vertebra, rib, sternum, scapula, or pelvis were reviewed while survival information and clinical data were obtained from medical records, veterinarians, and owners. Forty-six dogs were included in the analysis of histopathological variables and 27 dogs with complete clinical data were included in the analysis of clinical variables. In the histopathologic cox regression model, there was no significant association between any histologic feature of osteosarcoma, including grade, and survival time. In the clinical cox regression model, there was a significant association between the location of the tumor and survival time as well as between the percent elevation of alkaline phosphatase (ALP) above normal and survival time. Controlling for ALP elevation, dogs with osteosarcoma located in the scapula had a significantly greater hazard for death (2.8) compared to dogs with tumors in other locations. Controlling for tumor location, every 100% increase in ALP from normal increased the hazard for death by 1.7. For canine osteosarcomas of the flat and irregular bones, histopathological features, including grade do not appear to be rigorous predictors of survival. Clinical variables such as increased ALP levels and tumor location in the scapula were associated with decreased survival times.

2D versus 3D in the kinematic analysis of the horse at the trot.

PubMed

Miró, F; Santos, R; Garrido-Castro, J L; Galisteo, A M; Medina-Carnicer, R

2009-08-01

The handled trot of three Lusitano Purebred stallions was analyzed by using 2D and 3D kinematical analysis methods. Using the same capture and analysis system, 2D and 3D data of some linear (stride length, maximal height of the hoof trajectories) and angular (angular range of motion, inclination of bone segments) variables were obtained. A paired Student T-test was performed in order to detect statistically significant differences between data resulting from the two methodologies With respect to the angular variables, there were significant differences in scapula inclination, shoulder angle, cannon inclination and protraction-retraction angle in the forelimb variables, but none of them were statistically different in the hind limb. Differences between the two methods were found in most of the linear variables analyzed.

A method of measuring three-dimensional scapular attitudes using the optotrak probing system.

PubMed

Hébert, L J; Moffet, H; McFadyen, B J; St-Vincent, G

2000-01-01

To develop a method to obtain accurate three-dimensional scapular attitudes and to assess their concurrent validity and reliability. In this methodological study, the three-dimensional scapular attitudes were calculated in degrees, using a rotation matrix (cyclic Cardanic sequence), from spatial coordinates obtained with the probing of three non colinear landmarks first on an anatomical model and second on a healthy subject. Although abnormal movement of the scapula is related to shoulder impingement syndrome, it is not clearly understood whether or not scapular motion impairment is a predisposing factor. Characterization of three-dimensional scapular attitudes in planes and at joint angles for which sub-acromial impingement is more likely to occur is not known. The Optotrak probing system was used. An anatomical model of the scapula was built and allowed us to impose scapular attitudes of known direction and magnitude. A local coordinate reference system was defined with three non colinear anatomical landmarks to assess accuracy and concurrent validity of the probing method with fixed markers. Axial rotation angles were calculated from a rotation matrix using a cyclic Cardanic sequence of rotations. The same three non colinear body landmarks were digitized on one healthy subject and the three dimensional scapular attitudes obtained were compared between sessions in order to assess the reliability. The measure of three dimensional scapular attitudes calculated from data using the Optotrak probing system was accurate with means of the differences between imposed and calculated rotation angles ranging from 1.5 degrees to 4.2 degrees. Greatest variations were observed around the third axis of the Cardanic sequence associated with posterior-anterior transverse rotations. The mean difference between the Optotrak probing system method and fixed markers was 1.73 degrees showing a good concurrent validity. Differences between the two methods were generally very low for one and two direction displacements and the largest discrepancies were observed for imposed displacements combining movement about the three axes. The between sessions variation of three dimensional scapular attitudes was less than 10% for most of the arm positions adopted by a healthy subject suggesting a good reliability. The Optotrak probing system used with a standardized protocol lead to accurate, valid and reliable measures of scapular attitudes. Although abnormal range of motion of the scapula is often related to shoulder pathologies, reliable outcome measures to quantify three-dimensional scapular motion on subjects are not available. It is important to establish a standardized protocol to characterize three-dimensional scapular motion on subjects using a method for which the accuracy and validity are known. The method used in the present study has provided such a protocol and will now allow to verify to what extent, scapular motion impairment is linked to the development of specific shoulder pathologies.

Quantitative Anatomy of the Trapezius Muscle in the Human Fetus.

PubMed

Badura, Mateusz; Grzonkowska, Magdalena; Baumgart, Mariusz; Szpinda, Michał

2016-01-01

The trapezius muscle consists of three parts that are capable of functioning independently. Its superior part together with the levator scapulae and rhomboids elevate the shoulder, the middle part retracts the scapula, while the inferior part lowers the shoulder. The present study aimed to supplement numerical data and to provide growth dynamics of the trapezius in the human fetus. Using methods of anatomical dissection, digital image analysis (NIS Elements AR 3.0), and statistics (Student's t-test, regression analysis), we measured the length, the width and the surface area of the trapezius in 30 fetuses of both sexes (13™ k,17™ … ) aged 13-19 weeks. Neither sex nor laterality differences were found. All the studied parameters of the trapezius increased proportionately with age. The linear functions were computed as follows: y = -103.288 + 10.514 × age (r = 0.957) for total length of the trapezius muscle, y = -67.439 + 6.689 × age (r = 0.856) for length of its descending part, y = -8.493 + 1.033 × age (r = 0.53) for length of its transverse part, y = -27.545 + 2.802 × age (r = 0.791) for length of its ascending part, y = -19.970 + 2.505 × age (r = 0.875) for width of the trapezius muscle, and y = -2670.458 + 212.029 × age (r = 0.915) for its surface area. Neither sex nor laterality differences exist in the numerical data of the trapezius muscle in the human fetus. The descending part of trapezius is the longest, while its transverse part is the shortest. The growth dynamics of the fetal trapezius muscle follows proportionately.

Virtual reconstruction of glenoid bone defects using a statistical shape model.

PubMed

Plessers, Katrien; Vanden Berghe, Peter; Van Dijck, Christophe; Wirix-Speetjens, Roel; Debeer, Philippe; Jonkers, Ilse; Vander Sloten, Jos

2018-01-01

Description of the native shape of a glenoid helps surgeons to preoperatively plan the position of a shoulder implant. A statistical shape model (SSM) can be used to virtually reconstruct a glenoid bone defect and to predict the inclination, version, and center position of the native glenoid. An SSM-based reconstruction method has already been developed for acetabular bone reconstruction. The goal of this study was to evaluate the SSM-based method for the reconstruction of glenoid bone defects and the prediction of native anatomic parameters. First, an SSM was created on the basis of 66 healthy scapulae. Then, artificial bone defects were created in all scapulae and reconstructed using the SSM-based reconstruction method. For each bone defect, the reconstructed surface was compared with the original surface. Furthermore, the inclination, version, and glenoid center point of the reconstructed surface were compared with the original parameters of each scapula. For small glenoid bone defects, the healthy surface of the glenoid was reconstructed with a root mean square error of 1.2 ± 0.4 mm. Inclination, version, and glenoid center point were predicted with an accuracy of 2.4° ± 2.1°, 2.9° ± 2.2°, and 1.8 ± 0.8 mm, respectively. The SSM-based reconstruction method is able to accurately reconstruct the native glenoid surface and to predict the native anatomic parameters. Based on this outcome, statistical shape modeling can be considered a successful technique for use in the preoperative planning of shoulder arthroplasty. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report.

PubMed

Bhatt, Jiten B; Glaser, Randal; Chavez, Andre; Yung, Emmanuel

2013-11-01

Case report. Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established. The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period. Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner. The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia. Therapy, level 4.

Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

PubMed Central

2011-01-01

Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809 PMID:21777478

The influence of radiographic viewing perspective and demographics on the Critical Shoulder Angle

PubMed Central

Suter, Thomas; Popp, Ariane Gerber; Zhang, Yue; Zhang, Chong; Tashjian, Robert Z.; Henninger, Heath B.

2014-01-01

Background Accurate assessment of the critical shoulder angle (CSA) is important in clinical evaluation of degenerative rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the CSA, developed a classification system to identify malpositioned radiographs, and assessed the relationship between the CSA and demographic factors. Methods Glenoid height, width and retroversion were measured on 3D CT reconstructions of 68 cadaver scapulae. A digitally reconstructed radiograph was aligned perpendicular to the scapular plane, and retroversion was corrected to obtain a true antero-posterior (AP) view. In 10 scapulae, incremental anteversion/retroversion and flexion/extension views were generated. The CSA was measured and a clinically applicable classification system was developed to detect views with >2° change in CSA versus true AP. Results The average CSA was 33±4°. Intra- and inter-observer reliability was high (ICC≥0.81) but decreased with increasing viewing angle. Views beyond 5° anteversion, 8° retroversion, 15° flexion and 26° extension resulted in >2° deviation of the CSA compared to true AP. The classification system was capable of detecting aberrant viewing perspectives with sensitivity of 95% and specificity of 53%. Correlations between glenoid size and CSA were small (R≤0.3), and CSA did not vary by gender (p=0.426) or side (p=0.821). Conclusions The CSA was most susceptible to malposition in ante/retroversion. Deviations as little as 5° in anteversion resulted in a CSA >2° from true AP. A new classification system refines the ability to collect true AP radiographs of the scapula. The CSA was unaffected by demographic factors. PMID:25591458

Dorsal scapular nerve neuropathy: a narrative review of the literature

PubMed Central

Muir, Brad

2017-01-01

Objective The purpose of this paper is to elucidate this little known cause of upper back pain through a narrative review of the literature and to discuss the possible role of the dorsal scapular nerve (DSN) in the etiopathology of other similar diagnoses in this area including cervicogenic dorsalgia (CD), notalgia paresthetica (NP), SICK scapula and a posterolateral arm pain pattern. Background Dorsal scapular nerve (DSN) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back and costovertebral pain. These are common conditions presenting to chiropractic, physiotherapy, massage therapy and medical offices. Methods The methods used to gather articles for this paper included: searching electronic databases; and hand searching relevant references from journal articles and textbook chapters. Results One hundred-fourteen articles were retrieved. After removing duplicates, there were 57 articles of which 29 were retrieved. There were 26 articles and textbook chapters retrieved by hand searching equaling 55 articles retrieved of which 47 relevant articles were used in this report. Discussion The anatomy, pathway and function of the dorsal scapular nerve can be varied and exceptionally rarely may include a sensory component. The signs and symptoms, therefore, may include pain, atrophy, scapular winging, and dysesthesia. The mechanism of injury to the DSN is also quite varied ranging from postural to overuse in overhead work and sport. Other conditions in this area, including CD, NP, SICK scapula and a posterolateral arm pain pattern bear a striking resemblance to DSN neuropathy. Conclusion DSN neuropathy should be included in the list of common differential diagnoses of upper and mid-thoracic pain, stiffness, dysesthesia and dysfunction. The study also brings forward interesting connections between DSN neuropathy, CD, NP, SICK scapula and a posterolateral arm pain pattern. PMID:28928496

Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain.

PubMed

Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S; Zebis, Mette K

2011-07-22

Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. ISRCTN60264809.

Adaptive scapula bone remodeling computational simulation: Relevance to regenerative medicine

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

Sharma, Gulshan B., E-mail: gbsharma@ucalgary.ca; University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, Pennsylvania 15213; University of Calgary, Schulich School of Engineering, Department of Mechanical and Manufacturing Engineering, Calgary, Alberta T2N 1N4

Shoulder arthroplasty success has been attributed to many factors including, bone quality, soft tissue balancing, surgeon experience, and implant design. Improved long-term success is primarily limited by glenoid implant loosening. Prosthesis design examines materials and shape and determines whether the design should withstand a lifetime of use. Finite element (FE) analyses have been extensively used to study stresses and strains produced in implants and bone. However, these static analyses only measure a moment in time and not the adaptive response to the altered environment produced by the therapeutic intervention. Computational analyses that integrate remodeling rules predict how bone will respondmore » over time. Recent work has shown that subject-specific two- and three dimensional adaptive bone remodeling models are feasible and valid. Feasibility and validation were achieved computationally, simulating bone remodeling using an intact human scapula, initially resetting the scapular bone material properties to be uniform, numerically simulating sequential loading, and comparing the bone remodeling simulation results to the actual scapula’s material properties. Three-dimensional scapula FE bone model was created using volumetric computed tomography images. Muscle and joint load and boundary conditions were applied based on values reported in the literature. Internal bone remodeling was based on element strain-energy density. Initially, all bone elements were assigned a homogeneous density. All loads were applied for 10 iterations. After every iteration, each bone element’s remodeling stimulus was compared to its corresponding reference stimulus and its material properties modified. The simulation achieved convergence. At the end of the simulation the predicted and actual specimen bone apparent density were plotted and compared. Location of high and low predicted bone density was comparable to the actual specimen. High predicted bone density was greater than actual specimen. Low predicted bone density was lower than actual specimen. Differences were probably due to applied muscle and joint reaction loads, boundary conditions, and values of constants used. Work is underway to study this. Nonetheless, the results demonstrate three dimensional bone remodeling simulation validity and potential. Such adaptive predictions take physiological bone remodeling simulations one step closer to reality. Computational analyses are needed that integrate biological remodeling rules and predict how bone will respond over time. We expect the combination of computational static stress analyses together with adaptive bone remodeling simulations to become effective tools for regenerative medicine research.« less

Anatomy of Shoulder Girdle Muscle Modifications and Walking Adaptation in the Scaly Chinese Pangolin (Manis Pentadactyla Pentadactyla: Pholidota) Compared with the Partially Osteoderm-Clad Armadillos (Dasypodidae).

PubMed

Kawashima, Tomokazu; Thorington, Richard W; Bohaska, Paula W; Chen, Yen-Jean; Sato, Fumi

2015-07-01

Because pangolins are unique mammals with a body and limbs almost entirely sheathed in hard keratinous overlapping scales and with digging and climbing abilities, the shoulder girdle muscles may differ significantly from those of other mammals including the partially osteoderm-clad armadillos. Therefore, we conducted a functional anatomical study of the shoulder girdle muscles in Chinese pangolins (Manis pentadactyla pentadactyla, Pholidota) and some armadillo species (Dasypodidae). Our CT scans revealed that the pangolin's overlapping scales are hard structures completely encasing the limbs. The armadillo's limbs, however, are covered with small relatively soft non-overlapping scales embedded in the skin, and articulate completely free of the hard osteodermal carapace. The attachments of some shoulder girdle muscles in the pangolin have moved from the surrounding edges of the scapula to the spine, and they, therefore, fully cover the scapula. In addition, some pangolin shoulder girdle muscles cross the shoulder joint to insert on the distal humerus, but this does not occur in armadillos. We cannot rule out the possibility that these muscle modifications represent adaptations for digging and/or climbing in pangolins. Our results and previous literature do not establish specific links between them and locomotive modes. However, we propose that the Chinese pangolin may use its derived muscular features when walking to move its armor-restricted forelimbs more effectively by swinging its head from side to side. © 2015 Wiley Periodicals, Inc.

Low-energy versus middle-energy extracorporeal shockwave therapy for the treatment of snapping scapula bursitis

PubMed Central

Acar, Nihat

2017-01-01

Objective: Extracorporeal shockwave therapy (ESWT) has been used successfully in treatment of musculoskeletal disorders. Our objective was to assess the effectiveness of low versus middle-energy ESWT on snapping scapula bursitis. Methods: Thirty-five patients, divided into two groups, group (L), received low-energy ESWT, group (M) received middle-energy ESWT. Groups were evaluated at 1,3,6 and 12 months using the Visual Analogue Scale (VAS), the Constant-Murley scoring (CMS) and the Roles and Maudsley criteria. Results: In groups (L) and (M), VAS average values after 1,3,6 months and one year were (43±5.17, 38±4.33, 28±4.18 and 19±3.39) and (37±4.85, 26±4.74, 21±4.45 and 7±3.42) respectively. At six and twelve months, statistical difference was detected, P (0.034, 0.026) respectively. After one year of completing the treatment, the average values of CMS were (83.5±6.44 and 91±5.33) respectively, P=0.046. Roles and Maudsley criteria demonstrated that, patients in group (L), 6 (35%) excellent, 5 (29%) good, 4 (24%) acceptable and 2 (12%) had poor results. Whereas, patients in group (M), 11 (61%) excellent, 3 (17%) good, 3 (17%) acceptable and 1 (5%) had poor results. Conclusion: Although low-energy ESWT showed good early-term results, but middle-energy ESWT protocol demonstrated better early-term, Mid-term, and late-term results. PMID:28523033

The influence of unstable modified wall squat exercises on the posture of female university students

PubMed Central

Lee, Yoonmi

2015-01-01

[Purpose] The purpose of this study was to examine the effect of unstable modified wall squat exercises on the posture of female university students. [Subjects] The subjects of this study were 30 female university students who were equally and randomly allocated to an unstable modified wall squat exercises group the experimental group and a stable modified wall squat exercises group the control group. [Methods] Both groups performed their respective exercises for 30 minutes three times per week over a six-week period. Using BackMapper, trunk inclination, trunk imbalance, pelvic position, pelvic torsion, pelvic rotation, and position of the scapulae were evaluated. [Results] The unstable modified wall squat exercises group obtained significant results for trunk inclination, trunk imbalance, pelvic position, pelvic torsion, position of the scapulae, while the stable modified wall squat exercises group obtained significant results for trunk imbalance and pelvic position. [Conclusion] Unstable modified wall squat exercises may be applied as a method to correct the posture of average adults. PMID:26356770

An Expert System Advisor for Medical Evaluation Boards

DTIC Science & Technology

1991-12-01

Condition OR REFERRAL=MedicalBoard_Slip !Condition AND PROBLEM=Spine_Scapulae.. Sacroiliac !Condition THEN ACTION=Refer-toMEB !Rule conclusion BECAUSE "In...Rule conclusion BECAUSE "In Accordance With The VA Schedule For Rating Disabilities" RULE N3 !Mandatory rule label IF Problem= Sacroiliac Joint

The 3-M syndrome. A heritable low birthweight dwarfism.

PubMed

Van Goethem, H; Malvaux, P

1987-10-01

Two male siblings and one girl with the 3-M syndrome are reported. The main clinical features include low birthweight, proportionate dwarfism, hatched-shaped cranio-facial configuration, abnormalities of mouth and teeth, short broad neck with prominent trapezius, pectus deformity, transverse grooves of anterior chest, and winged scapulae.

Modeling of Human Joint Structures.

DTIC Science & Technology

1982-09-01

Acromioclavicular Joint .... ............. ... 20 Glenohumeral Joint .... ................ . 20 HIP JOINT .................. ...... 21 Iliofemoral Ligament...clavicle articulates with the manubrium of the sternum, and the acromioclavicular joint, where the clavicle articulates with the acromion process of the...the interclavicular ligament. Acromioclavicular Joint This articulation between the distal end of the clavicle and the acromion of the scapula is

[Effectiveness of an individualised physiotherapy program versus group therapy on neck pain and disability in patients with acute and subacute mechanical neck pain].

PubMed

Antúnez Sánchez, Leonardo Gregorio; de la Casa Almeida, María; Rebollo Roldán, Jesús; Ramírez Manzano, Antonio; Martín Valero, Rocío; Suárez Serrano, Carmen

To compare the efficacy in reducing neck pain and disability in an individualised physiotherapy treatment with group treatment in acute and subacute mechanical neck pain. Randomised clinical trial. Health Area of University Hospital Virgen del Rocío, Seville, Spain. A total of 90 patients diagnosed with mechanical neck pain of up to one month onset, distributed randomly into two groups: (i)individualised treatment; (ii)group treatment. The treatment consisted of 15 sessions of about 60minutes for both groups. Individual treatment consisted of 15minutes of infrared heat therapy, 17minutes of massage, and analytical passive stretching of the trapezius muscles and angle of the scapula. The group treatment consisted of a program of active mobilisation, isometric contractions, self-stretching, and postural recommendations. Pain was measured at the beginning and end of treatment pain using a Visual Analogue Scale (VAS) and an algometer applied on the trapezius muscles and angle of the scapula, and neck disability using the Neck Disability Index. Both treatments were statistically significant (P<.001) in improving all variables. Statistically significant differences (P<.001) were found for all of them in favour of individualised treatment compared to group treatment. Patients with acute or subacute mechanical neck pain experienced an improvement in pain and neck disability after receiving either of the physiotherapy treatments used in our study, with the individual treatment being more effective than collective. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Three-dimensional planning and use of patient-specific guides improve glenoid component position: an in vitro study.

PubMed

Walch, Gilles; Vezeridis, Peter S; Boileau, Pascal; Deransart, Pierric; Chaoui, Jean

2015-02-01

Glenoid component positioning is a key factor for success in total shoulder arthroplasty. Three-dimensional (3D) measurements of glenoid retroversion, inclination, and humeral head subluxation are helpful tools for preoperative planning. The purpose of this study was to assess the reliability and precision of a novel surgical method for placing the glenoid component with use of patient-specific templates created by preoperative surgical planning and 3D modeling. A preoperative computed tomography examination of cadaveric scapulae (N = 18) was performed. The glenoid implants were virtually placed, and patient-specific guides were created to direct the guide pin into the desired orientation and position in the glenoid. The 3D orientation and position of the guide pin were evaluated by performing a postoperative computed tomography scan for each scapula. The differences between the preoperative planning and the achieved result were analyzed. The mean error in 3D orientation of the guide pin was 2.39°, the mean entry point position error was 1.05 mm, and the mean inclination angle error was 1.42°. The average error in the version angle was 1.64°. There were no technical difficulties or complications related to use of patient-specific guides for guide pin placement. Quantitative analysis of guide pin positioning demonstrated a good correlation between preoperative planning and the achieved position of the guide pin. This study demonstrates the reliability and precision of preoperative planning software and patient-specific guides for glenoid component placement in total shoulder arthroplasty. Copyright © 2015. Published by Elsevier Inc.

Comparison of Surface Properties in Natural and Artificially Generated Fractures in a Crystalline Rock

NASA Astrophysics Data System (ADS)

Vogler, Daniel; Walsh, Stuart D. C.; Bayer, Peter; Amann, Florian

2017-11-01

This work studies the roughness characteristics of fracture surfaces from a crystalline rock by analyzing differences in surface roughness between fractures of various types and sizes. We compare the surface properties of natural fractures sampled in situ and artificial (i.e., man-made) fractures created in the same source rock under laboratory conditions. The topography of the various fracture types is compared and characterized using a range of different measures of surface roughness. Both natural and artificial, and tensile and shear fractures are considered, along with the effects of specimen size on both the geometry of the fracture and its surface characterization. The analysis shows that fracture characteristics are substantially different between natural shear and artificial tensile fractures, while natural tensile fracture often spans the whole result domain of the two other fracture types. Specimen size effects are also evident, not only as scale sensitivity in the roughness metrics, but also as a by-product of the physical processes used to generate the fractures. Results from fractures generated with Brazilian tests show that fracture roughness at small scales differentiates fractures from different specimen sizes and stresses at failure.

Upper-Limb Exercises for Stroke Patients through the Direct Engagement of an Embodied Agent

DTIC Science & Technology

2011-03-01

hemiparesis . To alleviate impairments, pa- tients pursue therapy services at the acute, sub-acute, and chronic phases as necessary. Patients need...year-old male who suffered from a stroke 15 years ago. He has right hemiparesis and ambu- lates with a quad cane. He has limited scapula and minimal

A new basal sauropodiform dinosaur from the Lower Jurassic of Yunnan Province, China

NASA Astrophysics Data System (ADS)

Wang, Ya-Ming; You, Hai-Lu; Wang, Tao

2017-02-01

The Lufeng Formation in Lufeng Basin of Yunnan Province, southwestern China preserves one of the richest terrestrial Lower Jurassic vertebrate faunas globally, especially for its basal sauropodomorphs, such as Lufengosaurus and Yunnanosaurus. Here we report a new taxon, Xingxiulong chengi gen. et sp. nov. represented by three partial skeletons with overlapping elements. Xingxiulong possesses a number of autapomorphies, such as transversely expanded plate-like summit on top of the neural spine of posterior dorsal vertebrae, four sacral vertebrae, robust scapula, and elongated pubic plate approximately 40% of the total length of the pubis. Phylogenetic analysis resolves Xingxiulong as a basal member of Sauropodiformes, and together with another two Lufeng basal sauropodiforms Jingshanosaurus and Yunnanosaurus, they represent the basalmost lineages of this clade, indicating its Asian origin. Although being relatively primitive, Xingxiulong displays some derived features normally occurred in advanced sauropodiforms including sauropods, such as a four sacral-sacrum, a robust scapula, and a pubis with elongated pubic plate. The discovery of Xingxiulong increases the diversity of basal sauropodomorphs from the Lufeng Formation and indicates a more complicated scenario in the early evolution of sauropodiforms.

Surgical treatment for non-union of the mid-shaft clavicle using a reconstruction plate: scapular malposition is related to poor results.

PubMed

Huang, Teng-Le; Lin, Feng-Huei; Hsu, Horng-Chaung

2009-03-01

A retrospective study was performed to evaluate the use of an AO reconstruction plate in open reduction and internal fixation for non-union of the mid-shaft clavicle, examining the relationship between the position of the scapula and final functional results and whether perioperative variables such as clavicular reconstruction ratio and period of non-union influence the position of the scapula. From January 1998 to January 2005, data on 21 people with symptomatic non-union of the mid-shaft clavicle were collected; 17 non-unions were atrophic and 4 were hypertrophic. Initially, treatment was conservative with a figure-of-eight bandage in 19 cases, and cerclage wire fixation in 2 cases. The follow-up period was 65.7 (24-108) months. Outcome analyses included standard clinical follow-up, plain radiography, the Constant-Murley scoring and subjective assessment. All non-unions united well in 13.6 (11-27) weeks. All patients were satisfied with their surgical results. Greater age and longer period of non-union resulted in a larger amount of scapular malposition, which related to poor functional results.

On the development of the shoulder girdle in Crocidura russula (Soricidae) and other placental mammals: evolutionary and functional aspects

PubMed Central

Großmann, Martin; Sánchez-Villagra, Marcelo R; Maier, Wolfgang

2002-01-01

The development of the shoulder girdle was studied in embryonic stages and a neonate of Crocidura russula using histological sections and 3-D reconstructions. Neonatal stages of Suncus etruscus and Mesocricetus auratus, both altricial placentals, were also studied. The earliest stage of C. russula, in which the scapula is still partially blastematous, has already a supraspinous fossa. The dorsal portion of the scapular spine does not develop from the anterior margin of the scapula. Its mode of development varies among the placentals studied to date. In some it is completely appositional bone, in others it consists of bone formed mostly by endochondral ossification of a dorsal cartilaginous process stemming from the acromium. During development the supraspinatus muscle increases in size in proportion to the infraspinatus muscle and the humeral head increases in size in relation to the glenoid fossa. Placentals have secondary cartilage in the sternal and acromial ends of the clavicle, a derived feature absent in Marsupialia. Even the most altricial placentals have a more developed shoulder girdle at birth than any newborn marsupial studied to date. PMID:12448772

The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: a retrospective analysis of 130 reconstructions performed over a period of 5 years in a single department.

PubMed

Mitsimponas, Konstantinos T; Iliopoulos, Christos; Stockmann, Philipp; Bumiller, Lars; Nkenke, Emeka; Neukam, Friedrich W; Schlegel, Karl-Andreas

2014-07-01

The scapular/parascapular free flap was described by Saijo in 1978 and has since then been widely used in reconstructive procedures. This is a retrospective study, describing our experience with the use of free scapula/parascapular flap in 130 reconstructions over a period of 5 years in the Department of Oral and Maxillofacial Surgery of the University Hospital of Erlangen. Demographical data, data regarding the underlying pathology, flap raising details, microvascular anastomoses, early and late postoperative complications will be presented. The flap was raised without problems and the donor site was primarily closed in all cases. Sixteen flaps required revision. Five transplants were lost (failure rate of 3.85%). Loss of part of the flap was observed in 3 cases (2.3%). The free scapula/parascapular flap is a versatile and reliable flap that can find many applications in the reconstruction of complex head and neck defects. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A technical report on ultrasound-guided scapulocostal syndrome injection.

PubMed

McCarthy, C; Harmon, D

2016-08-01

We describe a case report and technique for using an ultrasound scanner and a linear transducer to guide serratus posterior superior (SPS) muscle injection. A 43-year-old female presented with chronic pain centered under the right upper portion of her scapula impacting her activities of daily living. For the ultrasound-guided SPS muscle injection, the patient was placed in the prone position. The transducer was oriented in a transverse orientation at the level of the C6-T1 vertebrae. Here the SPS muscle attaches to the lower portion of the ligament nuchae and the intervening interspinous ligaments. The muscle fibers run inferiorly and laterally to attach to the 2nd-5th ribs which were identified along with the lateral portion of the serratus posterior superior muscle which is covered by the scapula. Real-time imaging was used to direct a spinal needle into the trigger points of the SPS muscle, where solution was injected under direct vision. The patient's pain symptoms improved significantly. Serratus posterior superior injection can confirm a diagnosis of scapulocostal syndrome and be therapeutically beneficial.

Differences in childhood adiposity influence upper limb fracture site

PubMed Central

Moon, Rebecca J; Lim, Adelynn; Farmer, Megan; Segaran, Avinash; Clarke, Nicholas MP; Dennison, Elaine M; Harvey, Nicholas C; Cooper, Cyrus; Davies, Justin H

2015-01-01

Introduction Although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children. Methods Height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3-18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data. Results 401 children (67.1% male, median age 11.71 years (range 3.54-17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI and SFT z-scores than those with UA fractures (p<0.05 for all). SFT z-scores were also higher in children with forearm fractures compared to hand fractures, but children withor hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p=0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p=0.003), whereas that of children with either UA (p=0.13) or hand fractures (29.1%, p=0.76) did not differ. The differences in anthropometry and overweight/obesity were similar for boys, but not present in girls. Conclusion Measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures. PMID:26027507

Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan.

PubMed

Ochi, Kensuke; Furuya, Takefumi; Ikari, Katsunori; Taniguchi, Atsuo; Yamanaka, Hisashi; Momohara, Shigeki

2013-01-01

Sites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future. The literature contains limited data describing the details of fractures at different skeletal sites in patients with RA. We evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires. Over a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups. Our results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.

Fractures of the Tibial Plateau Involve Similar Energies as the Tibial Pilon but Greater Articular Surface Involvement

PubMed Central

Dibbern, Kevin; Kempton, Laurence B.; Higgins, Thomas F.; Morshed, Saam; McKinley, Todd O.; Marsh, J. Lawrence; Anderson, Donald D.

2016-01-01

Patients with tibial pilon fractures have a higher incidence of post-traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated if clinical fracture classification systems accurately reflect severity. Seventy-five tibial plateau fractures and fifty-two tibial pilon fractures from a multi-institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT-based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2 to 33.2 Joules (J) and 3.6 to 32.2 J, respectively, and articular fracture edge lengths were 68.0 to 493.0 mm and 56.1 to 288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p<0.001). The clinical fracture classifications generally reflected severity, but there was substantial overlap of fracture severity measures between different classes. Clinical Significance Similar fracture energies with different degrees of articular surface involvement suggest a possible explanation for dissimilar rates of post-traumatic osteoarthritis for fractures of the tibial plateau compared to the tibial pilon. The substantial overlap of severity measures between different fracture classes may well have confounded prior clinical studies relying on fracture classification as a surrogate for severity. PMID:27381653

Scapular Resting Position and Gleno-Humeral Movement Dysfunction in Asymptomatic Racquet Players: A Case-Control Study

PubMed Central

Shimpi, Apurv P.; Bhakti, Shah; Roshni, Karnik; Rairikar, Savita A.; Shyam, Ashok; Sancheti, Parag K.

2015-01-01

Background: Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. Objectives: The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. Materials and Methods: 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. Results: There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. Conclusions: The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group. PMID:26715968

Scapular Resting Position and Gleno-Humeral Movement Dysfunction in Asymptomatic Racquet Players: A Case-Control Study.

PubMed

Shimpi, Apurv P; Bhakti, Shah; Roshni, Karnik; Rairikar, Savita A; Shyam, Ashok; Sancheti, Parag K

2015-12-01

Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group.

Anatomical and morphological study of the subcoracoacromial canal.

PubMed

Le Reun, O; Lebhar, J; Mateos, F; Voisin, J L; Thomazeau, H; Ropars, M

2016-12-01

Many clinical anatomy studies have looked into how variations in the acromion, coracoacromial ligament (CAL) and subacromial space are associated with rotator cuff injuries. However, no study up to now had defined anatomically the fibro-osseous canal that confines the supraspinatus muscle in the subcoracoacromial space. Through an anatomical study of the scapula, we defined the bone-related parameters of this canal and its anatomical variations. This study on dry bones involved 71 scapulas. With standardised photographs in two orthogonal views (superior and lateral), the surface area of the subcoracoacromial canal and the anatomical parameters making up this canal were defined and measured using image analysis software. The primary analysis evaluated the anatomical parameters of the canal as a function of three canal surface area groups; the secondary analysis looked into how variations in the canal surface area were related to the type of acromion according to the Bigliani classification. Relative to glenoid width, the group with a large canal surface area (L) had significantly less lateral overhang of the acromion than the group with a small canal surface area (S), with ratios of 0.41±0.23 and 0.58±0.3, respectively (P=0.04). The mean length of the CAL was 46±8mm in the L group and 39±9mm in the S group (P=0.003). The coracoacromial arch angle was 38°±11° in the L group and 34°±9° in the S group; the canal surface area was smaller in specimens with a smaller coracoacromial arch angle (P=0.20). Apart from acromial morphology, there could be innate anatomical features of the scapula that predispose people to extrinsic lesions to the supraspinatus tendon (lateral overhang, coracoacromial arch angle) by reducing the subcoracoacromial canal's surface area. Anatomical descriptive study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Cadaveric study validating in vitro monitoring techniques to measure the failure mechanism of glenoid implants against clinical CT.

PubMed

Junaid, Sarah; Gregory, Thomas; Fetherston, Shirley; Emery, Roger; Amis, Andrew A; Hansen, Ulrich

2018-03-23

Definite glenoid implant loosening is identifiable on radiographs, however, identifying early loosening still eludes clinicians. Methods to monitor glenoid loosening in vitro have not been validated to clinical imaging. This study investigates the correlation between in vitro measures and CT images. Ten cadaveric scapulae were implanted with a pegged glenoid implant and fatigue tested to failure. Each scapulae were cyclically loaded superiorly and CT scanned every 20,000 cycles until failure to monitor progressive radiolucent lines. Superior and inferior rim displacements were also measured. A finite element (FE) model of one scapula was used to analyze the interfacial stresses at the implant/cement and cement/bone interfaces. All ten implants failed inferiorly at the implant-cement interface, two also failed at the cement-bone interface inferiorly, and three showed superior failure. Failure occurred at of 80,966 ± 53,729 (mean ± SD) cycles. CT scans confirmed failure of the fixation, and in most cases, was observed either before or with visual failure. Significant correlations were found between inferior rim displacement, vertical head displacement and failure of the glenoid implant. The FE model showed peak tensile stresses inferiorly and high compressive stresses superiorly, corroborating experimental findings. In vitro monitoring methods correlated to failure progression in clinical CT images possibly indicating its capacity to detect loosening earlier for earlier clinical intervention if needed. Its use in detecting failure non-destructively for implant development and testing is also valuable. The study highlights failure at the implant-cement interface and early signs of failure are identifiable in CT images. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 9999:XX-XX, 2018. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.

Genetic research of fractures in carbonate reservoir: a case study of NT carbonate reservoir in the pre-Caspian basin

NASA Astrophysics Data System (ADS)

Fan, Zifei; Wang, Shuqin; Li, Jianxin; Zhao, Wenqi; Sun, Meng; Li, Weiqiang; Li, Changhai

2018-02-01

The degree of development and characteristics of fractures are key factors for the appraisal of carbonate reservoirs. In this paper, core data and well logging data from the NT oilfield in the Pre-Caspian Basin are used to study the formation mechanism and distribution characteristics of different genetic fractures, and analyze their influence on reservoir properties. Fractures in carbonate reservoirs can be divided into three categories according to their formation mechanism; these are tectonic fracture, dissolved fracture, and diagenetic fracture,which is further divided into interlayer fracture and stylolite. Fractures of different formation mechanism influence fluid seepage in different degree, tectonic fractures possessing strong connecting ability to pores, and dissolved fractures also improving reservoir properties effectively, however, diagenetic fractures contributing relatively little to fluid seepage.

Numerical simulation and fracture identification of dual laterolog in organic shale

NASA Astrophysics Data System (ADS)

Maojin, Tan; Peng, Wang; Qiong, Liu

2012-09-01

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

Energy attenuation performance of impact protection worn by motorcyclists in real-world crashes.

PubMed

Albanese, Bianca; Gibson, Tom; Whyte, Tom; Meredith, Lauren; Savino, Giovanni; de Rome, Liz; Baldock, Matthew; Fitzharris, Michael; Brown, Julie

2017-05-29

Laboratory studies have demonstrated that impact protectors (IP) used in motorcycle clothing can reduce fracture severities. While crash studies have reported IP are associated with reduced likelihood of soft tissue injury, there is little evidence of their effectiveness in reducing fracture likelihood. This discrepancy might be related to IP quality. There are mandatory requirements for IP supplied with protective clothing in Europe, but not elsewhere. This study examines the energy attenuation performance of IP used by Australian riders. IP were harvested from clothing worn by crashed riders admitted to hospital. The IP were examined and energy attenuation properties were determined using EN 1621-1 test procedures. Impact injury was identified from medical records and defined as fractures, dislocations, and avulsions that occurred following impact to the rider's shoulders, elbows, hips, and/or knees. Fisher's exact test was used to examine the relationship between meeting the EN 1621-1 energy attenuation requirements and impact injury. The association between the average and maximum transmitted force, and impact injury was examined using generalized estimating equations. Motorcycle riders were recruited as part of an in-depth crash study through three hospitals in New South Wales, Australia, between 2012 and 2014. Riders were interviewed, and engineers conducted site, vehicle, and clothing inspections. Clothing was collected, or identical garments were purchased. Clothing was inspected for 62 riders. Of these, 19 wore clothing incorporating 76 IP. Twenty-six of these were impacted in the crash event. Almost all impacted IP (96%) were CE marked, and most (83%) met Level 1 energy attenuation requirements of EN 1621-1 when tested. Of the 26 impacted IP, four were associated with impact injuries, including midshaft and distal clavicle fractures and a scapula and olecranon fracture. No associations between meeting EN 1621-1 requirements and impact injury were found (p = 0.5). There was no association between average force transmitted and impact injury (95% CI: 0.91-1.24); however, as maximum force transmitted increased, the odds of impact injury increased (95% CI: 1.01-1.2). These results indicate a high probability of impact injury at 50 kN, the limit of maximum transmitted force specified in EN 1621-1. The allowable transmitted force of EN 1621-1 may be too high to effectively reduce the probability of impact injury. This is not surprising, given human tolerance levels that are reported in literature. Reducing the force limit below the reported fracture tolerance limits might be difficult with current technology. However, there is scope to reduce the EN 1621-1 maximum limit of 50 kN transmitted force. A reduction in the maximum force limit would improve rider protection and appears feasible, as 77% of tested IP recorded a maximum force <35 kN. This level of transmitted force is estimated to be associated with <20% probability of impact injury. While the performance of IP available to Australian riders is not regulated, most IP was CE marked. The results indicate a significant association between maximum transmitted force, tested according to EN 1621-1 procedures, and impact injury. Further investigation of the EN 1621-1 requirements may be warranted. This work will interest those targeting protective equipment for motorcyclists as a mechanism for reducing injury to these vulnerable road users.

Structural, Morphological, and Functional Correlates of Corneal Endothelial Toxicity Following Corneal Exposure to Sulfur Mustard Vapor

DTIC Science & Technology

2013-10-01

fentanyl patch (25 lg/h) was placed anterior to the scapula. On the day of exposure, rabbits were anesthetized with an intramuscular administration of 15 mg...sterile saline to flush residual agent. Rabbits were returned to cages and provided food and water ad libitum. Fentanyl patches were replaced after 72

Radiolabeled Microsphere Technique in Conscious Subjects during Acceleration Exposures on the USAFSAM Centrifuge.

DTIC Science & Technology

1980-03-01

function even though the pump is pumping air into the blood manifold. R-2 is secured to the plate with two thumb screws, and when the syringes are...the scapula . The animals were allowed 2-4 weeks of surgical recovery before the acceleration studies were performed. Experimental Protocol--On the day

Evaluation of Interacavitary Chemotherapy Delivery for Treatment of Mammary Carcinoma

DTIC Science & Technology

2005-04-01

Celltiter 96 Aqueous one solution cell proliferation assay - Promega) in 96 well plates were used, each well received 100 ul of cell culture medium and...treatments: a) polotax (200 ul of 22% poloxamer/5.4mg/ml taxol suspension) in wound, b) 200 ul polotax remote (between 2 scapulae ), c) 200 ul 22% poloxamer in

Hip fracture types in men and women change differently with age

PubMed Central

2010-01-01

Background Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. Methods Patients of 50 years and older, with a diagnosis of hip fracture, discharged from two local acute care hospitals over a 5 year period (n = 2150) were analyzed as a function of age and gender to explore the relative proportions of intertrochanteric and subcapital fractures, and the change in relative proportion in the two genders with age. Results Overall, for the genders combined, the proportion of intertrochanteric fractures increases with age (p = .007). In women this increase is significant (p < .001), but in men the opposite pattern is observed, with the proportion of intertrochanteric fractures falling significantly with age (p = .025). Conclusions The pattern of hip fractures is different in men and women with aging. It is likely that the pattern difference reflects differences in type and rate of bone loss in the genders, but it is conjectured that the changing rate and pattern of falling with increasing age may also be important. The two main hip fracture types should be considered distinct and different and be studied separately in studies of cause and prevention. PMID:20214771

Investigation of the Effect of Cemented Fractures on Fracturing Network Propagation in Model Block with Discrete Orthogonal Fractures

NASA Astrophysics Data System (ADS)

Wang, Y.; Li, C. H.

2017-07-01

Researchers have recently realized that the natural fractures in shale reservoirs are often cemented or sealed with various minerals. However, the influence of cement characteristics of natural fracture on fracturing network propagation is still not well understood. In this work, laboratory-scaled experiments are proposed to prepare model blocks with discrete orthogonal fractures network with different strength of natural fracture, in order to reveal the influence of cemented natural fractures on the interactions between hydraulic fractures and natural fractures. A series of true triaxial hydraulic fracturing experiments were conducted to investigate the mechanism of hydraulic fracture initiation and propagation in model blocks with natural fractures of different cement strength. The results present different responses of interactions between hydraulic and natural fractures, which can be reflected on the pump pressure profiles and block failure morphology. For model blocks with fluctuated pump pressure curves, the communication degree of hydraulic and natural fractures is good, which is confirmed by a proposed new index of "P-SRV." The most significant finding is that too high and too low strength properties of cemented natural fracture are adverse to generate complex fracturing network. This work can help us better understand how cemented natural fractures affect the fracturing network propagation subsurface and give us reference to develop more accurate hydraulic fracturing models.

Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability.

PubMed

Schulz-Drost, S; Grupp, S; Pachowsky, M; Oppel, P; Krinner, S; Mauerer, A; Hennig, F F; Langenbach, A

2017-04-01

Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral-axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions. Fifteen patients were stabilized by locked plate osteosynthesis (MatrixRib ® ) between May 2012 and April 2014 and prospectively followed up. Flail chest injuries were managed through limited incisions to the anterior, the lateral, and the posterior parts of the chest wall or their combinations. Each approach was 4-10 cm using Alexis ® retractor. One minimized approach offered sufficient access at least to four ribs posterior and laterally, four pairs of ribs anterior in all cases. There was no need to divide latissimus dorsi muscle. Trapezius und rhomboid muscles were only limited divided, whereas a subcutaneous dissection of serratus and abdominis muscles was necessary. A follow-up showed sufficient consolidation. pneumothorax (2) and seroma (2). Minimized approaches allow sufficient stabilization of severe dislocated rib fractures without extensive dissection or division of the important muscles. Keeping the arm and, thus, the scapula mobile is very important for providing the largest reachable surface of the rib cage through each approach.

Pelvic crescent fractures: variations in injury mechanism and radiographic pattern.

PubMed

Gehlert, Rick J; Xing, Zhiqing; DeCoster, Thomas A

2014-01-01

Pelvic crescent fracture, also known as sacroiliac fracture-dislocation, is traditionally considered as a lateral compression injury and a vertically stable injury. Thirty consecutive cases were analyzed and it was found that 63% of cases were caused by lateral compression (LC), 27% by anteroposterior compression (APC), and 10% by vertical shear (VS). APC and VS injuries cause significant displacement of the anterior iliac fragment, but 21% of LC injury cases showed minimal displacement and were treated successfully with nonoperative treatment. Different injury mechanisms also produce different types of pelvic instability. More important, different injury mechanisms produce distinct radiographic fracture patterns regarding the obliquity of the fracture line and fracture surface. These differences in the fracture pattern will influence the decision of internal fixation options. Therefore, treatment of pelvic crescent fractures should be based on individual analysis of injury mechanism and radiographic fracture pattern.

A three-dimensional morphometric analysis of upper forelimb morphology in the enigmatic tapir (Perissodactyla: Tapirus) hints at subtle variations in locomotor ecology.

PubMed

MacLaren, Jamie A; Nauwelaerts, Sandra

2016-11-01

Forelimb morphology is an indicator for terrestrial locomotor ecology. The limb morphology of the enigmatic tapir (Perissodactyla: Tapirus) has often been compared to that of basal perissodactyls, despite the lack of quantitative studies comparing forelimb variation in modern tapirs. Here, we present a quantitative assessment of tapir upper forelimb osteology using three-dimensional geometric morphometrics to test whether the four modern tapir species are monomorphic in their forelimb skeleton. The shape of the upper forelimb bones across four species (T. indicus; T. bairdii; T. terrestris; T. pinchaque) was investigated. Bones were laser scanned to capture surface morphology and 3D landmark analysis was used to quantify shape. Discriminant function analyses were performed to reveal features which could be used for interspecific discrimination. Overall our results show that the appendicular skeleton contains notable interspecific differences. We demonstrate that upper forelimb bones can be used to discriminate between species (>91% accuracy), with the scapula proving the most diagnostic bone (100% accuracy). Features that most successfully discriminate between the four species include the placement of the cranial angle of the scapula, depth of the humeral condyle, and the caudal deflection of the olecranon. Previous studies comparing the limbs of T. indicus and T. terrestris are corroborated by our quantitative findings. Moreover, the mountain tapir T. pinchaque consistently exhibited the greatest divergence in morphology from the other three species. Despite previous studies describing tapirs as functionally mediportal in their locomotor style, we find osteological evidence suggesting a spectrum of locomotor adaptations in the tapirs. We conclude that modern tapir forelimbs are neither monomorphic nor are tapirs as conserved in their locomotor habits as previously described. J. Morphol. 277:1469-1485, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Resting Orientations of Dinosaur Scapulae and Forelimbs: A Numerical Analysis, with Implications for Reconstructions and Museum Mounts.

PubMed

Senter, Phil; Robins, James H

2015-01-01

The inclination of the scapular blade and the resting pose of the forelimb in dinosaurs differ among reconstructions and among skeletal mounts. For most dinosaurian taxa, no attempt has previously been made to quantify the correct resting positions of these elements. Here, we used data from skeletons preserved in articulation to quantify the resting orientations of the scapula and forelimb in dinosaurs. Specimens were included in the study only if they were preserved lying on their sides; for each specimen the angle between forelimb bones at a given joint was included in the analysis only if the joint was preserved in articulation. Using correlation analyses of the angles between the long axis of the sacrum, the first dorsal centrum, and the scapular blade in theropods and Eoraptor, we found that vertebral hyperextension does not influence scapular orientation in saurischians. Among examined taxa, the long axis of the scapular blade was found to be most horizontal in bipedal saurischians, most vertical in basal ornithopods, and intermediate in hadrosauroids. We found that in bipedal dinosaurs other than theropods with semilunate carpals, the resting orientation of the elbow is close to a right angle and the resting orientation of the wrist is such that the hand exhibits only slight ulnar deviation from the antebrachium. In theropods with semilunate carpals the elbow and wrist are more flexed at rest, with the elbow at a strongly acute angle and with the wrist approximately at a right angle. The results of our study have important implications for correct orientations of bones in reconstructions and skeletal mounts. Here, we provide recommendations on bone orientations based on our results.

Laboratory investigation of shale rock to identify fracture propagation in vertical direction to bedding

NASA Astrophysics Data System (ADS)

Peng, Tan; Yan, Jin; Bing, Hou; Yingcao, Zhou; Ruxin, Zhang; Zhi, Chang; Meng, Fan

2018-06-01

Affected by beddings and natural fractures, fracture geometry in the vertical plane is complex in shale formation, which differs from a simple fracture in homogeneous sandstone reservoirs. However, the propagation mechanism of a hydraulic fracture in the vertical plane has not been well understood. In this paper, a true tri-axial pressure machine was deployed for shale horizontal well fracturing simulation experiments of shale outcrops. The effects of multiple factors on hydraulic fracture vertical propagation were studied. The results revealed that hydraulic fracture initiation and propagation displayed four basic patterns in the vertical plane of laminated shale formation. A hydraulic fracture would cross the beddings under the high vertical stress difference between a vertical stress and horizontal minimum stress of 12 MPa, while a hydraulic fracture propagates along the beddings under a low vertical stress difference of 3 MPa. Four kinds of fracture geometry, including a single main fracture, a nonplanar fracture, a complex fracture, and a complex fracture network, were observed due to the combined effects of flow rate and viscosity. Due to the influence of binding strength (or cementing strength) on the fracture communication effects between a hydraulic fracture and the beddings, the opening region of the beddings takes the shape of an ellipse.

Comparison of temporal bone fractures in children and adults.

PubMed

Kang, Ho Min; Kim, Myung Gu; Hong, Seok Min; Lee, Ho Yun; Kim, Tae Hyun; Yeo, Seung Geun

2013-05-01

Contrary to our expectation, that the clinical characteristics of temporal bone fracture would differ in children and adults, we found that the two groups were similar. Most studies of temporal bone fractures have been performed in adults. To our knowledge, no study has investigated differences in temporal bone fractures in children and adults. We therefore investigated differences in temporal bone fractures in adults and children by examining the manifestations and clinical symptoms of temporal bone fractures in pediatric patients. The demographic and clinical characteristics were assessed in 32 children and 186 adults with temporal bone fractures. All patients underwent computed tomography of the temporal bone. Causes of fracture, gender distribution, manifestations of temporal bone fracture, and clinical symptoms were similar in adults and children (p > 0.05 each). Petrous fracture, ear fullness, dizziness, and tinnitus were significantly more frequent in adults than in children (p < 0.05 each).

Fracture Toughness of Polypropylene-Based Particulate Composites

PubMed Central

Arencón, David; Velasco, José Ignacio

2009-01-01

The fracture behaviour of polymers is strongly affected by the addition of rigid particles. Several features of the particles have a decisive influence on the values of the fracture toughness: shape and size, chemical nature, surface nature, concentration by volume, and orientation. Among those of thermoplastic matrix, polypropylene (PP) composites are the most industrially employed for many different application fields. Here, a review on the fracture behaviour of PP-based particulate composites is carried out, considering the basic topics and experimental techniques of Fracture Mechanics, the mechanisms of deformation and fracture, and values of fracture toughness for different PP composites prepared with different particle scale size, either micrometric or nanometric.

Effects of scapula-upward taping using kinesiology tape in a patient with shoulder pain caused by scapular downward rotation

PubMed Central

Kim, Byeong-Jo; Lee, Jung-Hoon

2015-01-01

[Purpose] The aim of this study was to evaluate the effects of scapula-upward taping (SUT) in a patient with shoulder pain caused by scapular downward rotation (SDR). [Subject] A 26-year-old male with SDR experienced severe pain in the left shoulder when he lifted his left upper extremity to hold the handle in a bus and during and after push-up exercise. [Methods] The patient underwent SUT for a period of 1 month, 5 times per week, for an average of 9 h/d. [Results] The patient’s radiographs showed that the degree of SDR had decreased; the left shoulder pain also decreased in the resting state and during and after push-up exercise. The manual muscle strength test grades of the upper trapezius, lower trapezius, and serratus anterior had increased. The patient was able to lift the left upper extremity to hold the handle in a bus and perform the push-up exercise without experiencing any pain. [Conclusion] Repeated SUT application may be a beneficial treatment method for alleviating the degree of SDR and shoulder pain in SDR patients. PMID:25729213

Treatment of war injuries of the shoulder with external fixators.

PubMed

Davila, Slavko; Mikulić, Danko; Davila, Neda Jarza; Popović, Ljiljana; Zupancić, Bozidar

2005-05-01

In this retrospective study, 18 patients with war injuries of the shoulder were reviewed to evaluate the technical problems associated with external fixation and to analyze the incidence of infection and late functional results. The average patient age was 28.5 years. All patients were male. Thirteen patients had explosive wounds, whereas five wounds were caused by gunshot missiles. All injuries were extensive in terms of bone and soft tissue defects. Six patients presented with complex injuries involving neurovascular structures. Sixteen patients were treated with external fixation. Application of the proximal pins of the external fixator through the humeral head was possible in eight patients, the scapula served as the site of proximal fixation in four patients, only the clavicle was available for placement of pins in two patients, and both the scapula and the clavicle had to be pinned to achieve proximal stabilization in two patients. In two patients, fixation was not possible and early amputation was performed. Infection was eventually eradicated in all patients, allowing for adequate soft tissue coverage of the wounds. Analysis of functional results at an average of 6 years after the injury showed a considerable degree of functional deficit in most patients.

Study of the trapezius muscle region pressure pain threshold and latency time in young people with and without depressed scapula.

PubMed

Lee, Kuan-Ting; Chuang, Chiung-Cheng; Lai, Chien-Hung; Ye, Jing-Jhao; Wu, Chien-Lung

2015-02-01

The scapula is stabilized in or moved to a certain position to coordinate shoulder function and achieve shoulder and arm movement during the athletic and daily activities. An alteration in the scapular position both at rest and during arm movements is commonly associated with shoulder injury or dysfunction. The purpose of this study was to assess the influence of the depressed scapular position using pressure pain threshold (PPT) and delayed muscle activation of the upper and middle trapezius muscles. The study included 20 subjects who were divided into normal shoulder (n = 12) and depressed shoulder (n = 8) group. PPT was measured in a relaxed position. Muscle activity was recorded using surface electromyography and by calculating each shrug's muscle latency time (MLT). The results revealed that the healthy young subjects with depressed scapular position had significantly lower PPT levels than those with normal scapular position both in the upper and middle trapezius muscle (P < 0.05). MLT of the upper trapezius was significantly delayed in both sides during the shoulder shrugs (P < 0.05). Copyright © 2014 Elsevier Ltd. All rights reserved.

Establishment of a Method to Measure Length of the Ulnar Nerve and Standardize F-wave Values in Clinically Normal Beagles

PubMed Central

HIRASAWA, Shun; SHIMIZU, Miki; MARUI, Yuumi; KISHIMOTO, Miori; OKUNO, Seiichi

2014-01-01

We designed a new method of measuring the length of the ulnar nerve and determining standard values for F-wave parameters of the ulnar nerve in clinically normal beagles. Nerve length must be precisely measured to determine F-wave latency and conduction velocity. The length of the forelimb has served as the length of the ulnar nerve for F-wave assessments, but report indicates that F-wave latency is proportional to the length of the pathway traveled by nerve impulses. Therefore, we measured the surface distance from a stimulus point to the spinous process of the first thoracic vertebra (nerve length 1) and the anterior horn of the scapula (nerve length 2) as landmarks through the olecranon and the shoulder blade acromion. The correlation coefficients between the shortest F-wave latency and the length of nerves 1, 2 or the forelimb were 0.61, 0.7 and 0.58. Nerve length 2 generated the highest value. Furthermore, the anterior horn of the scapula was easily palpated in any dog regardless of well-fed body. We concluded that nerve length 2 was optimal for measuring the length of the ulnar nerve. PMID:25649942

Sex determination from scapular length measurements by CT scans images in a Caucasian population.

PubMed

Giurazza, F; Schena, E; Del Vescovo, R; Cazzato, R L; Mortato, L; Saccomandi, P; Paternostro, F; Onofri, L; Zobel, B Beomonte

2013-01-01

Together with race, stature and age, sex is a main component of the biological identity. Thanks to its proportional correlation with parts of the human body, sex can be evaluated form the skeleton. The most accurate approach to determine sex by bone size is based on os coxae or skull. After natural disaster their presence can never be guaranteed, therefore the development of methods of sex determination using other skeletal elements can result crucial. Herein, sexual dimorphism in the human scapula is used to develop a two-variable discriminant function for sex estimation. We have enrolled 100 males and 100 females who underwent thoracic CT scan evaluation and we have estimated two scapular diameters. The estimation has been carried out by analyzing images of the scapulae of each patient after three dimensional post-processing reconstructions. The two-variable function allows to obtain an overall accuracy of 88% on the calibration sample. Furthermore, we have employed the mentioned function on a collection of 10 individual test sample from the collection of the "Museo di Anatomia Umana di Firenze" of the Università degli Studi di Firenze; sex has been correctly predicted on 9 skeletons.

X-cephalometric study of different parts of the upper airway space and changes in hyoid position following mandibular fractures.

PubMed

Chen, L-J; Zhao, M-C; Pan, X-F; Wei, Y-Q; Wang, D-Y

2013-09-01

This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function of patients. Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.

Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures.

PubMed

Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart

2013-01-01

Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age <75 years and male sex were risk factors for subsequent fracture. This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all patients with hip fracture, with or without subsequent fractures, need the same robust holistic care. The risks of subsequent fractures should be addressed in patients with hip fracture and should be reduced where possible by education regarding fracture prevention and regular rehabilitation programs. Efforts should be made to decrease the rates of major long-bone fractures and their burdens, even though such fractures have only a minor effect on survival in community-dwelling individuals.

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

Initiation and propagation of mixed mode fractures in granite and sandstone

NASA Astrophysics Data System (ADS)

Rück, Marc; Rahner, Roman; Sone, Hiroki; Dresen, Georg

2017-10-01

We investigate mixed mode fracture initiation and propagation in experimentally deformed granite and sandstone. We performed a series of asymmetric loading tests to induce fractures in cylindrical specimens at confining pressures up to 20 MPa. Loading was controlled using acoustic emission (AE) feedback control, which allows studying quasi-static fracture propagation for several hours. Location of acoustic emissions reveals distinct differences in spatial-temporal fracture evolution between granite and sandstone samples. Before reaching peak stress in experiments performed on granite, axial fractures initiate first at the edge of the indenter and then propagate through the entire sample. Secondary inclined fractures develop during softening of the sample. In sandstone, inclined shear fractures nucleate at peak stress and propagate through the specimen. AE source type analysis shows complex fracturing in both materials with pore collapse contributing significantly to fracture growth in sandstone samples. We compare the experimental results with numerical models to analyze stress distribution and energy release rate per unit crack surface area in the samples at different stages during fracture growth. We thereby show that for both rock types the energy release rate increases approximately linearly during fracture propagation. The study illuminates how different material properties modify fracture initiation direction under similar loading conditions.

Effect of Random Natural Fractures on Hydraulic Fracture Propagation Geometry in Fractured Carbonate Rocks

NASA Astrophysics Data System (ADS)

Liu, Zhiyuan; Wang, Shijie; Zhao, Haiyang; Wang, Lei; Li, Wei; Geng, Yudi; Tao, Shan; Zhang, Guangqing; Chen, Mian

2018-02-01

Natural fractures have a significant influence on the propagation geometry of hydraulic fractures in fractured reservoirs. True triaxial volumetric fracturing experiments, in which random natural fractures are created by placing cement blocks of different dimensions in a cuboid mold and filling the mold with additional cement to create the final test specimen, were used to study the factors that influence the hydraulic fracture propagation geometry. These factors include the presence of natural fractures around the wellbore, the dimension and volumetric density of random natural fractures and the horizontal differential stress. The results show that volumetric fractures preferentially formed when natural fractures occurred around the wellbore, the natural fractures are medium to long and have a volumetric density of 6-9%, and the stress difference is less than 11 MPa. The volumetric fracture geometries are mainly major multi-branch fractures with fracture networks or major multi-branch fractures (2-4 fractures). The angles between the major fractures and the maximum horizontal in situ stress are 30°-45°, and fracture networks are located at the intersections of major multi-branch fractures. Short natural fractures rarely led to the formation of fracture networks. Thus, the interaction between hydraulic fractures and short natural fractures has little engineering significance. The conclusions are important for field applications and for gaining a deeper understanding of the formation process of volumetric fractures.

Rib Fracture Diagnosis in the Panscan Era.

PubMed

Murphy, Charles E; Raja, Ali S; Baumann, Brigitte M; Medak, Anthony J; Langdorf, Mark I; Nishijima, Daniel K; Hendey, Gregory W; Mower, William R; Rodriguez, Robert M

2017-12-01

With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). Under trauma imaging protocols that commonly incorporate chest CT, two thirds of rib fractures were observed on chest CT only. Patients with rib fractures had higher admission rates and mortality than those without rib fractures. First or second rib fractures were associated with significantly higher mortality and great vessel injury. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Biomechanical analysis of the circular friction hand massage.

PubMed

Ryu, Jeseong; Son, Jongsang; Ahn, Soonjae; Shin, Isu; Kim, Youngho

2015-01-01

A massage can be beneficial to relieve muscle tension on the neck and shoulder area. Various massage systems have been developed, but their motions are not uniform throughout different body parts nor specifically targeted to the neck and shoulder areas. Pressure pattern and finger movement trajectories of the circular friction hand massage on trapezius, levator scapulae, and deltoid muscles were determined to develop a massage system that can mimic the motion and the pressure of the circular friction massage. During the massage, finger movement trajectories were measured using a 3D motion capture system, and finger pressures were simultaneously obtained using a grip pressure sensor. Results showed that each muscle had different finger movement trajectory and pressure pattern. The trapezius muscle experienced a higher pressure, longer massage time (duration of pressurization), and larger pressure-time integral than the other muscles. These results could be useful to design a better massage system simulating human finger movements.

The impact of computer display height and desk design on 3D posture during information technology work by young adults.

PubMed

Straker, L; Burgess-Limerick, R; Pollock, C; Murray, K; Netto, K; Coleman, J; Skoss, R

2008-04-01

Computer display height and desk design to allow forearm support are two critical design features of workstations for information technology tasks. However there is currently no 3D description of head and neck posture with different computer display heights and no direct comparison to paper based information technology tasks. There is also inconsistent evidence on the effect of forearm support on posture and no evidence on whether these features interact. This study compared the 3D head, neck and upper limb postures of 18 male and 18 female young adults whilst working with different display and desk design conditions. There was no substantial interaction between display height and desk design. Lower display heights increased head and neck flexion with more spinal asymmetry when working with paper. The curved desk, designed to provide forearm support, increased scapula elevation/protraction and shoulder flexion/abduction.

Investigation of a relationship between external force to shoulder and chest injury of WorldSID and THUMS in 32 km/h oblique pole side impact.

PubMed

Tanaka, Shinobu; Hayashi, Shigeki; Fukushima, Satoshi; Yasuki, Tsuyoshi

2013-01-01

This article describes the chest injury risk reduction effect of shoulder restraints using finite element (FE) models of the worldwide harmonized side impact dummy (WorldSID) and Total Human Model for Safety (THUMS) in an FE model 32 km/h oblique pole side impact. This research used an FE model of a mid-sized vehicle equipped with various combinations of curtain shield air bags, torso air bags, and shoulder restraint air bags. As occupant models, AM50 WorldSID and THUMS AM50 Version 4 were used for comparison. The research investigated the effect of shoulder restraint air bag on chest injury by comparing cases with and without a shoulder side air bag. The maximum external force to the chest was reduced by shoulder restraint air bag in both WorldSID and THUMS, reducing chest injury risk as measured by the amount of rib deflection, number of the rib fractures, and rib deflection ratio. However, it was also determined that the external force to shoulder should be limited to the chest injury threshold because the external shoulder force transmits to the chest via the arm in the case of WorldSID and via the scapula in the case of THUMS. Because these results show the shoulder restraint air bag effect on chest injury risk, the vent hole size of the shoulder restraint air bag was changed for varying reaction forces to investigate the relationship between the external force to the shoulder and the risk of chest injury. In the case of THUMS, an external shoulder force of 1.8 kN and more force from the shoulder restraint air bag was necessary to help prevent rib fracture. Increasing external force applied to shoulder up to 6.2 kN (the maximum force used in this study) did not induce any rib or clavicle fractures in the THUMS. When the shoulder restraint air bag generated external force to the shoulder from 1.8 to 6.2 kN in THUMS, which were applied to the WorldSID, the shoulder deflection ranged from 35 to 68 mm, and the shoulder force ranged from 1.8 to 2.3 kN. In the test configuration used, a shoulder restraint using the air bag helps reduce chest injury risk by lowering the maximum magnitude of external force to the shoulder and chest. To help reduce rib fracture risk in the THUMS, the shoulder restraint air bag was expected to generate a force of 3.7 kN with a minimum rib deflection ratio. This corresponds to a shoulder rib deflection of 60 mm and a shoulder load of 2.2 kN in WorldSID. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Determination of Fracture Patterns in Glass and Glassy Polymers.

PubMed

Baca, Allison C; Thornton, John I; Tulleners, Frederic A

2016-01-01

The study of fractures of glass, glassy-type materials, and plastic has long been of interest to the forensic community. The focus of this interest has been the use of glass and polymer fractures to associate items of evidence under the assumption that each fracture is different. Generally, it is well-accepted that deviations exist; however, the emphasis has been on classifying and predicting fracture rather than determining that each fracture is different. This study documented the controlled fracture patterns of 60 glass panes, 60 glass bottles, and 60 plastic tail light lens covers using both dynamic impact and static pressure methods under closely controlled conditions. Each pattern was intercompared, and based on the limited specimens tested in this study, the results illustrate that the fracture patterns are different. Further repetitive studies, under controlled conditions, will be needed to provide more statistical significance to the theory that each fracture forms a nonreproducible fracture pattern. © 2015 American Academy of Forensic Sciences.

Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions.

PubMed

Lee, Ellen L; Craig, Matthew; Scarboro, Mark

2015-01-01

The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors. Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively. There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted). Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed and symmetric across the thorax compared to belted occupants in crashes with a deployed frontal airbag. Other factors, such as occupant kinematics and occupant age, also produced differing patterns of fractures. Normative data on rib fracture patterns in real-world occupants can contribute to understanding injury mechanisms and the role of different causation factors, which can ultimately help prevent fractures and improve vehicle safety.

Experimental Investigation on the Basic Law of Directional Hydraulic Fracturing Controlled by Dense Linear Multi-Hole Drilling

NASA Astrophysics Data System (ADS)

Zhao, Xinglong; Huang, Bingxiang; Wang, Zhen

2018-06-01

Directional rupture is a significant and routine problem for ground control in mines. Directional hydraulic fracturing controlled by dense linear multi-hole drilling was proposed. The physical model experiment, performed by the large-scale true triaxial hydraulic fracturing experimental system, aims to investigate the basic law of directional hydraulic fracturing controlled by dense linear multi-hole drilling, the impact of three different pumping modes on the initiation and propagation of hydraulic fractures among boreholes are particular investigated. The experimental results indicated that there are mutual impacts among different boreholes during crack propagation, which leads to a trend of fracture connection. Furthermore, during propagation, the fractures not only exhibit an overall bias toward the direction in which the boreholes are scattered but also partially offset against the borehole axes and intersect. The directional fracturing effect of equivalent pumping rate in each borehole is better than the other two pumping modes. In practical applications, because of rock mass heterogeneity, there may be differences in terms of filtration rate and effective input volume in different boreholes; thus, water pressure increase and rupture are not simultaneous in different boreholes. Additionally, if the crack initiation directions of different boreholes at different times are not consistent with each other, more lamellar failure planes will occur, and the mutual influences of these lamellar failure planes cause fractures to extend and intersect.

Radionuclide Gas Transport through Nuclear Explosion-Generated Fracture Networks

PubMed Central

Jordan, Amy B.; Stauffer, Philip H.; Knight, Earl E.; Rougier, Esteban; Anderson, Dale N.

2015-01-01

Underground nuclear weapon testing produces radionuclide gases which may seep to the surface. Barometric pumping of gas through explosion-fractured rock is investigated using a new sequentially-coupled hydrodynamic rock damage/gas transport model. Fracture networks are produced for two rock types (granite and tuff) and three depths of burial. The fracture networks are integrated into a flow and transport numerical model driven by surface pressure signals of differing amplitude and variability. There are major differences between predictions using a realistic fracture network and prior results that used a simplified geometry. Matrix porosity and maximum fracture aperture have the greatest impact on gas breakthrough time and window of opportunity for detection, with different effects between granite and tuff simulations highlighting the importance of accurately simulating the fracture network. In particular, maximum fracture aperture has an opposite effect on tuff and granite, due to different damage patterns and their effect on the barometric pumping process. From stochastic simulations using randomly generated hydrogeologic parameters, normalized detection curves are presented to show differences in optimal sampling time for granite and tuff simulations. Seasonal and location-based effects on breakthrough, which occur due to differences in barometric forcing, are stronger where the barometric signal is highly variable. PMID:26676058

Radionuclide Gas Transport through Nuclear Explosion-Generated Fracture Networks.

PubMed

Jordan, Amy B; Stauffer, Philip H; Knight, Earl E; Rougier, Esteban; Anderson, Dale N

2015-12-17

Underground nuclear weapon testing produces radionuclide gases which may seep to the surface. Barometric pumping of gas through explosion-fractured rock is investigated using a new sequentially-coupled hydrodynamic rock damage/gas transport model. Fracture networks are produced for two rock types (granite and tuff) and three depths of burial. The fracture networks are integrated into a flow and transport numerical model driven by surface pressure signals of differing amplitude and variability. There are major differences between predictions using a realistic fracture network and prior results that used a simplified geometry. Matrix porosity and maximum fracture aperture have the greatest impact on gas breakthrough time and window of opportunity for detection, with different effects between granite and tuff simulations highlighting the importance of accurately simulating the fracture network. In particular, maximum fracture aperture has an opposite effect on tuff and granite, due to different damage patterns and their effect on the barometric pumping process. From stochastic simulations using randomly generated hydrogeologic parameters, normalized detection curves are presented to show differences in optimal sampling time for granite and tuff simulations. Seasonal and location-based effects on breakthrough, which occur due to differences in barometric forcing, are stronger where the barometric signal is highly variable.

Modeling of the Non-Auditory Response to Blast Overpressure. Calculation of the Internal Mechanical Response of Sheep to Blast Loading

DTIC Science & Technology

1990-01-01

through the esophagus into the left lung lobe and fially to the left rib surface. Spinal Process of Sixth Vertebra Seventh Vertebra Scapula Esophagus...for the calculations are as follows: 2.54 cm 12.7 cm 2.64 cm ’ J End Plate + Transducer Plexiglas (hard) or_ Closed-Cell Neoprene (soft) Figure 4

[Arthroscopic excision of elastofibroma dorsi at scapulothoracic joint: a surgical technique].

PubMed

Çakmak, Gökhan; Ergün, Tarkan; Şahin, M Şükrü

2014-01-01

Elastofibroma dorsi is a rare soft tissue pseudotumor which is located at the anteroinferior aspect of the scapula. In this article, we report a 19-year-old female case who had arthroscopic marginal excision of elastofibroma dorsi at the scapulothoracic joint without recurrences during follow-up. The arthroscopic marginal excision of the elastofibroma dorsi may have good clinical results in selected cases.

Developing bones are differentially affected by compromised skeletal muscle formation

PubMed Central

Nowlan, Niamh C.; Bourdon, Céline; Dumas, Gérard; Tajbakhsh, Shahragim; Prendergast, Patrick J.; Murphy, Paula

2010-01-01

Mechanical forces are essential for normal adult bone function and repair, but the impact of prenatal muscle contractions on bone development remains to be explored in depth in mammalian model systems. In this study, we analyze skeletogenesis in two ‘muscleless’ mouse mutant models in which the formation of skeletal muscle development is disrupted; Myf5nlacZ/nlacZ:MyoD−/− and Pax3Sp/Sp (Splotch). Ossification centers were found to be differentially affected in the muscleless limbs, with significant decreases in bone formation in the scapula, humerus, ulna and femur, but not in the tibia. In the scapula and humerus, the morphologies of ossification centers were abnormal in muscleless limbs. Histology of the humerus revealed a decreased extent of the hypertrophic zone in mutant limbs but no change in the shape of this region. The elbow joint was also found to be clearly affected with a dramatic reduction in the joint line, while no abnormalities were evident in the knee. The humeral deltoid tuberosity was significantly reduced in size in the Myf5nlacZ/nlacZ:MyoD−/− mutants while a change in shape but not in size was found in the humeral tuberosities of the Pax3Sp/Sp mutants. We also examined skeletal development in a ‘reduced muscle’ model, the Myf5nlacZ/+:MyoD−/− mutant, in which skeletal muscle forms but with reduced muscle mass. The reduced muscle phenotype appeared to have an intermediate effect on skeletal development, with reduced bone formation in the scapula and humerus compared to controls, but not in other rudiments. In summary, we have demonstrated that skeletal development is differentially affected by the lack of skeletal muscle, with certain rudiments and joints being more severely affected than others. These findings indicate that the response of skeletal progenitor cells to biophysical stimuli may depend upon their location in the embryonic limb, implying a complex interaction between mechanical forces and location-specific regulatory factors affecting bone and joint development. PMID:19948261

The cat vertebral column: stance configuration and range of motion

NASA Technical Reports Server (NTRS)

Macpherson, J. M.; Ye, Y.; Peterson, B. W. (Principal Investigator)

1998-01-01

This study examined the configuration of the vertebral column of the cat during independent stance and in various flexed positions. The range of motion in the sagittal plane is similar across most thoracic and lumbar joints, with the exception of a lesser range at the transition region from thoracic-type to lumbar-type vertebrae. The upper thoracic column exhibits most of its range in dorsiflexion and the lower thoracic and lumbar in ventroflexion. Lateral flexion is limited to less than 5 degrees at all segments. The range in torsion is almost 180 degrees and occurs primarily in the midthoracic region, T4-T11. Contrary to the depiction in most atlases, the standing cat exhibits several curvatures, including a mild dorsiflexion in the lower lumbar segments, a marked ventroflexion in the lower thoracic and upper lumbar segments, and a profound dorsiflexion in the upper thoracic (above T9) and cervical segments. The curvatures are not significantly changed by altering stance distance but are affected by head posture. During stance, the top of the scapula lies well above the spines of the thoracic vertebrae, and the glenohumeral joint is just below the bodies of vertebrae T3-T5. Using a simple static model of the vertebral column in the sagittal plane, it was estimated that the bending moment due to gravity is bimodal with a dorsiflexion moment in the lower thoracic and lumbar region and a ventroflexion moment in the upper thoracic and cervical region. Given the bending moments and the position of the scapula during stance, it is proposed that two groups of scapular muscles provide the major antigravity support for the head and anterior trunk. Levator scapulae and serratus ventralis form the lateral group, inserting on the lateral processes of cervical vertebrae and on the ribs. The major and minor rhomboids form the medial group, inserting on the spinous tips of vertebrae from C4 to T4. It is also proposed that the hypaxial muscles, psoas major, minor, and quadratus lumborum could support the lumbar trunk during stance.

The Shear Mechanisms of Natural Fractures during the Hydraulic Stimulation of Shale Gas Reservoirs.

PubMed

Zhang, Zhaobin; Li, Xiao

2016-08-23

The shearing of natural fractures is important in the permeability enhancement of shale gas reservoirs during hydraulic fracturing treatment. In this work, the shearing mechanisms of natural fractures are analyzed using a newly proposed numerical model based on the displacement discontinuities method. The fluid-rock coupling system of the model is carefully designed to calculate the shearing of fractures. Both a single fracture and a complex fracture network are used to investigate the shear mechanisms. The investigation based on a single fracture shows that the non-ignorable shearing length of a natural fracture could be formed before the natural fracture is filled by pressurized fluid. Therefore, for the hydraulic fracturing treatment of the naturally fractured shale gas reservoirs, the shear strength of shale is generally more important than the tensile strength. The fluid-rock coupling propagation processes of a complex fracture network are simulated under different crustal stress conditions and the results agree well with those of the single fracture. The propagation processes of complex fracture network show that a smaller crustal stress difference is unfavorable to the shearing of natural fractures, but is favorable to the formation of complex fracture network.

The Shear Mechanisms of Natural Fractures during the Hydraulic Stimulation of Shale Gas Reservoirs

PubMed Central

Zhang, Zhaobin; Li, Xiao

2016-01-01

The shearing of natural fractures is important in the permeability enhancement of shale gas reservoirs during hydraulic fracturing treatment. In this work, the shearing mechanisms of natural fractures are analyzed using a newly proposed numerical model based on the displacement discontinuities method. The fluid-rock coupling system of the model is carefully designed to calculate the shearing of fractures. Both a single fracture and a complex fracture network are used to investigate the shear mechanisms. The investigation based on a single fracture shows that the non-ignorable shearing length of a natural fracture could be formed before the natural fracture is filled by pressurized fluid. Therefore, for the hydraulic fracturing treatment of the naturally fractured shale gas reservoirs, the shear strength of shale is generally more important than the tensile strength. The fluid-rock coupling propagation processes of a complex fracture network are simulated under different crustal stress conditions and the results agree well with those of the single fracture. The propagation processes of complex fracture network show that a smaller crustal stress difference is unfavorable to the shearing of natural fractures, but is favorable to the formation of complex fracture network. PMID:28773834

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.

Differences in standing and sitting postures of youth with idiopathic scoliosis from quantitative analysis of digital photographs.

PubMed

Fortin, Carole; Ehrmann Feldman, Debbie; Cheriet, Farida; Labelle, Hubert

2013-08-01

The objective of this study was to explore whether differences in standing and sitting postures of youth with idiopathic scoliosis could be detected from quantitative analysis of digital photographs. Standing and sitting postures of 50 participants aged 10-20-years-old with idiopathic scoliosis (Cobb angle: 15° to 60°) were assessed from digital photographs using a posture evaluation software program. Based on the XY coordinates of markers, 13 angular and linear posture indices were calculated in both positions. Paired t-tests were used to compare values of standing and sitting posture indices. Significant differences between standing and sitting positions (p < 0.05) were found for head protraction, shoulder elevation, scapula asymmetry, trunk list, scoliosis angle, waist angles, and frontal and sagittal plane pelvic tilt. Quantitative analysis of digital photographs is a clinically feasible method to measure standing and sitting postures among youth with scoliosis and to assist in decisions on therapeutic interventions.

Geographic differences in fractures among women

PubMed Central

Litwic, Anna; Edwards, Mark; Cooper, Cyrus; Dennison, Elaine

2013-01-01

Osteoporotic fracture is associated with considerable morbidity and mortality in women throughout the world. However, significant variation in hip fracture rates among women from different nations have been observed, and are likely to represent a combination of real and apparent differences due to ascertainment bias. Higher rates are observed in Caucasian women, with lowest rates observed in black women and intermediate rates among Asian women. These differences are likely to represent a combination of genetic and environmental differences; for example, among European women, the highest fracture rates are observed in Scandinavian women where vitamin D insufficiency is common. In all groups, an expansion in absolute fracture numbers is anticipated due to demographic changes. PMID:23181532

Management of civilian ballistic fractures.

PubMed

Seng, V S; Masquelet, A C

2013-12-01

The management of ballistic fractures, which are open fractures, has often been studied in wartime and has benefited from the principles of military surgery with debridement and lavage, and the use of external fixation for bone stabilization. In civilian practice, bone stabilization of these fractures is different and is not performed by external fixation. Fifteen civilian ballistic fractures, Gustilo II or IIIa, two associated with nerve damage and none with vascular damage, were reviewed. After debridement and lavage, ten internal fixations and five conservative treatments were used. No superficial or deep surgical site infection was noted. Fourteen of the 15 fractures (93%) healed without reoperation. Eleven of the 15 patients (73%) regained normal function. Ballistic fractures have a bad reputation due to their many complications, including infections. In civilian practice, the use of internal fixation is not responsible for excessive morbidity, provided debridement and lavage are performed. Civilian ballistic fractures, when they are caused by low-velocity firearms, differ from military ballistic fractures. Although the principle of surgical debridement and lavage remains the same, bone stabilization is different and is similar to conventional open fractures. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Fracture of ECAP-deformed iron and the role of extrinsic toughening mechanisms

PubMed Central

Hohenwarter, A.; Pippan, R.

2013-01-01

The fracture behaviour of pure iron deformed by equal-channel angular pressing via route A was examined. The fracture toughness was determined for different specimen orientations and measured in terms of the critical plane strain fracture toughness, KIC, the critical J integral, JIC, and the crack opening displacement for crack initiation, CODi. The results demonstrate that the crack plane orientation has a pronounced effect on the fracture toughness. Different crack plane orientations lead to either crack deflection or delamination, resulting in increased fracture resistance in comparison to one remarkably weak specimen orientation. The relation between the microstructure typical for the applied deformation route and the enormous differences in the fracture toughness depending on the crack plane orientation will be analyzed in this paper. PMID:23645995

Comparison of tibial shaft ski fractures in children and adults.

PubMed

Hamada, Tomo; Matsumoto, Kazu; Ishimaru, Daichi; Sumi, Hiroshi; Shimizu, Katsuji

2014-09-01

To examine whether child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures. Descriptive epidemiological study. Prospectively analyzed the epidemiologic factors, injury types, and injury mechanisms at Sumi Memorial Hospital. This study analyzed information obtained from 276 patients with tibial fractures sustained during skiing between 2004 and 2012. We focused on 174 ski-related tibial shaft fractures with respect to the following factors: age, gender, laterality of fracture, skill level, mechanism of fracture (fall vs collision), scene of injury (steepness of slope), snow condition, and weather. Fracture pattern was graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and mechanical direction [external (ER) or internal rotation (IR)]. Tibial shaft fractures were the most common in both children (89.3%) and adults (47.4%). There were no significant differences in gender, side of fracture, mechanism of fracture, snow condition, or weather between children and adults. Skill levels were significantly lower in children than in adults (P < 0.0001). Type A fractures were more dominant in children (73 cases, 72.3%) than in adults (39 cases, 53.4%). There was significantly more ER in children than in adults (P < 0.0001). Among children, female patients had significantly more IR than ER; in contrast, among adults, women were injured by ER. We found significant differences in some of these parameters, suggesting that child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures.

Fundamental differences in axial and appendicular bone density in stress fractured and uninjured Royal Marine recruits--a matched case-control study.

PubMed

Davey, Trish; Lanham-New, Susan A; Shaw, Anneliese M; Cobley, Rosalyn; Allsopp, Adrian J; Hajjawi, Mark O R; Arnett, Timothy R; Taylor, Pat; Cooper, Cyrus; Fallowfield, Joanne L

2015-04-01

Stress fracture is a common overuse injury within military training, resulting in significant economic losses to the military worldwide. Studies to date have failed to fully identify the bone density and bone structural differences between stress fractured personnel and controls due to inadequate adjustment for key confounding factors; namely age, body size and physical fitness; and poor sample size. The aim of this study was to investigate bone differences between male Royal Marine recruits who suffered a stress fracture during the 32 weeks of training and uninjured control recruits, matched for age, body weight, height and aerobic fitness. A total of 1090 recruits were followed through training and 78 recruits suffered at least one stress fracture. Bone mineral density (BMD) was measured at the lumbar spine (LS), femoral neck (FN) and whole body (WB) using Dual X-ray Absorptiometry in 62 matched pairs; tibial bone parameters were measured using peripheral Quantitative Computer Tomography in 51 matched pairs. Serum C-terminal peptide concentration was measured as a marker of bone resorption at baseline, week-15 and week-32. ANCOVA was used to determine differences between stress fractured recruits and controls. BMD at the LS, WB and FN sites was consistently lower in the stress fracture group (P<0.001). Structural differences between the stress fracture recruits and controls were evident in all slices of the tibia, with the most prominent differences seen at the 38% tibial slice. There was a negative correlation between the bone cross-sectional area and BMD at the 38% tibial slice. There was no difference in serum CTx concentration between stress fracture recruits and matched controls at any stage of training. These results show evidence of fundamental differences in bone mass and structure in stress fracture recruits, and provide useful data on bone risk factor profiles for stress fracture within a healthy military population. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Microseismic Velocity Imaging of the Fracturing Zone

NASA Astrophysics Data System (ADS)

Zhang, H.; Chen, Y.

2015-12-01

Hydraulic fracturing of low permeability reservoirs can induce microseismic events during fracture development. For this reason, microseismic monitoring using sensors on surface or in borehole have been widely used to delineate fracture spatial distribution and to understand fracturing mechanisms. It is often the case that the stimulated reservoir volume (SRV) is determined solely based on microseismic locations. However, it is known that for some fracture development stage, long period long duration events, instead of microseismic events may be associated. In addition, because microseismic events are essentially weak and there exist different sources of noise during monitoring, some microseismic events could not be detected and thus located. Therefore the estimation of the SRV is biased if it is solely determined by microseismic locations. With the existence of fluids and fractures, the seismic velocity of reservoir layers will be decreased. Based on this fact, we have developed a near real time seismic velocity tomography method to characterize velocity changes associated with fracturing process. The method is based on double-difference seismic tomography algorithm to image the fracturing zone where microseismic events occur by using differential arrival times from microseismic event pairs. To take into account varying data distribution for different fracking stages, the method solves the velocity model in the wavelet domain so that different scales of model features can be obtained according to different data distribution. We have applied this real time tomography method to both acoustic emission data from lab experiment and microseismic data from a downhole microseismic monitoring project for shale gas hydraulic fracturing treatment. The tomography results from lab data clearly show the velocity changes associated with different rock fracturing stages. For the field data application, it shows that microseismic events are located in low velocity anomalies. By combining low velocity anomalies with microseismic events, we should better estimate the SRV.

Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008–2013) in Kyoto prefecture, Japan

PubMed Central

Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu

2016-01-01

Summary Background The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Methods Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. Results There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had “uncertain” as the cause of injury than trochanteric fracture in all age groups. Conclusions Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures. PMID:27252738

Radionuclide gas transport through nuclear explosion-generated fracture networks

DOE PAGES

Jordan, Amy B.; Stauffer, Philip H.; Knight, Earl E.; ...

2015-12-17

Underground nuclear weapon testing produces radionuclide gases which may seep to the surface. Barometric pumping of gas through explosion-fractured rock is investigated using a new sequentially-coupled hydrodynamic rock damage/gas transport model. Fracture networks are produced for two rock types (granite and tuff) and three depths of burial. The fracture networks are integrated into a flow and transport numerical model driven by surface pressure signals of differing amplitude and variability. There are major differences between predictions using a realistic fracture network and prior results that used a simplified geometry. Matrix porosity and maximum fracture aperture have the greatest impact on gasmore » breakthrough time and window of opportunity for detection, with different effects between granite and tuff simulations highlighting the importance of accurately simulating the fracture network. In particular, maximum fracture aperture has an opposite effect on tuff and granite, due to different damage patterns and their effect on the barometric pumping process. From stochastic simulations using randomly generated hydrogeologic parameters, normalized detection curves are presented to show differences in optimal sampling time for granite and tuff simulations. In conclusion, seasonal and location-based effects on breakthrough, which occur due to differences in barometric forcing, are stronger where the barometric signal is highly variable.« less

Radionuclide gas transport through nuclear explosion-generated fracture networks

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

Jordan, Amy B.; Stauffer, Philip H.; Knight, Earl E.

Underground nuclear weapon testing produces radionuclide gases which may seep to the surface. Barometric pumping of gas through explosion-fractured rock is investigated using a new sequentially-coupled hydrodynamic rock damage/gas transport model. Fracture networks are produced for two rock types (granite and tuff) and three depths of burial. The fracture networks are integrated into a flow and transport numerical model driven by surface pressure signals of differing amplitude and variability. There are major differences between predictions using a realistic fracture network and prior results that used a simplified geometry. Matrix porosity and maximum fracture aperture have the greatest impact on gasmore » breakthrough time and window of opportunity for detection, with different effects between granite and tuff simulations highlighting the importance of accurately simulating the fracture network. In particular, maximum fracture aperture has an opposite effect on tuff and granite, due to different damage patterns and their effect on the barometric pumping process. From stochastic simulations using randomly generated hydrogeologic parameters, normalized detection curves are presented to show differences in optimal sampling time for granite and tuff simulations. In conclusion, seasonal and location-based effects on breakthrough, which occur due to differences in barometric forcing, are stronger where the barometric signal is highly variable.« less

Determining when a fracture occurred: Does the method matter? Analysis of the similarity of three different methods for estimating time since fracture of juvenile long bones.

PubMed

Drury, Anne; Cunningham, Craig

2018-01-01

Radiographic fracture date estimation is a critical component of skeletal trauma analysis in the living. Several timetables have been proposed for how the appearance of radiographic features can be interpreted to provide a likely time frame for fracture occurrence. This study compares three such timetables for pediatric fractures, by Islam et al. (2000), Malone et al. (2011), and Prosser et al. (2012), in order to determine whether the fracture date ranges produced by using these methods are in agreement with one another. Fracture date ranges were estimated for 112 long bone fractures in 96 children aged 1-17 years, using the three different timetables. The extent of similarity of the intervals was tested by statistically comparing the overlap between the ranges. Results showed that none of the methods were in perfect agreement with one another. Differences seen included the size of the estimated date range for when a fracture occurred, and the specific dates given for both the upper and lower ends of the fracture date range. There was greater similarity between the ranges produced by Malone et al. (2011) and both the other two studies than there was between Islam et al. (2000) and Prosser et al. (2012). The greatest similarity existed between Malone et al. (2011) and Islam et al. (2000). The extent of differences between methods can vary widely, depending on the fracture analysed. Using one timetable gives an average earliest possible fracture date of less than 2 days before another, but the range was extreme, with one method estimating minimum time since fracture as 25 days before another method for a given fracture. In most cases, one method gave maximum time since fracture as a week less than the other two methods, but range was extreme and some estimates were nearly two months different. The variability in fracture date estimates given by these timetables indicates that caution should be exercised when estimating the timing of a juvenile fracture if relying solely on one of the published guides. Future research should be undertaken to compare these methods on a population of known fracture timing, and to better understand the relationship between age of the individual, skeletal health, fracture healing rates, and radiographic characteristics of fracture healing. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Mechanisms of traumatic shoulder injury in elite rugby players.

PubMed

Crichton, James; Jones, Doug R; Funk, Lennard

2012-06-01

Shoulder injuries in rugby players are common, but the mechanisms of injury are less well understood. This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce. Twenty-four elite rugby players, referred to the senior author for diagnosis and management of shoulder injuries, were selected. Videos of the injuries were independently reviewed by rugby-medical experts to describe the mechanisms of injury. The mechanisms reported were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms. The authors identified three mechanisms of shoulder injury from the video analysis. These are the 'Try-Scorer', characterised by hyperflexion of the outstretched arm such as when scoring a try; the 'Tackler', extension of the abducted arm behind the player while tackling; and the 'Direct Impact', a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ). These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and superior labrum anterior-posterior tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause acromioclavicular joint dislocation and scapula fractures, injuries that were not seen with the other mechanisms. Greater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury-prevention methods.

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.

USAFSAM Review and Analysis of Radiofrequency Radiation Bioeffects Literature. Fifth Report.

DTIC Science & Technology

1985-03-01

exteriorized between the scapulae. The tip of the catheter was positioned at the juncture between the superior and inferior venae cavae . With this preparation...other than in connection with a definitely Government-related procure- ment, the United States Government incurs no responsibility or any obligation...Between experimental sessions, Frey and Seifert measured the power density with a quarter-wave dipole connected to a commercial thermistor and power meter

Fitting unanchored puzzle pieces in the skeleton: appropriate 3D scapular positions for the quadrupedal support in tetrapods.

PubMed

Fujiwara, Shin-Ichi

2018-05-01

Deducing the scapular positions of extinct tetrapod skeletons remains difficult, because the scapulae and rib cage are connected with each other not directly by skeletal joint, but by thoracic muscles. In extant non-testudine quadrupedal tetrapods, the top positions of the scapulae/suprascapulae occur at the anterior portion of the rib cage, above the vertebral column and near the median plane. The adequacy of this position was tested using three-dimensional mechanical models of Felis, Rattus and Chamaeleo that assumed stances on a forelimb on a single side and the hindlimbs. The net moment about the acetabulum generated by the gravity force and the contractive forces of the anti-gravity thoracic muscles, and the resistance of the rib to vertical compression between the downward gravity and upward lifting force from the anti-gravity thoracic muscle depend on the scapular position. The scapular position common among quadrupeds corresponds to the place at which the roll and yaw moments of the uplifted portion of the body are negligible, where the pitch moment is large enough to lift the body, and above the ribs having high strength against vertical compression. These relationships between scapular position and rib cage morphology should allow reliable reconstruction of limb postures of extinct taxa. © 2018 Anatomical Society.

The effect of adenotonsillectomy on the position of head, cervical and thoracic spine and scapular girdle of mouth breathing children.

PubMed

Neiva, Patricia Dayrell; Franco, Letícia Paiva; Kirkwood, Renata Noce; Becker, Helena Gonçalves

2018-04-01

The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. Post-adenotonsilectomy postural benefits have not yet been described. To investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing before and after adenotonsillectomy. Forty-nine mouth breathing children (6.3 ± 1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery. The kinematic data were obtained using the system Qualysis ProReflex ® . There was a significant decrease in forward head position, shoulders protrusion, elevation and anterior tilt of the scapula after surgery compared to the pre-operative. One of adenotonsillectomy results is the improvement of the posture of the head and the shoulder girdle of mouth breathing children. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children. Copyright © 2018 Elsevier B.V. All rights reserved.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

PubMed

de Pádua, Michelle; Sauer, Juliana F; João, Silvia M A

2018-01-01

The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment. The sample studied was 74 children of both sexes ages 5 to 12 years. Of these, 34 had visual impairment and 40 were control children. Digital photos from the standing position were used to analyze posture. Postural variables, such as tilt of the head, shoulder position, scapula position, lateral deviation of the spine, ankle position in the frontal plane and head posture, angle of thoracic kyphosis, angle of lumbar lordosis, pelvis position, and knee position in the frontal and sagittal planes, were measured with the Postural Assessment Software 0.63, version 36 (SAPO, São Paulo, Brazil), with markers placed in predetermined bony landmarks. The main results of this study showed that children with visual impairment have increased head tilt (P < .001), shoulder deviation in frontal plane (P = .004), lateral deviation of the spine (P < .001), changes in scapula position (P = .012), higher thoracic kyphosis (P = .004), and lower lumbar lordosis (P < .001). Visual impairment influences postural alignment. Children with visual impairment had increased head tilt, uneven shoulders, greater lateral deviation of the spine, thoracic kyphosis, lower lumbar lordosis, and more severe valgus deformities on knees. Copyright © 2017. Published by Elsevier Inc.

Efficacy and safety of a new coverlet device on skin microclimate management: a pilot study in critical care patients.

PubMed

Forriez, O; Masseline, J; Coadic, D; David, V; Trouiller, P; Sztrymf, B

2017-02-02

To test the effect of a new coverlet device, allowing air circulation at the body/underlying surface interface, on skin microclimate management. This prospective observational pilot study took place in a 15-bed university-affiliated intensive care unit. Overall, 34 mechanically ventilated patients were included. Skin humidity and temperature were monitored before and after the implementation of the tested device at the occiput, scapulas, buttocks and sacrum. Humidity and temperature were evaluated through surface skin impedance and an infra-red thermometer, respectively. Health professionals were asked to evaluate the device. After implementation of the coverlet device, there was a rapid, sustained and significant decrease in skin humidity at all sites ranging from 6 % to 15 %, excluding the occiput. Skin temperature also significantly decreased from 1 % at both scapulas, but not at the other studied body sites. No side effects were observed. Health professionals reported that the device was easy and quick to install. Although they did not report a subjective improvement in skin moisture or temperature, they considered the device to be efficient. Although limited by its design, this pilot study suggests a good efficacy of the studied device on skin microclimate management. Further data are warranted to test the clinical implications of our findings.

The fracture strength of ceramic brackets: a comparative study.

PubMed

Flores, D A; Caruso, J M; Scott, G E; Jeiroudi, M T

1990-01-01

Recent demand for esthetic brackets has led to the development and use of ceramic brackets in orthodontics. The purpose of this study was to compare the fracture strength of different ceramic brackets under different surface conditions and ligation methods using a torsional wire bending force. Five different bracket types (two polycrystalline, two single-crystal, and one metal) were tested using elastic and wire ligation, with half being scratched and the other half remaining unscratched. Results showed a significant difference between bracket types and surface conditions. Non-scratched single-crystal brackets had higher fracture strengths and slightly higher fracture loads than polycrystalline brackets. However, single-crystal brackets were significantly adversely affected by surface damage (scratching), while polycrystalline brackets were not significantly affected by surface damage. The fracture behavior of ceramic brackets followed the Griffith model where fracture strength decreased following surface damage.

In vitro fracture resistance of three commercially available zirconia crowns for primary molars.

PubMed

Townsend, Janice A; Knoell, Patrick; Yu, Qingzhao; Zhang, Jian-Feng; Wang, Yapin; Zhu, Han; Beattie, Sean; Xu, Xiaoming

2014-01-01

The purpose of this study was to measure the fracture resistance of primary mandibular first molar zirconia crowns from three different manufacturers-EZ Pedo (EZP), NuSmile (NSZ), and Kinder Krowns (KK)-and compare it with the thickness of the zirconia crowns and the measured fracture resistance of preveneered stainless steel crowns (SSCs). The thickness of 20 zirconia crowns from three manufacturers were measured. The mean force required to fracture the crowns was determined. Preveneered NuSmile (NSW) SSCs were tested as a control. EZP crowns were significantly thicker in three of the six measured locations. The force required to fracture the EZP crown was significantly higher than that required for NSZ and KK. There was a positive correlation between fracture resistance and crown thickness in the mesial, distal, mesioocclusal, and distoocclusal dimensions. None of the zirconia crowns proved to be as resistant to fracture as the preveneered SSCs. Statistically significant differences were found among the forces required to fracture zirconia crowns by three different manufacturers. The increase in force correlated with crown thickness. The forces required to fracture the preveneered stainless steel crowns were greater than the forces required to fracture all manufacturers' zirconia crowns.

Effects of foot posture on fifth metatarsal fracture healing: a finite element study.

PubMed

Brilakis, Emmanuel; Kaselouris, Evaggelos; Xypnitos, Frank; Provatidis, Christopher G; Efstathopoulos, Nicolas

2012-01-01

The goal of this study was to evaluate the effects of maintaining different foot postures during healing of proximal fifth metatarsal fractures for each of 3 common fracture types. A 3-dimensional (3D) finite element model of a human foot was developed and 3 loading situations were evaluated, including the following: (1) normal weightbearing, (2) standing with the affected foot in dorsiflexion at the ankle, and (3) standing with the affected foot in eversion. Three different stages of the fracture-healing process were studied, including: stage 1, wherein the material interposed between the fractured edges was the initial connective tissue; stage 2, wherein connective tissue had been replaced by soft callus; and stage 3, wherein soft callus was replaced by mature bone. Thus, 30 3D finite element models were analyzed that took into account fracture type, foot posture, and healing stage. Different foot postures did not statistically significantly affect the peak-developed strains on the fracture site. When the fractured foot was everted or dorsiflexed, it developed a slightly higher strain within the fracture than when it was in the normal weightbearing position. In Jones fractures, eversion of the foot caused further torsional strain and we believe that this position should be avoided during foot immobilization during the treatment of fifth metatarsal base fractures. Tuberosity avulsion fractures and Jones fractures seem to be biomechanically stable fractures, as compared with shaft fractures. Our understanding of the literature and experience indicate that current clinical observations and standard therapeutic options are in accordance with the results that we observed in this investigation, with the exception of Jones fractures. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Prevalence of carpal fracture in Singapore.

PubMed

Hey, Hwee Weng Dennis; Dennis, Hey Hwee Weng; Chong, Alphonsus Khin Sze; Sze, Alphonsus Chong Khin; Murphy, Diarmuid

2011-02-01

To determine the prevalence of carpal fracture in Singapore, to compare demographic differences between isolated scaphoid and other carpal fractures, and to identify parameters associated with multiple carpal fractures. A total of 149 patients with 162 carpal fractures seen at the National University Hospital in 2009 were enrolled into the study. We retrospectively reviewed their case records and radiographic studies. Pertinent demographic data including patient age, gender, occupation, injured wrist, dominant hand, mechanism of injury, and type of carpal fracture were then recorded and statistically analyzed. We also performed a separate analysis of isolated scaphoid versus other carpal fractures and single versus multiple carpal fractures. Patients with carpal fracture were predominantly male (132), below 40 years of age (116), and usually right hand dominant (136). The more common occupations were students (30), full-time military national servicemen (24), and construction workers (14). Most presented after a fall on an outstretched hand from standing height (81). The scaphoid was the most common single carpal fracture (99). This was followed by triquetrum (27), hamate (5), pisiform (4), lunate (2), capitate (1), and trapezium (1). No fracture of the trapezoid was encountered. Ten patients had multiple carpal fractures, of which 4 were perilunate fracture dislocations. The mean age and male/female ratio for isolated scaphoid and other carpal fractures was 26 years versus 41 years (p<.001) and 13:1 versus 4:1 (p=.036), respectively. A high-energy mechanism of injury was the only parameter associated with multiple carpal fractures (p=.009). The prevalence of carpal fracture in our population was consistent with studies performed in other countries. Military conscription was identified as an at-risk activity predisposing to carpal fracture. Isolated scaphoid and other carpal fractures exhibit different demographics in terms of age and gender, which may be related to differences in the mechanism of injury. A high-energy mechanism of injury was associated with multiple carpal fractures. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Bone loss from the hand in women following distal forearm fracture.

PubMed

Ingle, B M; Eastell, R

2001-01-01

Bone loss occurs after distal forearm fracture, but it is unclear if this bone loss is fully recovered. We designed a cross-sectional study to evaluate the time course of the bone loss from the hand after distal forearm fracture. We identified 40 women who had a fracture of the distal forearm within the previous 4.5 years. Their ages ranged from 42 to 81 (mean 64 years) and time since fracture 6 to 54 (mean 28 months). These were compared with 95 women (mean age 67, range 57 to 80 years) from a population-based cohort. Lumbar spine (LS) and hand bone mineral density (BMD) were measured in all subjects using a Hologic QDR 1000/W densitometer. Ultrasound of the fingers of both hands was measured in the forearm fracture group using a DBM Sonic 1200 R model. Compared to controls, LS BMD was decreased by 6.4% (p<0.001), non-fractured hand by 3.2% (p<0.001) and the fractured hand by 6.1% (p<0.001) in the forearm fracture group. The mean difference in bone density between the fractured and non-fractured hand was 0.0207 g/cm2, the average value for the non-fractured hand being 0.304 g/cm2. The decement in hand BMD was equivalent to 6.2% (p<0.0001). The difference in hand BMD between the fractured and non-fractured side was greatest when the time since fracture was short; there was no further difference in hand BMD after 2 years. Ultrasound showed a mean difference of 18.7 m/s in amplitude-dependent speed of sound (AD-SoS) with the average value being 1893 m/s. A 1.0% decrease was observed in the fractured hand AD-SoS (p<0.05). A strong relationship was observed between AD-SoS and BMD in both hands (r = 0.70, p<0.001). We conclude that distal forearm fracture results in a significant decrease in hand BMD that is partially reversible. The decrease in hand BMD is reflected in the ultrasound properties of the finger phalanx.

Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population.

PubMed

Cho, Yoon-Je; Kang, Kyung-Chung; Chun, Young-Soo; Rhyu, Kee Hyung; Kim, Sang-Jun; Jang, Tae-Su

2018-05-03

There still remains controversy on the pathomechanism of atypical femoral fracture (AFF). The angle of lateral bowing and bone mineral density showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. In addition to the use of bisphosphonate, mechanical factors might play important roles in the occurrence of AFFs. Although AFF could be divided into subtrochanteric and diaphyseal fracture according to the location of fractures, there is a lack of evidence regarding differences between two fractures and etiology of the occurrence. The aim of study is to determine differences between atypical subtrochanteric and diaphyseal fracture in Korean population. Between February 2010 and March 2015, 51 AFFs in 40 patients were included in this study. Their medical records were retrospectively reviewed. The AFF patients satisfied all the diagnostic criteria of the 2014 revised edition of the ASMBR. To analyze the differences according to the location of fracture, the AFFs were divided into subtrochanteric (n = 16) and diaphyseal (n = 35) fracture groups. The following factors were compared between two groups: patients' demographics, underlying diseases, laboratory findings (serum-25(OH) VitD3, osteocalcin, c-telopeptide, ALP, Ca, and P), bone mineral density (BMD), duration of bisphosphonate (BP) usage, and lateral bowing of the femur at time of the fracture. All AFFs happened in female patients (mean age, 73.8 years) who have received bisphosphonate treatments except three patients. The mean duration of bisphosphonate usage was 95.3 months. Between the two groups, demographic data (age, height, weight, and BMI), underlying diseases, laboratory findings, hip BMD, and duration of BP treatment were comparable to each other (p > 0.05). However, the subtrochanteric fracture group showed higher FNSBA (femoral neck shaft bowing angle, p < 0.001) and spine BMD (p = 0.014) compared to the diaphyseal fracture group. Angle of lateral bowing (FNSBA) and spine BMD showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. According to our results, femoral bowing and spine BMD may play important roles in the AFF locations.

Atypical Fractures are Mainly Subtrochanteric in Singapore and Diaphyseal in Sweden: A Cross-Sectional Study.

PubMed

Schilcher, Jörg; Howe, Tet Sen; Png, Meng Ai; Aspenberg, Per; Koh, Joyce S B

2015-11-01

We have previously noted a dichotomy in the location of atypical fractures along the femoral shaft in Swedish patients, and a mainly subtrochanteric location of atypical fractures in descriptions of patients from Singapore. These unexpected differences were now investigated by testing the following hypotheses in a cross-sectional study: first, that there is a dichotomy also in Singapore; second, that the relation between subtrochanteric and diaphyseal location is different between the two countries; third, that the location is related to femoral bow. The previously published Swedish sample (n = 151) was re-measured, and a new Singaporean sample (n = 75) was established. Both samples were based on radiographic classification of all femoral fractures in women above 55 years of age. The distance between the fracture line and the lesser trochanter was measured. Femoral bow was classified as present or absent on frontal radiographs. Frequency distribution of the measured distances was analyzed using the Bayesian information criterion to choose the best description of the observed variable distribution in terms of a compilation of normally distributed subgroups. The analysis showed a clear dichotomy of the fracture location: either subtrochanteric or diaphyseal. Subtrochanteric fractures comprised 48% of all fractures in Singapore, and 17% in Sweden (p = 0.0001). In Singapore, femoral bow was associated with more fractures in the diaphyseal subgroup (p = 0.0001). This was not seen in Sweden. A dichotomous location of atypical fractures was confirmed, because it was found also in Singapore. The fractures showed a different localization pattern in the two countries. This difference may be linked to anatomical variations, but might also be related to cultural differences between the two populations that influence physical activity. © 2015 American Society for Bone and Mineral Research.

Numerical Simulation of Permeability Change in Wellbore Cement Fractures after Geomechanical Stress and Geochemical Reactions Using X-ray Computed Tomography Imaging.

PubMed

Kabilan, Senthil; Jung, Hun Bok; Kuprat, Andrew P; Beck, Anthon N; Varga, Tamas; Fernandez, Carlos A; Um, Wooyong

2016-06-21

X-ray microtomography (XMT) imaging combined with three-dimensional (3D) computational fluid dynamics (CFD) modeling technique was used to study the effect of geochemical and geomechanical processes on fracture permeability in composite Portland cement-basalt caprock core samples. The effect of fluid density and viscosity and two different pressure gradient conditions on fracture permeability was numerically studied by using fluids with varying density and viscosity and simulating two different pressure gradient conditions. After the application of geomechanical stress but before CO2-reaction, CFD revealed fluid flow increase, which resulted in increased fracture permeability. After CO2-reaction, XMT images displayed preferential precipitation of calcium carbonate within the fractures in the cement matrix and less precipitation in fractures located at the cement-basalt interface. CFD estimated changes in flow profile and differences in absolute values of flow velocity due to different pressure gradients. CFD was able to highlight the profound effect of fluid viscosity on velocity profile and fracture permeability. This study demonstrates the applicability of XMT imaging and CFD as powerful tools for characterizing the hydraulic properties of fractures in a number of applications like geologic carbon sequestration and storage, hydraulic fracturing for shale gas production, and enhanced geothermal systems.

A randomized controlled comparison of stretching procedures for posterior shoulder tightness.

PubMed

McClure, Philip; Balaicuis, Jenna; Heiland, David; Broersma, Mary Ellen; Thorndike, Cheryl K; Wood, April

2007-03-01

Randomized controlled trial, To compare changes in shoulder internal rotation range of motion (ROM), for 2 stretching exercises, the "cross-body stretch" and the "sleeper stretch," in individuals with posterior shoulder tightness. Recently, some authors have expressed the belief that the sleeper stretch is better than the cross-body stretch to address glenohumeral posterior tightness because the scapula is stabilized. Fifty-four asymptomatic subjects (20 males, 34 females) participated in the study. The control group (n=24) consisted of subjects with a between-shoulder difference in internal rotation ROM of less than 10 degrees, whereas those subjects with more than a 10 degrees difference were randomly assigned to 1 of 2 intervention groups, the sleeper stretch group (n=15) or the cross-body stretch group (n=15). Shoulder internal rotation ROM, with the arm abducted to 90 degrees and scapula motion prevented, was measured before and after a 4-week intervention period. Subjects in the control group were asked not to engage in any new stretching activities, while subjects in the 2 stretching groups were asked to perform stretching exercises on the more limited side only, once daily for 5 repetitions, holding each stretch for 30 seconds. The improvements in internal rotation ROM for the subjects in the cross-body stretch group (mean +/- SD, 20.0 degrees +/- 12.9 degrees) were significantly greater than for the subjects in the control group (5.9 degrees +/- 9.4 degrees, P = .009). The gains in the sleeper stretch group (12.4 degrees +/- 10.4 degrees) were not significant compared to those of the control group (P = .586) and those of the cross-body stretch group (P = .148). The cross-body stretch in individuals with limited shoulder internal rotation ROM appears to be more effective than no stretching in controls without internal rotation asymmetry to improve shoulder internal rotation ROM. While the improvement in internal rotation from the cross-body stretch was greater than for the sleeper stretch and of a magnitude that could be clinically significant, the small sample size likely precluded statistical significance between groups.

Impact of 3 years ivermectin treatment on onchocerciasis in Yanomami communities in the Brazilian Amazon.

PubMed

Banic, Dalma M; Calvão-Brito, Regina H S; Marchon-Silva, Verônica; Schuertez, Joana C; de Lima Pinheiro, Luís Renerys; da Costa Alves, Marilene; Têva, Antônio; Maia-Herzog, Marilza

2009-11-01

In the current study, it was assessed, for the first time, the effect of ivermectin treatment administered twice a year on the prevalence and morbidity of onchocerciasis in the hyperendemic Yanomami communities of the Roraima State (Brazil). Physical and parasitological examinations were carried out every 6 months until six drug rounds of treatment were completed. The coverage during the six rounds of ivermectin treatment ranged from 89% to 92% of the eligible Yanomami population. Overall, comparison of results at pre-treatment with results after six rounds of treatment, the prevalence of infection had declined from 87% to 42% (P<0.0001, CI 95%=0.05-0.22); the community microfilarial load (CMFL) fell from 1.17 to 0.53Mf/mg of skin; and the crude intensity of infection (MFL-Total) decreased from 18.95 to 1.96Mf/mg of skin during the same period (P<0.0001, for both microfilarial loads). Although no significant difference was observed between microfilarial densities in skin snips from iliac crest and scapula after the 6th round of ivermectin treatment it was observed that the prevalence of positive skin snips was significantly higher when skin snips were taken from iliac crest (42%) than from scapula (8%) (P=0.001, CI 95%=3.41-22.67). After six rounds of ivermectin treatments, no significant differences were observed in the prevalences of palpable nodules and of onchodermatitis in relation to pre-treatment prevalences, from 45% to 41% and from 17% to 20% (P>0.05, for both). These findings suggest that mass population treatment should continue without interruption and achieve higher levels of drug coverage in order to alleviate disease manifestations and interrupt infection transmission to hasten the elimination of onchocerciasis in Yanomami communities. In addition, the sensitivity of iliac crest snips for parasitological assessment in epidemiological surveillance of Yanomami communities may increase the acceptance of the population in biopsy sampling and seems to be a good choice for assessing the success of control programs.

Fracture-fault network characterization of pavement imagery of the Whitby Mudstone, Yorkshire

NASA Astrophysics Data System (ADS)

Boersma, Quinten; Hardebol, Nico; Houben, Maartje; Barnhoorn, Auke; Drury, Martyn

2015-04-01

Natural fractures play an important role in the hydrocarbon production from tight reservoirs. The need for fracture network pathways by fraccing matters particularly for shale gas prospects, due to their micro- to nano-darcies matrix permeabilities. The study of natural fractures from outcrops helps to better understand network connectivity and possibility of reactivating pre-existing planes of weakness, induced by hydraulic stimulation. Microseismicity also show that natural fractures are reactivated during fraccing in tight gas reservoirs and influence the success of the stimulation. An accurate understanding of natural fracture networks can help in predicting the development of fracture networks. In this research we analyze an outcrop analogue, the Whitby Mustone Formation (WMF), in terms of its horizontal fracture network. The WMF is the time equivalent of the Posidonia Shale Formation (PSF), which on itself is the main shale gas prospect in the Dutch subsurface. The fracture network of the WMF is characterized by a system of steep dipping joints with two dominant directions with N-S and E-W strike. The network was digitized from bird-view imagery of the pavement with a spatial extent of ~100 m at sub-cm resolution. The imagery is interpreted in terms of orientation and length distributions, intensity and fractal dimensions. Samples from the field were analyzed for rock strength and sample mineralogy. The results indicate that the fracture networks greatly differ per bed. Observed differences are for example; the geometry of the fracture network, its cumulative length distribution law, the fracture intensity, the fracture length vs its orientation and the fractal dimension. All these parameters greatly influence fracture network connectivity, the probability that longer fractures exist within the pavement and whether the network is more prone to clustering or scattering. Apart from the differences, the networks display a fairly similar orthogonal arrangement with dominant large (> 5-10 m) N-S striking fractures and smaller E-W striking cross-joints (< 2-3 m). A nested network arrangement is indicated by some smaller-scale N-S fractures abutting against the E-W striking ones. Furthermore, abutment relations provide some constraints on relative time. Timing indications with respect to burial-exhumation are difficult to establish. Some joints are cemented and measurable from the high-resolution imagery. The vein measurements helped establishing a first order relation between the fracture aperture with respect to their length and confirm that longer fractures have a wider aperture. The above stated parameters and results all prove to be very valuable information which can help predict the geometries of the different fracture networks present within the PSF. It is important to understand the possible mechanisms which can cause these differences in fracture network characteristics. Bulk lithological variations between beds are minor, mainly consisting of clay minerals. Furthermore, some quartz and pyrite is present in all samples and TOC is present in variable amounts. However, the occurrence of concretions up to 0.5m in size correlates with notable differences in distinct network arrangement. Therefore it appears that the presence of these concretions greatly alters the overall strength of the rock, hence the fracture network geometry.

AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement.

PubMed

Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B

2017-02-01

Background  The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods  A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results  Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Conclusion  Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence  Level III.

AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement

PubMed Central

Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B.

2016-01-01

Background The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was “substantial” for fracture types and “fair” for fracture groups with no difference accounting for location, training level, or specialty. Conclusion Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence Level III PMID:28119795

Epidemiology of metatarsal stress fractures versus tibial and femoral stress fractures during elite training.

PubMed

Finestone, Aharon; Milgrom, Charles; Wolf, Omer; Petrov, Kaloyan; Evans, Rachel; Moran, Daniel

2011-01-01

The training of elite infantry recruits takes a year or more. Stress fractures are known to be endemic in their basic training and the clinical presentation of tibial, femoral, and metatarsal stress fractures are different. Stress fracture incidence during the subsequent progressively more demanding training is not known. The study hypothesis was that after an adaptation period, the incidence of stress fractures during the course of 1 year of elite infantry training would fall in spite of the increasingly demanding training. Seventy-six male elite infantry recruits were followed for the development of stress fractures during a progressively more difficult training program composed of basic training (1 to 14 weeks), advanced training (14 to 26 weeks), and unit training (26 to 52 weeks). Subjects were reviewed regularly and those with clinical suspicion of stress fracture were assessed using bone scan and X-rays. The incidence of stress fractures was 20% during basic training, 14% during advanced training and 23% during unit training. There was a statistically significant difference in the incidence of tibial and femoral stress fractures versus metatarsal stress fractures before and after the completion of phase II training at week 26 (p=0.0001). Seventy-eight percent of the stress fractures during phases I and II training were either tibial or femoral, while 91% of the stress fractures in phase III training were metatarsal. Prior participation in ball sports (p=0.02) and greater tibial length (p=0.05) were protective factors for stress fracture. The study hypothesis that after a period of soldier adaptation, the incidence of stress fractures would decrease in spite of the increasingly demanding elite infantry training was found to be true for tibial and femoral fractures after 6 months of training but not for metatarsal stress fractures. Further studies are required to understand the mechanism of this difference but physicians and others treating stress fractures should be aware of this pattern.

Discontinuities in effective permeability due to fracture percolation

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

Hyman, Jeffrey De'Haven; Karra, Satish; Carey, James William

Motivated by a triaxial coreflood experiment with a sample of Utica shale where an abrupt jump in permeability was observed, possibly due to the creation of a percolating fracture network through the sample, we perform numerical simulations based on the experiment to characterize how the effective permeability of otherwise low-permeability porous media depends on fracture formation, connectivity, and the contrast between the fracture and matrix permeabilities. While a change in effective permeability due to fracture formation is expected, the dependence of its magnitude upon the contrast between the matrix permeability and fracture permeability and the fracture network structure is poorlymore » characterized. We use two different high-fidelity fracture network models to characterize how effective permeability changes as percolation occurs. The first is a dynamic two-dimensional fracture propagation model designed to mimic the laboratory settings of the experiment. The second is a static three-dimensional discrete fracture network (DFN) model, whose fracture and network statistics are based on the fractured sample of Utica shale. Once the network connects the inflow and outflow boundaries, the effective permeability increases non-linearly with network density. In most networks considered, a jump in the effective permeability was observed when the embedded fracture network percolated. We characterize how the magnitude of the jump, should it occur, depends on the contrast between the fracture and matrix permeabilities. For small contrasts between the matrix and fracture permeabilities the change is insignificant. However, for larger contrasts, there is a substantial jump whose magnitude depends non-linearly on the difference between matrix and fracture permeabilities. A power-law relationship between the size of the jump and the difference between the matrix and fracture permeabilities is observed. In conclusion, the presented results underscore the importance of fracture network topology on the upscaled properties of the porous medium in which it is embedded.« less

Discontinuities in effective permeability due to fracture percolation

DOE PAGES

Hyman, Jeffrey De'Haven; Karra, Satish; Carey, James William; ...

2018-01-31

Motivated by a triaxial coreflood experiment with a sample of Utica shale where an abrupt jump in permeability was observed, possibly due to the creation of a percolating fracture network through the sample, we perform numerical simulations based on the experiment to characterize how the effective permeability of otherwise low-permeability porous media depends on fracture formation, connectivity, and the contrast between the fracture and matrix permeabilities. While a change in effective permeability due to fracture formation is expected, the dependence of its magnitude upon the contrast between the matrix permeability and fracture permeability and the fracture network structure is poorlymore » characterized. We use two different high-fidelity fracture network models to characterize how effective permeability changes as percolation occurs. The first is a dynamic two-dimensional fracture propagation model designed to mimic the laboratory settings of the experiment. The second is a static three-dimensional discrete fracture network (DFN) model, whose fracture and network statistics are based on the fractured sample of Utica shale. Once the network connects the inflow and outflow boundaries, the effective permeability increases non-linearly with network density. In most networks considered, a jump in the effective permeability was observed when the embedded fracture network percolated. We characterize how the magnitude of the jump, should it occur, depends on the contrast between the fracture and matrix permeabilities. For small contrasts between the matrix and fracture permeabilities the change is insignificant. However, for larger contrasts, there is a substantial jump whose magnitude depends non-linearly on the difference between matrix and fracture permeabilities. A power-law relationship between the size of the jump and the difference between the matrix and fracture permeabilities is observed. In conclusion, the presented results underscore the importance of fracture network topology on the upscaled properties of the porous medium in which it is embedded.« less

The subsurface impact of hydraulic fracturing in shales- Perspectives from the well and reservoir

NASA Astrophysics Data System (ADS)

ter Heege, Jan; Coles, Rhys

2017-04-01

It has been identified that the main risks of subsurface shale gas operations in the U.S.A. and Canada are associated with (1) drilling and well integrity, (2) hydraulic fracturing, and (3) induced seismicity. Although it is unlikely that hydraulic fracturing operations result in direct pathways of enhanced migration between stimulated fracture disturbed rock volume and shallow aquifers, operations may jeopardize well integrity or induce seismicity. From the well perspective, it is often assumed that fluid injection leads to the initiation of tensile (mode I) fractures at different perforation intervals along the horizontal sections of shale gas wells if pore pressure exceeds the minimum principal stress. From the reservoir perspective, rise in pore pressure resulting from fluid injection may lead to initiation of tensile fractures, reactivation of shear (mode II) fractures if the criterion for failure in shear is exceeded, or combinations of different fracturing modes. In this study, we compare tensile fracturing simulations using conventional well-based models with shear fracturing simulations using a fractured shale model with characteristic fault populations. In the fractured shale model, stimulated permeability is described by an analytical model that incorporates populations of reactivated faults and that combines 3D permeability tensors for layered shale matrix, damage zone and fault core. Well-based models applied to wells crosscutting the Posidonia Shale Formation are compared to generic fractured shale models, and fractured shale models are compared to micro-seismic data from the Marcellus Shale. Focus is on comparing the spatial distribution of permeability, stimulated reservoir volume and seismicity, and on differences in fracture initiation pressure and fracture orientation for tensile and shear fracturing end-members. It is shown that incorporation of fault populations (for example resulting from analysis of 3D seismics or outcrops) in hydraulic fracturing models provides better constraints on well pressures, stimulated fracture disturbed volume and induced seismicity. Thereby, it helps assessing the subsurface impact of hydraulic fracturing in shales and mitigating risks associated with loss of loss of well integrity, loss of fracture containment, and induced seismicity.

Fall with and without fracture in elderly: what's different?

PubMed

Kantayaporn, Choochat

2012-10-01

Falling fracture was one of the health problems in elderly. This presentation aimed to identify the factors of fall that caused fractures. The retrospective case-control study was designed. Samples were all who experienced fall within 1 year in Lamphun. Factors included age, gender underlying diseases, chronic drugs used, history of parent fragility fracture, age of menopause, steroid used, body mass index, visual acuity and time up and go test were studied. Multivariate regression analysis was used. 336 cases of fractures in 1,244 cases of fall were found. Significant factors of falling fracture group that were different from fall without fracture group included age, female gender, menopause before age of 45 and visual impairment. Visual impairment was the other key factor rather than osteoporosis that caused fall with fracture. The author suggested that falling fracture prevention programs should be included correction of visual impairment other than osteoporosis treatment.

Rate decline curves analysis of multiple-fractured horizontal wells in heterogeneous reservoirs

NASA Astrophysics Data System (ADS)

Wang, Jiahang; Wang, Xiaodong; Dong, Wenxiu

2017-10-01

In heterogeneous reservoir with multiple-fractured horizontal wells (MFHWs), due to the high density network of artificial hydraulic fractures, the fluid flow around fracture tips behaves like non-linear flow. Moreover, the production behaviors of different artificial hydraulic fractures are also different. A rigorous semi-analytical model for MFHWs in heterogeneous reservoirs is presented by combining source function with boundary element method. The model are first validated by both analytical model and simulation model. Then new Blasingame type curves are established. Finally, the effects of critical parameters on the rate decline characteristics of MFHWs are discussed. The results show that heterogeneity has significant influence on the rate decline characteristics of MFHWs; the parameters related to the MFHWs, such as fracture conductivity and length also can affect the rate characteristics of MFHWs. One novelty of this model is to consider the elliptical flow around artificial hydraulic fracture tips. Therefore, our model can be used to predict rate performance more accurately for MFHWs in heterogeneous reservoir. The other novelty is the ability to model the different production behavior at different fracture stages. Compared to numerical and analytic methods, this model can not only reduce extensive computing processing but also show high accuracy.

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.

[Distal clavicle fractures. Classifications and management].

PubMed

Ockert, Ben; Wiedemann, E; Haasters, F

2015-05-01

Fractures of the distal third of the clavicle represent 10-30% of all clavicle fractures . Frequently, these fractures result in instability due to a combination of bony and ligamentous injury. Thus, assessment of the stability is essential for adequate treatment of these fractures. This article presents a review of the different classification systems for distal clavicle fractures with respect to anatomical and functional factors to allow for comprehensive assessment of stability. Furthermore, the different treatment options for each fracture type are analyzed. Fractures to the distal third of the clavicle without instability can be treated conservatively with satisfactory outcome. In contrast, instability may result in symptomatic non-union under conservative treatment; therefore, distal clavicle fractures with instability should be treated operatively with respect to the functional demands of the patient. Operative treatment with locked plating in combination with coracoclavicular fixation results in excellent functional results. Arthroscopically assisted fracture fixation may be beneficial in terms of a minimally invasive approach as well as assessment and treatment of associated glenohumeral lesions.

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures.

PubMed

Heare, Austin; Kramer, Nicholas; Salib, Christopher; Mauffrey, Cyril

2017-07-01

Despite overall improved outcomes with open reduction and internal fixation of acetabular fractures, posterior wall fractures show disproportionately poor results. The effect of weight bearing on outcomes of fracture management has been investigated in many lower extremity fractures, but evidence-based recommendations in posterior wall acetabular fractures are lacking. The authors systematically reviewed the current literature to determine if a difference in outcome exists between early and late postoperative weight-bearing protocols for surgically managed posterior wall acetabular fractures. PubMed and MEDLINE were searched for posterior wall acetabular fracture studies that included weight-bearing protocols and Merle d'Aubigné functional scores. Twelve studies were identified. Each study was classified as either early or late weight bearing. Early weight bearing was defined as full, unrestricted weight bearing at or before 12 weeks postoperatively. Late weight bearing was defined as restricted weight bearing for greater than 12 weeks postoperatively. The 2 categories were then compared by functional score using a 2-tailed t test and by complication rate using chi-square analysis. Six studies (152 fractures) were placed in the early weight-bearing category. Six studies (302 fractures) were placed in the late weight-bearing category. No significant difference in Merle d'Aubigné functional scores was found between the 2 groups. No difference was found regarding heterotopic ossification, avascular necrosis, superficial infections, total infections, or osteoarthritis. This systematic review found no difference in functional outcome scores or complication rates between early and late weight-bearing protocols for surgically treated posterior wall fractures. [Orthopedics. 2017: 40(4):e652-e657.]. Copyright 2017, SLACK Incorporated.

Flow and fracture behavior of aluminum alloy 6082-T6 at different tensile strain rates and triaxialities.

PubMed

Chen, Xuanzhen; Peng, Yong; Peng, Shan; Yao, Song; Chen, Chao; Xu, Ping

2017-01-01

This study aims to investigate the flow and fracture behavior of aluminum alloy 6082-T6 (AA6082-T6) at different strain rates and triaxialities. Two groups of Charpy impact tests were carried out to further investigate its dynamic impact fracture property. A series of tensile tests and numerical simulations based on finite element analysis (FEA) were performed. Experimental data on smooth specimens under various strain rates ranging from 0.0001~3400 s-1 shows that AA6082-T6 is rather insensitive to strain rates in general. However, clear rate sensitivity was observed in the range of 0.001~1 s-1 while such a characteristic is counteracted by the adiabatic heating of specimens under high strain rates. A Johnson-Cook constitutive model was proposed based on tensile tests at different strain rates. In this study, the average stress triaxiality and equivalent plastic strain at facture obtained from numerical simulations were used for the calibration of J-C fracture model. Both of the J-C constitutive model and fracture model were employed in numerical simulations and the results was compared with experimental results. The calibrated J-C fracture model exhibits higher accuracy than the J-C fracture model obtained by the common method in predicting the fracture behavior of AA6082-T6. Finally, the Scanning Electron Microscope (SEM) of fractured specimens with different initial stress triaxialities were analyzed. The magnified fractographs indicate that high initial stress triaxiality likely results in dimple fracture.

The effect of early operative stabilization on late displacement of zone I and II sacral fractures.

PubMed

Emohare, Osa; Slinkard, Nathaniel; Lafferty, Paul; Vang, Sandy; Morgan, Robert

2013-02-01

This study was designed to evaluate the effect on displacement of early operative stabilization on unstable fractures when compared to stable fractures of the sacrum. Patient consisted of those sustaining traumatic pelvic fractures that also included sacral fractures of Denis type I and type II classification, who were over 18 at the time of the study. Patients were managed emergently, as judged appropriate at the time and then subsequently divided into two cohorts, comprising those who were either treated operatively or non-operatively. The operative group comprised those treated with either internal fixation or external fixation. Twenty-eight patients had zone II fractures, and 20 had zone I fractures. Zone II fractures showed average displacements of 6.5mm and 6.9mm in the rostral-caudal and anteroposterior directions, respectively, at final follow up. Zone I fractures had average displacements of 6.6mm and 6.1mm in both directions. There were no significant differences between zone I and II sacral fractures (rostral-caudal P=0.74, anteroposterior P=0.24). Average changes in fracture displacement in patients with zone I fractures were 0.6-1.0mm in both directions. Average changes in zone II fractures were 1.8-1.5mm in both directions. There were no significant differences between the average changes in zone I and II fractures in any direction (rostral-caudal P=0.64, anteroposterior P=0.68) or in average displacements at final follow up in any of zone or the entire cohort. Statistically significant differences were noted in average changes in displacement in zone II fractures in the anteroposterior plane (P=0.03) and the overall cohort in the anteroposterior plane (P=0.02). Operative fixation for unstable sacral fractures ensures displacement at follow up is comparable with stable fractures treated non operatively. Copyright © 2012 Elsevier Ltd. All rights reserved.

Characterising rock fracture aperture-spacing relationships using power-law relationships: some considerations

NASA Astrophysics Data System (ADS)

Brook, Martin; Hebblewhite, Bruce; Mitra, Rudrajit

2016-04-01

The size-scaling of rock fractures is a well-studied problem in geology, especially for permeability quantification. The intensity of fractures may control the economic exploitation of fractured reservoirs because fracture intensity describes the abundance of fractures potentially available for fluid flow. Moreover, in geotechnical engineering, fractures are important for parameterisation of stress models and excavation design. As fracture data is often collected from widely-spaced boreholes where core recovery is often incomplete, accurate interpretation and representation of fracture aperture-frequency relationships from sparse datasets is important. Fracture intensity is the number of fractures encountered per unit length along a sample scanline oriented perpendicular to the fractures in a set. Cumulative frequency of fractures (F) is commonly related to fracture aperture (A) in the form of a power-law (F = aA-b), with variations in the size of the a coefficient between sites interpreted to equate to fracture frequency for a given aperture (A). However, a common flaw in this approach is that even a small change in b can have a large effect on the response of the fracture frequency (F) parameter. We compare fracture data from the Late Permian Rangal Coal Measures from Australia's Bowen Basin, with fracture data from Jurassic carbonates from the Sierra Madre Oriental, northeastern Mexico. Both power-law coefficient a and exponent b control the fracture aperture-frequency relationship in conjunction with each other; that is, power-laws with relatively low a coefficients have relatively high b exponents and vice versa. Hence, any comparison of different power-laws must take both a and b into consideration. The corollary is that different sedimentary beds in the Sierra Madre carbonates do not show ˜8× the fracture frequency for a given fracture aperture, as based solely on the comparison of coefficient a. Rather, power-law "sensitivity factors" developed from both Sierra Madre and the Bowen Basin span similar ranges, indicating that the factor of increase in frequency (F) for a doubling of aperture size (A) shows similar relationships and variability from both sites. Despite their limitations, we conclude that fracture aperture-frequency power-law relationships are valid and, when interpreted carefully, provide a useful basis for comparing rock fracture distributions across different sites.

Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity.

PubMed

Becker, Carolyn; Crow, Scott; Toman, Jared; Lipton, Carter; McMahon, Don J; Macaulay, William; Siris, Ethel

2006-01-01

Osteoporosis is a major public health problem in the United States of America and around the world, largely due to the morbidity and mortality associated with osteoporotic fractures. In the past decade, large epidemiologic studies have contributed greatly to our understanding of patients who fracture. However, most studies are limited to postmenopausal white women. In this retrospective review, we analyze data from 185 men and women with acute fragility fractures who received osteoporosis consultations during admission to a single urban hospital between 2001 and 2003. Men and women differed in terms of risk factors for falls and osteoporosis but had areal bone mineral density (BMD) measurements remarkably similar, except at the total hip. Black and Hispanic subjects with fractures were significantly younger than whites yet were much more likely to have serious co-morbidities, such as diabetes mellitus and hypertension. In spite of significantly higher BMD measurements, black patients had the highest rates of vitamin D deficiency and secondary hyperparathyroidism. Patients admitted with hip fractures differed from those with non-hip fractures on a number of important variables. Based on these data, we conclude that elderly subjects admitted to an urban hospital with osteoporotic fractures are a heterogeneous group, with features that vary according to fracture type, gender and ethnicity. Future studies of patients with clinical fragility fractures should include ample numbers of men and ethnic minorities, since differences in underlying risk factors may suggest alternative strategies for fracture prevention.

Advanced Prosthetic Gait Training Tool

DTIC Science & Technology

2011-09-01

Placed above the medial border of the scapula on the level of T3 T7 T7 spinous process CLAV Placed in the center of the clavicles RCLAV, LCLAV...Right Shoulder  Right Hand B  Right Elbow  Right Toe  Right Wrist  Upper Neck    Lower Neck    Head Right    Right  Clavicle     Left  Clavicle     Head

Nonconventional Remission of Miliaria rubra during Heat Acclimation: Case Report,

DTIC Science & Technology

1987-01-01

folliculitis , furunculosis, or anhidrotic heat exhaustion (1,2). Severe cases involve diurnal irritation, discomfort and isamnia to a degree that causes a...L/hr) in the heat. A skin biopsy (right scapula) on day 8 was negative for miliaria rubra but was positive for chronic folliculitis , which was...sparsely distributed over the skin. This finding supported previous reports that miliaria rubra may be a precursor of folliculitis (1,2). Daily entering

Elevated-temperature fracture resistances of monolithic and composite ceramics using chevron-notched bend tests

NASA Technical Reports Server (NTRS)

Ghosh, Asish; Jenkins, Michael G.; Ferber, Mattison K.; Peussa, Jouko; Salem, Jonathan A.

1992-01-01

The quasi-static fracture behaviors of monolithic ceramics (SiC, Si3N4, MgAl2O4), self-reinforced monoliths (acicular grained Si3N4, acicular grained mullite), and ceramic matrix composites (SiC whisker/Al2O3 matrix, TiB2 particulate/SiC matrix, SiC fiber/CVI SiC matrix, Al2O3 fiber/CVI SiC matrix) were measured over the temperature range of 20 to 1400 C. The chevron notched, bend bar test geometry was essential for characterizing the elevated temperature fracture resistances of this wide range of quasi-brittle materials during stable crack growth. Fractography revealed the differences in the fracture behavior of the different materials at the various temperatures. The fracture resistances of the self-reinforced monoliths were comparable to those of the composites and the fracture mechanisms were found to be similar at room temperature. However at elevated temperatures the differences of the fracture behavior became apparent where the superior fracture resistance of the self-reinforced monoliths were attributed to the minor amounts of glassy, intergranular phases which were often more abundant in the composites and affected the fracture behavior when softened by elevated temperatures.

Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (manual) and white-collar (office) workers.

PubMed

Fernández-de-las-Peñas, César; Gröbli, Christian; Ortega-Santiago, Ricardo; Fischer, Christine Stebler; Boesch, Daniel; Froidevaux, Philippe; Stocker, Lilian; Weissmann, Richard; González-Iglesias, Javier

2012-07-01

To describe the prevalence and referred pain area of trigger points (TrPs) in blue-collar (manual) and white-collar (office) workers, and to analyze if the referred pain pattern elicited from TrPs completely reproduces the overall spontaneous pain pattern. Sixteen (62% women) blue-collar and 19 (75% women) white-collar workers were included in this study. TrPs in the temporalis, masseter, upper trapezius, sternocleidomastoid, splenius capitis, oblique capitis inferior, levator scapulae, scalene, pectoralis major, deltoid, infraspinatus, extensor carpi radialis brevis and longus, extensor digitorum communis, and supinator muscles were examined bilaterally (hyper-sensible tender spot within a palpable taut band, local twitch response with snapping palpation, and elicited referred pain pattern with palpation) by experienced assessors blinded to the participants' condition. TrPs were considered active when the local and referred pain reproduced any symptom and the patient recognized the pain as familiar. The referred pain areas were drawn on anatomic maps, digitized, and measured. Blue-collar workers had a mean of 6 (SD: 3) active and 10 (SD: 5) latent TrPs, whereas white-collar workers had a mean of 6 (SD: 4) active and 11 (SD: 6) latent TrPs (P>0.548). No significant differences in the distribution of active and latent TrPs in the analyzed muscles between groups were found. Active TrPs in the upper trapezius, infraspinatus, levator scapulae, and extensor carpi radialis brevis muscles were the most prevalent in both groups. Significant differences in referred pain areas between muscles (P<0.001) were found; pectoralis major, infraspinatus, upper trapezius, and scalene muscles showed the largest referred pain areas (P<0.01), whereas the temporalis, masseter, and splenius capitis muscles showed the smallest (P<0.05). The combination of the referred pain from TrPs reproduced the overall clinical pain area in all participants. Blue-collar and white-collar workers exhibited a similar number of TrPs in the upper quadrant musculature. The referred pain elicited by active TrPs reproduced the overall pain pattern. The distribution of TrPs was not significantly different between groups. Clinicians should examine for the presence of muscle TrPs in blue-collar and white-collar workers.

The reliability of three-dimensional scapular attitudes in healthy people and people with shoulder impingement syndrome.

PubMed

Roy, Jean-Sébastien; Moffet, Hélène; Hébert, Luc J; St-Vincent, Guy; McFadyen, Bradford J

2007-06-21

Abnormal scapular displacements during arm elevation have been observed in people with shoulder impingement syndrome. These abnormal scapular displacements were evaluated using different methods and instruments allowing a 3-dimensional representation of the scapular kinematics. The validity and the intrasession reliability have been shown for the majority of these methods for healthy people. However, the intersession reliability on healthy people and people with impaired shoulders is not well documented. This measurement property needs to be assessed before using such methods in longitudinal comparative studies. The objective of this study is to evaluate the intra and intersession reliability of 3-dimensional scapular attitudes measured at different arm positions in healthy people and to explore the same measurement properties in people with shoulder impingement syndrome using the Optotrak Probing System. Three-dimensional scapular attitudes were measured twice (test and retest interspaced by one week) on fifteen healthy subjects (mean age 37.3 years) and eight subjects with subacromial shoulder impingement syndrome (mean age 46.1 years) in three arm positions (arm at rest, 70 degrees of humerothoracic flexion and 90 degrees of humerothoracic abduction) using the Optotrak Probing System. Two different methods of calculation of 3-dimensional scapular attitudes were used: relative to the position of the scapula at rest and relative to the trunk. Intraclass correlation coefficient (ICC) and standard error of measure (SEM) were used to estimate intra and intersession reliability. For both groups, the reliability of the three-dimensional scapular attitudes for elevation positions was very good during the same session (ICCs from 0.84 to 0.99; SEM from 0.6 degrees to 1.9 degrees ) and good to very good between sessions (ICCs from 0.62 to 0.97; SEM from 1.2 degrees to 4.2 degrees ) when using the method of calculation relative to the trunk. Higher levels of intersession reliability were found for the method of calculation relative to the trunk in anterior-posterior tilting at 70 degrees of flexion compared to the method of calculation relative to the scapula at rest. The estimation of three-dimensional scapular attitudes using the method of calculation relative to the trunk is reproducible in the three arm positions evaluated and can be used to document the scapular behavior.

The reliability of three-dimensional scapular attitudes in healthy people and people with shoulder impingement syndrome

PubMed Central

Roy, Jean-Sébastien; Moffet, Hélène; Hébert, Luc J; St-Vincent, Guy; McFadyen, Bradford J

2007-01-01

Background Abnormal scapular displacements during arm elevation have been observed in people with shoulder impingement syndrome. These abnormal scapular displacements were evaluated using different methods and instruments allowing a 3-dimensional representation of the scapular kinematics. The validity and the intrasession reliability have been shown for the majority of these methods for healthy people. However, the intersession reliability on healthy people and people with impaired shoulders is not well documented. This measurement property needs to be assessed before using such methods in longitudinal comparative studies. The objective of this study is to evaluate the intra and intersession reliability of 3-dimensional scapular attitudes measured at different arm positions in healthy people and to explore the same measurement properties in people with shoulder impingement syndrome using the Optotrak Probing System. Methods Three-dimensional scapular attitudes were measured twice (test and retest interspaced by one week) on fifteen healthy subjects (mean age 37.3 years) and eight subjects with subacromial shoulder impingement syndrome (mean age 46.1 years) in three arm positions (arm at rest, 70° of humerothoracic flexion and 90° of humerothoracic abduction) using the Optotrak Probing System. Two different methods of calculation of 3-dimensional scapular attitudes were used: relative to the position of the scapula at rest and relative to the trunk. Intraclass correlation coefficient (ICC) and standard error of measure (SEM) were used to estimate intra and intersession reliability. Results For both groups, the reliability of the three-dimensional scapular attitudes for elevation positions was very good during the same session (ICCs from 0.84 to 0.99; SEM from 0.6° to 1.9°) and good to very good between sessions (ICCs from 0.62 to 0.97; SEM from 1.2° to 4.2°) when using the method of calculation relative to the trunk. Higher levels of intersession reliability were found for the method of calculation relative to the trunk in anterior-posterior tilting at 70° of flexion compared to the method of calculation relative to the scapula at rest. Conclusion The estimation of three-dimensional scapular attitudes using the method of calculation relative to the trunk is reproducible in the three arm positions evaluated and can be used to document the scapular behavior. PMID:17584933

Comparative Evaluation of Fracture Resistance and Mode of Failure of Zirconia and Titanium Abutments with Different Diameters.

PubMed

Shabanpour, Reza; Mousavi, Niloufar; Ghodsi, Safoura; Alikhasi, Marzieh

2015-08-01

The purpose of the current study was to compare the fracture resistance and mode of failure of zirconia and titanium abutments with different diameters. Fourteen groups of abutments including prefabricated zirconia, copy-milled zirconia and titanium abutments of an implant system (XiVE, Dentsply) were prepared in different diameters. An increasing vertical load was applied to each specimen until failure occurred. Fracture resistance was measured in each group using the universal testing machine. Moreover, the failure modes were studied and categorized as abutment screw fracture, connection area fracture, abutment body fracture, abutment body distortion, screw distortion and connection area distortion. Groups were statistically compared using univariate and post-hoc tests. The level of statistical significance was set at 5%. Fabrication method (p = 0.03) and diameter (p < 0.001) had significant effect on the fracture resistance of abutments. Fracture resistance of abutments with 5.5 mm diameter was higher than other diameters (p < 0.001). The observed modes of failure were dependent on the abutment material as well. All of the prefabricated titanium abutments fractured within the abutment screw. Abutment screw distortion, connection area fracture, and abutment body fracture were the common failure type in other groups. Diameter had a significant effect on fracture resistance of implant abutments, as abutments with greater diameters were more resistant to static loads. Copy-milled abutments showed lower fracture resistance as compared to other experimental groups. Although zirconia abutments have received great popularity among clinicians and even patients selecting them for narrow implants should be with caution.

Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies

PubMed Central

2010-01-01

Background Vitamin D supplementation for fracture prevention is widespread despite conflicting interpretation of relevant randomised controlled trial (RCT) evidence. This study summarises quantitatively the current evidence from RCTs and observational studies regarding vitamin D, parathyroid hormone (PTH) and hip fracture risk. Methods We undertook separate meta-analyses of RCTs examining vitamin D supplementation and hip fracture, and observational studies of serum vitamin D status (25-hydroxyvitamin D (25(OH)D) level), PTH and hip fracture. Results from RCTs were combined using the reported hazard ratios/relative risks (RR). Results from case-control studies were combined using the ratio of 25(OH)D and PTH measurements of hip fracture cases compared with controls. Original published studies of vitamin D, PTH and hip fracture were identified through PubMed and Web of Science databases, searches of reference lists and forward citations of key papers. Results The seven eligible RCTs identified showed no significant difference in hip fracture risk in those randomised to cholecalciferol or ergocalciferol supplementation versus placebo/control (RR = 1.13[95%CI 0.98-1.29]; 801 cases), with no significant difference between trials of <800 IU/day and ≥800 IU/day. The 17 identified case-control studies found 33% lower serum 25(OH)D levels in cases compared to controls, based on 1903 cases. This difference was significantly greater in studies with population-based compared to hospital-based controls (χ21 (heterogeneity) = 51.02, p < 0.001) and significant heterogeneity was present overall (χ216 (heterogeneity) = 137.9, p < 0.001). Serum PTH levels in hip fracture cases did not differ significantly from controls, based on ten case-control studies with 905 cases (χ29 (heterogeneity) = 149.68, p < 0.001). Conclusions Neither higher nor lower dose vitamin D supplementation prevented hip fracture. Randomised and observational data on vitamin D and hip fracture appear to differ. The reason for this is unclear; one possible explanation is uncontrolled confounding in observational studies. Post-fracture PTH levels are unrelated to hip fracture risk. PMID:20540727

Application of fracture mechanics to failure in manatee rib bone.

PubMed

Yan, Jiahau; Clifton, Kari B; Reep, Roger L; Mecholsky, John J

2006-06-01

The Florida manatee (Trichechus manatus latirostris) is listed as endangered by the U.S. Department of the Interior. Manatee ribs have different microstructure from the compact bone of other mammals. Biomechanical properties of the manatee ribs need to be better understood. Fracture toughness (K(C)) has been shown to be a good index to assess the mechanical performance of bone. Quantitative fractography can be used in concert with fracture mechanics equations to identify fracture initiating defects/cracks and to calculate the fracture toughness of bone materials. Fractography is a standard technique for analyzing fracture behavior of brittle and quasi-brittle materials. Manatee ribs are highly mineralized and fracture in a manner similar to quasi-brittle materials. Therefore, quantitative fractography was applied to determine the fracture toughness of manatee ribs. Average fracture toughness values of small flexure specimens from six different sizes of manatees ranged from 1.3 to 2.6 MPa(m)(12). Scanning electron microscope (SEM) images show most of the fracture origins were at openings for blood vessels and interlayer spaces. Quantitative fractography and fracture mechanics can be combined to estimate the fracture toughness of the material in manatee rib bone. Fracture toughness of subadult and calf manatees appears to increase as the size of the manatee increases. Average fracture toughness of the manatee rib bone materials is less than the transverse fracture toughness of human and bovine tibia and femur.

The Geothermic Fatigue Hydraulic Fracturing Experiment in Äspö Hard Rock Laboratory, Sweden: New Insights Into Fracture Process through In-situ AE Monitoring

NASA Astrophysics Data System (ADS)

Kwiatek, G.; Plenkers, K.; Zang, A.; Stephansson, O.; Stenberg, L.

2016-12-01

The geothermic Fatigue Hydraulic Fracturing (FHF) in situ experiment (Nova project 54-14-1) took place in the Äspö Hard Rock Laboratory/Sweden in a 1.8 Ma old granitic to dioritic rock mass. The experiment aims at optimizing geothermal heat exchange in crystalline rock mass by multistage hydraulic fracturing at 10 m scale. Six fractures are driven by three different water injection schemes (continuous, cyclic, pulse pressurization) inside a 28 m long, horizontal borehole at depth level 410 m. The rock volume subject to hydraulic fracturing and monitored by three different networks with acoustic emission (AE), micro-seismicity and electromagnetic sensors is about 30 m x 30 m x 30 m in size. The 16-channel In-situ AE monitoring network by GMuG monitored the rupture generation and propagation in the frequency range 1000 Hz to 100,000 Hz corresponding to rupture dimensions from cm- to dm-scale. The in-situ AE monitoring system detected and analyzed AE activity in-situ (P- and S-wave picking, localization). The results were used to review the ongoing microfracturing activity in near real-time. The in-situ AE monitoring network successfully recorded and localized 196 seismic events for most, but not all, hydraulic fractures. All AE events detected in-situ occurred during fracturing time periods. The source parameters (fracture sizes, moment magnitudes, static stress drop) of AE events framing injection periods were calculated using the combined spectral fitting/spectra ratio techniques. The AE activity is clustered in space and clearly outline the fractures location, its orientation, and expansion as well as their temporal evolution. The outward migration of AE events away from the borehole is observed. Fractures extend up to 7 m from the injection interval in the horizontal borehole. The fractures orientation and location correlate for most fractures roughly with the results gained by image packer. Clear differences in seismic response between hydraulic fractures in different formations and injection schemes are visible which need further investigation. For further analysis all AE data of fracturing time periods were recorded continuously with 1 MHz sampling frequency per channel.

Ipsilateral intact fibula as a predictor of tibial plafond fracture pattern and severity.

PubMed

Luk, Pamela C; Charlton, Timothy P; Lee, Jackson; Thordarson, David B

2013-10-01

The objective of this study was to determine whether there is a difference in fracture pattern and severity of comminution between tibial plafond fractures with and without associated fibular fractures using computed tomography (CT). We hypothesized that the presence of an intact fibula was predictive of increased tibial plafond fracture severity. This was a case control, radiographic review performed at a single level I university trauma center. Between November 2007 and July 2011, 104 patients with 107 operatively treated tibial pilon fractures and preoperative CT scans were identified: 70 patients with 71 tibial plafond fractures had associated fibular fractures, and 34 patients with 36 tibial plafond fractures had intact fibulas. Four criteria were compared between the 2 groups: AO/OTA classification of distal tibia fractures, Topliss coronal and sagittal fracture pattern classification, plafond region of greatest comminution, and degree of proximal extension of fracture line. The intact fibula group had greater percentages of AO/OTA classification B2 type (5.5 vs 0, P = .046) and B3 type (52.8 vs 28.2, P = .013). Conversely, the percentage of AO/OTA classification C3 type was greater in the fractured fibula group (53.5 vs 30.6, P = .025). Evaluation using the Topliss sagittal and coronal classifications revealed no difference between the 2 groups (P = .226). Central and lateral regions of the plafond were the most common areas of comminution in fractured fibula pilons (32% and 31%, respectively). The lateral region of the plafond was the most common area of comminution in intact fibula pilon fractures (42%). There was no statistically significant difference (P = .71) in degree of proximal extension of fracture line between the 2 groups. Tibial plafond fractures with intact fibulas were more commonly associated with AO/OTA classification B-type patterns, whereas those with fractured fibulas were more commonly associated with C-type patterns. An intact fibula may be predictive of less comminution of the plafond. The lateral and central regions of the plafond were the most common areas of comminution in tibial plafond fractures, regardless of fibular status. Level III, case control study.

Body Temperature Monitoring Using Subcutaneously Implanted Thermo-loggers from Holstein Steers

PubMed Central

Lee, Y.; Bok, J. D.; Lee, H. J.; Lee, H. G.; Kim, D.; Lee, I.; Kang, S. K.; Choi, Y. J.

2016-01-01

Body temperature (BT) monitoring in cattle could be used to early detect fever from infectious disease or physiological events. Various ways to measure BT have been applied at different locations on cattle including rectum, reticulum, milk, subcutis and ear canal. In other to evaluate the temperature stability and reliability of subcutaneous temperature (ST) in highly fluctuating field conditions for continuous BT monitoring, long term ST profiles were collected and analyzed from cattle in autumn/winter and summer season by surgically implanted thermo-logger devices. Purposes of this study were to assess ST in the field condition as a reference BT and to determine any location effect of implantation on ST profile. In results, ST profile in cattle showed a clear circadian rhythm with daily lowest at 05:00 to 07:00 AM and highest around midnight and rather stable temperature readings (mean±standard deviation [SD], 37.1°C to 37.36°C±0.91°C to 1.02°C). STs are 1.39°C to 1.65°C lower than the rectal temperature and sometimes showed an irregular temperature drop below the normal physiologic one: 19.4% or 36.4% of 54,192 readings were below 36.5°C or 37°C, respectively. Thus, for BT monitoring purposes in a fever-alarming-system, a correction algorithm is necessary to remove the influences of ambient temperature and animal resting behavior especially in winter time. One way to do this is simply discard outlier readings below 36.5°C or 37°C resulting in a much improved mean±SD of 37.6°C±0.64°C or 37.8°C±0.55°C, respectively. For location the upper scapula region seems the most reliable and convenient site for implantation of a thermo-sensor tag in terms of relatively low influence by ambient temperature and easy insertion compared to lower scapula or lateral neck. PMID:26732455

Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women.

PubMed

Tanaka, S; Kuroda, T; Saito, M; Shiraki, M

2013-01-01

This cohort study of 1,614 postmenopausal Japanese women followed for 6.7 years showed that overweight/obesity and underweight are both risk factors for fractures at different sites. Fracture risk assessment may be improved if fracture sites are taken into account and BMI is categorized. The effect of body mass index (BMI) on fracture at a given level of bone mineral density (BMD) is controversial, since varying associations between BMI and fracture sites have been reported. A total of 1,614 postmenopausal Japanese women were followed for 6.7 years in a hospital-based cohort study. Endpoints included incident vertebral, femoral neck, and long-bone fractures. Rate ratios were estimated by Poisson regression models adjusted for age, diabetes mellitus, BMD, prior fracture, back pain, and treatment by estrogen. Over a mean follow-up period of 6.7 years, a total of 254 clinical and 335 morphometric vertebral fractures, 48 femoral neck fractures, and 159 long-bone fractures were observed. Incidence rates of vertebral fracture in underweight and normal weight women were significantly lower than overweight or obese women by 0.45 (95 % confidence interval: 0.32 to 0.63) and 0.61 (0.50 to 0.74), respectively, if BMD and other risk factors were adjusted, and by 0.66 (0.48 to 0.90) and 0.70 (0.58 to 0.84) if only BMD was not adjusted. Incidence rates of femoral neck and long-bone fractures in the underweight group were higher than the overweight/obese group by 2.15 (0.73 to 6.34) and 1.51 (0.82 to 2.77) and were similar between normal weight and overweight/obesity. Overweight/obesity and underweight are both risk factors for fractures at different sites. Fracture risk assessment may be improved if fracture sites are taken into account and BMI is categorized.

[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.

Experimental analysis of multiple factors on hydraulic fracturing in coalbed methane reservoirs

PubMed Central

Ma, Geng; Liu, Xiao; Tao, Yunqi; Feng, Dan; Li, Rui

2018-01-01

Hydraulic fracturing can improve the permeability of coalbed methane (CBM) reservoirs effectively, which is of great significance to the commercial production of CBM. However, the efficiency of hydraulic fracturing is affected by multiple factors. The mechanism of fracture initiation, morphology and propagation in CBM reservoirs is not clear and need to be further explored. Hydraulic fracturing experiment is an accurate tool to explore these mechanisms. The quantity of experimental coal rock is large and processing method is complex, so specimen made of similar materials was applied to replace coal rock. The true triaxial hydraulic fracturing experimental apparatus, 3D scanning device for coal rock section were applied to carry out hydraulic fracturing experiment. The results show that the initiation pressure is inversely proportional to the horizontal stress difference (Δσ) and positively related to fracturing fluid injection rate. When vertical stress (σv) is constant, the initiation pressure and fracture width decrease with the increasing of Δσ. Natural fractures can be connected by main fracture when propagates perpendicular to the direction of minimum horizontal stress (σh), then secondary fractures and fracture network form in CBM reservoirs. When two stresses of crustal stress are close and far different from the third one, the fracture morphology and propagation become complex. Influenced by perforations and filtration of fracturing fluid in specimen, fracturing fluid flows to downward easily after comparing horizontal well fracturing with vertical well fracturing. Fracture width increases with the decreasing of elastic modulus, the intensity of fracture is positively related with the elastic modulus of coal rock. The research results can provide theoretical basis and technical support for the efficient development of CBM. PMID:29621295

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

Experimental analysis of multiple factors on hydraulic fracturing in coalbed methane reservoirs.

PubMed

Zhang, Fan; Ma, Geng; Liu, Xiao; Tao, Yunqi; Feng, Dan; Li, Rui

2018-01-01

Hydraulic fracturing can improve the permeability of coalbed methane (CBM) reservoirs effectively, which is of great significance to the commercial production of CBM. However, the efficiency of hydraulic fracturing is affected by multiple factors. The mechanism of fracture initiation, morphology and propagation in CBM reservoirs is not clear and need to be further explored. Hydraulic fracturing experiment is an accurate tool to explore these mechanisms. The quantity of experimental coal rock is large and processing method is complex, so specimen made of similar materials was applied to replace coal rock. The true triaxial hydraulic fracturing experimental apparatus, 3D scanning device for coal rock section were applied to carry out hydraulic fracturing experiment. The results show that the initiation pressure is inversely proportional to the horizontal stress difference (Δσ) and positively related to fracturing fluid injection rate. When vertical stress (σv) is constant, the initiation pressure and fracture width decrease with the increasing of Δσ. Natural fractures can be connected by main fracture when propagates perpendicular to the direction of minimum horizontal stress (σh), then secondary fractures and fracture network form in CBM reservoirs. When two stresses of crustal stress are close and far different from the third one, the fracture morphology and propagation become complex. Influenced by perforations and filtration of fracturing fluid in specimen, fracturing fluid flows to downward easily after comparing horizontal well fracturing with vertical well fracturing. Fracture width increases with the decreasing of elastic modulus, the intensity of fracture is positively related with the elastic modulus of coal rock. The research results can provide theoretical basis and technical support for the efficient development of CBM.

Stress-Induced Fracturing of Reservoir Rocks: Acoustic Monitoring and μCT Image Analysis

NASA Astrophysics Data System (ADS)

Pradhan, Srutarshi; Stroisz, Anna M.; Fjær, Erling; Stenebråten, Jørn F.; Lund, Hans K.; Sønstebø, Eyvind F.

2015-11-01

Stress-induced fracturing in reservoir rocks is an important issue for the petroleum industry. While productivity can be enhanced by a controlled fracturing operation, it can trigger borehole instability problems by reactivating existing fractures/faults in a reservoir. However, safe fracturing can improve the quality of operations during CO2 storage, geothermal installation and gas production at and from the reservoir rocks. Therefore, understanding the fracturing behavior of different types of reservoir rocks is a basic need for planning field operations toward these activities. In our study, stress-induced fracturing of rock samples has been monitored by acoustic emission (AE) and post-experiment computer tomography (CT) scans. We have used hollow cylinder cores of sandstones and chalks, which are representatives of reservoir rocks. The fracture-triggering stress has been measured for different rocks and compared with theoretical estimates. The population of AE events shows the location of main fracture arms which is in a good agreement with post-test CT image analysis, and the fracture patterns inside the samples are visualized through 3D image reconstructions. The amplitudes and energies of acoustic events clearly indicate initiation and propagation of the main fractures. Time evolution of the radial strain measured in the fracturing tests will later be compared to model predictions of fracture size.

Integrated workflow for characterizing and modeling fracture network in unconventional reservoirs using microseismic data

NASA Astrophysics Data System (ADS)

Ayatollahy Tafti, Tayeb

We develop a new method for integrating information and data from different sources. We also construct a comprehensive workflow for characterizing and modeling a fracture network in unconventional reservoirs, using microseismic data. The methodology is based on combination of several mathematical and artificial intelligent techniques, including geostatistics, fractal analysis, fuzzy logic, and neural networks. The study contributes to scholarly knowledge base on the characterization and modeling fractured reservoirs in several ways; including a versatile workflow with a novel objective functions. Some the characteristics of the methods are listed below: 1. The new method is an effective fracture characterization procedure estimates different fracture properties. Unlike the existing methods, the new approach is not dependent on the location of events. It is able to integrate all multi-scaled and diverse fracture information from different methodologies. 2. It offers an improved procedure to create compressional and shear velocity models as a preamble for delineating anomalies and map structures of interest and to correlate velocity anomalies with fracture swarms and other reservoir properties of interest. 3. It offers an effective way to obtain the fractal dimension of microseismic events and identify the pattern complexity, connectivity, and mechanism of the created fracture network. 4. It offers an innovative method for monitoring the fracture movement in different stages of stimulation that can be used to optimize the process. 5. Our newly developed MDFN approach allows to create a discrete fracture network model using only microseismic data with potential cost reduction. It also imposes fractal dimension as a constraint on other fracture modeling approaches, which increases the visual similarity between the modeled networks and the real network over the simulated volume.

Biochemical Markers of Bone Turnover in Percutaneous Vertebroplasty for Osteoporotic Compression Fracture

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

Komemushi, Atsushi, E-mail: kome64@yo.rim.or.jp; Tanigawa, Noboru; Kariya, Shuji

Purpose. To evaluate relationships between biochemical markers of bone turnover, bone mineral density, and new compression fractures following vertebroplasty. Methods. Initially, we enrolled 30 consecutive patients with vertebral compression fractures caused by osteoporosis. Twenty-three of the 30 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. The patients were divided into two groups: patients with new fractures (group F) and patients with no new fractures (group N). We analyzed differences in the following parameters between these two groups: serum bone alkaline phosphatase, urinary crosslinked N-telopeptide of type I collagen, urinary deoxypyridinoline, and bone mineral density.more » Next, the patients were divided into another two groups: patients with higher risk (group H: urinary crosslinked N-telopeptide of type I collagen >54.3 nmol BCE/mmol Cr or urinary deoxypyridinoline >7.6 nmol/mmol Cr, and serum bone alkaline phosphatase <29.0 U/l) and patients with lower risk (group L). We analyzed the difference in the rate of new fractures between these two groups. Results. We identified 9 new fractures in 7 patients. There were no significant differences between groups F and N. We identified 5 new fractures in 3 of the 4 patients in group H, and 4 new fractures in 4 of the 19 patients in group L. There was a significant difference in the rate of new fractures between groups H and L. Conclusions. A combination of high levels of bone resorption markers and normal levels of bone formation markers may be associated with increased risk of new recurrent fractures after percutaneous vertebroplasty.« less

Relationship between fracture of mandibular condyle and absence of unerupted mandibular third molar-a retrospective study.

PubMed

Rajan, Ritesh; Verma, Dinesh Kumar; Borle, R M; Yadav, Abhilasha

2016-06-01

The purpose of the present study was to find, if there exists, a co-relation between presence of unerupted mandibular third molar and fracture of mandibular condyle. A retrospective, multicenter study was done collecting the data of all mandibular condyle fractures treated from November 2006 till August 2015. Data was collected from the patient's records and radiographs for the following information: age, sex, etiology of fracture, presence and state of lower third molars, and associated fracture. The results were subjected to statistical analysis. Out of 180 patients of condylar fracture, unerupted third molars were present in 35 (19.44 %) cases compared to 145 (80.55 %) cases of condylar fracture where the unerupted third molars were not present. The difference was statistically significant (p < 0.05). In the unerupted third molar present group, isolated bilateral condylar fracture was seen in 4 (11.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 9 (25.7 %) cases, isolated unilateral condylar fracture in 0 (0.0 %) cases, and unilateral condylar fracture associated with other mandibular fractures in 17 (48.5 %) cases and condylar fracture associated with mid face fractures in 5 (14.2 %) cases. In the unerupted third molar absent group, isolated bilateral condylar fracture was seen in 5 (3.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 30 (20.6 %) cases, isolated unilateral condylar fracture in 24 (16.5 %) cases, unilateral condylar fracture associated with other mandibular fractures in 73 (50.34 %) cases, and condylar fracture associated with mid face fractures in 13(8.96 %) cases. The difference between the groups was statistically significant (p = 0.032). This study suggests that the fractures of mandibular condylar region have a significantly higher incidence in patients without an unerupted mandibular third molar.

Biomechanical assessment and clinical analysis of different intramedullary nailing systems for oblique fractures.

PubMed

Alierta, J A; Pérez, M A; Seral, B; García-Aznar, J M

2016-09-01

The aim of this study is to evaluate the fracture union or non-union for a specific patient that presented oblique fractures in tibia and fibula, using a mechanistic-based bone healing model. Normally, this kind of fractures can be treated through an intramedullary nail using two possible configurations that depends on the mechanical stabilisation: static and dynamic. Both cases are simulated under different fracture geometries in order to understand the effect of the mechanical stabilisation on the fracture healing outcome. The results of both simulations are in good agreement with previous clinical experience. From the results, it is demonstrated that the dynamization of the fracture improves healing in comparison with a static or rigid fixation of the fracture. This work shows the versatility and potential of a mechanistic-based bone healing model to predict the final outcome (union, non-union, delayed union) of realistic 3D fractures where even more than one bone is involved.

Gender differences influence the outcome of geriatric rehabilitation following hip fracture.

PubMed

Arinzon, Zeev; Shabat, Shay; Peisakh, Alexander; Gepstein, Reuven; Berner, Yitshal N

2010-01-01

Hip fracture represents the most dramatic expression of the disease, in terms of morbidity, medical cost and mortality. The incidence of hip fracture increases substantially with age. The purpose of this study was to evaluate the association between gender and geriatric rehabilitation outcome after traumatic hip fracture. Ninety-nine community-dwelling elderly patients (older than 65 years), 64 women and 35 men, who were admitted to geriatric rehabilitation after operated hip fracture were studied. We assessed the patients' clinical and demographic data, preoperative risk (ASA), type of fracture and orthopedic repair, pain intensity (VAS), cognitive (MMSE), mood (Zung IDS), and functional status (FIM) on admission and at the end of geriatric rehabilitation. Men had higher mean number of comorbid conditions at the time of the fracture. Men recovered more from depressed mood in comparison with women during the rehabilitation. Significant improvement in FIM motor subscore on discharge was found in both groups. The FIM motor subscore gain was higher in men (24.47) in comparison with women (19.22, p=0.036). Those differences were demonstrated in mean subscores of transfers (p=0.004), and locomotion (p=0.019). Women were more functionally dependent in locomotion, transfers and sphincter control. There were no differences between the groups by duration on rehabilitation stay. Recovery after hip fracture depends in large part on the pre-fracture health and functional ability of the patient. Gender differences in functional recovery may affect therapeutic and rehabilitative decision making. Functional recovery after traumatic hip fracture was better in men in comparison with women.

Flow and fracture behavior of aluminum alloy 6082-T6 at different tensile strain rates and triaxialities

PubMed Central

Chen, Xuanzhen; Peng, Shan; Yao, Song; Chen, Chao; Xu, Ping

2017-01-01

This study aims to investigate the flow and fracture behavior of aluminum alloy 6082-T6 (AA6082-T6) at different strain rates and triaxialities. Two groups of Charpy impact tests were carried out to further investigate its dynamic impact fracture property. A series of tensile tests and numerical simulations based on finite element analysis (FEA) were performed. Experimental data on smooth specimens under various strain rates ranging from 0.0001~3400 s-1 shows that AA6082-T6 is rather insensitive to strain rates in general. However, clear rate sensitivity was observed in the range of 0.001~1 s-1 while such a characteristic is counteracted by the adiabatic heating of specimens under high strain rates. A Johnson-Cook constitutive model was proposed based on tensile tests at different strain rates. In this study, the average stress triaxiality and equivalent plastic strain at facture obtained from numerical simulations were used for the calibration of J-C fracture model. Both of the J-C constitutive model and fracture model were employed in numerical simulations and the results was compared with experimental results. The calibrated J-C fracture model exhibits higher accuracy than the J-C fracture model obtained by the common method in predicting the fracture behavior of AA6082-T6. Finally, the Scanning Electron Microscope (SEM) of fractured specimens with different initial stress triaxialities were analyzed. The magnified fractographs indicate that high initial stress triaxiality likely results in dimple fracture. PMID:28759617

3D Simulation of Multiple Simultaneous Hydraulic Fractures with Different Initial Lengths in Rock

NASA Astrophysics Data System (ADS)

Tang, X.; Rayudu, N. M.; Singh, G.

2017-12-01

Hydraulic fracturing is widely used technique for extracting shale gas. During this process, fractures with various initial lengths are induced in rock mass with hydraulic pressure. Understanding the mechanism of propagation and interaction between these induced hydraulic cracks is critical for optimizing the fracking process. In this work, numerical results are presented for investigating the effect of in-situ parameters and fluid properties on growth and interaction of multi simultaneous hydraulic fractures. A fully coupled 3D fracture simulator, TOUGH- GFEM is used for simulating the effect of different vital parameters, including in-situ stress, initial fracture length, fracture spacing, fluid viscosity and flow rate on induced hydraulic fractures growth. This TOUGH-GFEM simulator is based on 3D finite volume method (FVM) and partition of unity element method (PUM). Displacement correlation method (DCM) is used for calculating multi - mode (Mode I, II, III) stress intensity factors. Maximum principal stress criteria is used for crack propagation. Key words: hydraulic fracturing, TOUGH, partition of unity element method , displacement correlation method, 3D fracturing simulator

Sex differences in the spatial distribution of bone in relation to incident hip fracture: Findings from the AGES-Reykjavik study.

PubMed

Marques, Elisa A; Carballido-Gamio, Julio; Gudnason, Vilmundur; Sigurdsson, Gunnar; Sigurdsson, Sigurdur; Aspelund, Thor; Siggeirsdottir, Kristin; Launer, Lenore; Eiriksdottir, Gudny; Lang, Thomas; Harris, Tamara B

2018-05-16

In this case-cohort study, we used data-driven computational anatomy approaches to assess within and between sex spatial differences in proximal femoral bone characteristics in relation to incident hip fracture. One hundred male and 234 female incident hip fracture cases, and 1047 randomly selected noncase subcohort participants (562 female) were chosen from the population-based AGES-Reykjavik study (mean age of 77 years). The baseline -i.e. before hip fracture- hip quantitative computed tomography scans of these subjects were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties (thickness, vBMD and trabecular vBMD adjacent to the endosteal surface) of the proximal femur, respectively, in relation to incident hip fracture. Results showed that in both men and women: 1) the superior aspect of the femoral neck and the trochanteric region (except for cortical bone thickness) were consistently identified as being associated with incident hip fracture, and 2) differences in bone properties between noncases and incident hip fracture cases followed similar trends, were located at compatible regions, and manifested heterogeneity in the spatial distribution of their magnitude with focal regions showing larger differences. With respect to sex differences, most of the regions with a significant interaction between fracture group and sex showed: 1) differences of greater magnitude in men between noncases and incident hip fracture cases with different spatial distributions for all bone properties with the exception of cortical bone thickness, and 2) that while most of these regions showed better bone quality in male cases than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions including the anterior, posterior, and lateral aspects of the proximal femur. These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk. Copyright © 2017. Published by Elsevier Inc.

Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability.

PubMed

Baek, Hye Jin; Kim, Dong Wook; Ryu, Ji Hwa; Lee, Yoo Jin

2013-09-01

There has been no study to compare the diagnostic accuracy of an experienced radiologist with a trainee in nasal bone fracture. To compare the diagnostic accuracy between conventional radiography and computed tomography (CT) for the identification of nasal bone fractures and to evaluate the interobserver reliability between a staff radiologist and a trainee. A total of 108 patients who underwent conventional radiography and CT after acute nasal trauma were included in this retrospective study. Two readers, a staff radiologist and a second-year resident, independently assessed the results of the imaging studies. Of the 108 patients, the presence of a nasal bone fracture was confirmed in 88 (81.5%) patients. The number of non-depressed fractures was higher than the number of depressed fractures. In nine (10.2%) patients, nasal bone fractures were only identified on conventional radiography, including three depressed and six non-depressed fractures. CT was more accurate as compared to conventional radiography for the identification of nasal bone fractures as determined by both readers (P <0.05), all diagnostic indices of an experienced radiologist were similar to or higher than those of a trainee, and κ statistics showed moderate agreement between the two diagnostic tools for both readers. There was no statistical difference in the assessment of interobserver reliability for both imaging modalities in the identification of nasal bone fractures. For the identification of nasal bone fractures, CT was significantly superior to conventional radiography. Although a staff radiologist showed better values in the identification of nasal bone fracture and differentiation between depressed and non-depressed fractures than a trainee, there was no statistically significant difference in the interpretation of conventional radiography and CT between a radiologist and a trainee.

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.

Fracturesis Jointitis: Causes, Symptoms, and Treatment in Groundwater Communities.

PubMed

Manda, Alex K; Horsman, Eric

2015-01-01

Fracturesis Jointitis is a grammatical disorder characterized by failure or inability to understand the difference between overarching and specific terms of brittle deformation features. The disorder leads to the use of the word "fracture" as a specific type of discontinuity rather than as an overarching term for mechanical breaks in rocks. This condition appears to be prevalent among groundwater practitioners working with fractured rocks. Common signs and symptoms of Fracturesis Jointitis include the use of terms such as "joints and fractures" and "joints, faults and fractures" when describing fractures in rocks. At best, such terms imply that a "fracture" is one of many kinds of features like joints and faults, and at worst that joints and faults are not fractures but something else. Using proper terms to identify specific fracture types is critical because fractures may act as either barriers to groundwater flow (e.g., faults or deformation bands) or conduits for flow (e.g., faults and joints), The treatment for Fracturesis Jointitis involves an education campaign highlighting to the groundwater community the different fracture types that exist, the modes by which fractures propagate and the role that these fractures play in facilitating or hindering groundwater flow. Those afflicted by Fracturesis Jointitis can be cured of the condition by avoiding the word "fractures" in phrases such as "joints and fractures" or by adding descriptive words before the word "fractures" to specify fracture types (e.g., "foliation-parallel" fractures). Only with a concerted education campaign can we rid our community of Fracturesis Jointitis. © 2014, National Ground Water Association.

Digital diagnosis and treatment of mandibular condylar fractures based on Extensible Neuro imaging Archive Toolkit (XNAT)

PubMed Central

Ren, Jiayin; He, Mingyun; Huang, Yongqing; Tian, WeiDong; Tang, Wei

2018-01-01

Objectives The treatment of condylar fractures has long been controversial. In this paper, we established a database for accurate measurement, storage, management and analysis of patients’ data, in order to help determine the best treatment plan. Methods First of all, the diagnosis and treatment database was established based on XNAT, including 339 cases of condylar fractures and their related information. Then image segmentation, registration and three-dimensional (3D) measurement were used to measure and analyze the condyle shapes. Statistical analysis was used to analyze the anatomical structure changes of condyle and the surrounding tissues at different stages before and after treatment. The processes of condylar fracture reestablishment at different stages were also dynamically monitored. Finally, based on all these information, the digital diagnosis and treatment plans for condylar fractures were developed. Results For the patients less than 18 years old with no significant dislocation, surgical treatment and conservative treatment were equally effective for intracapsular fracture, and had no significant difference for neck and basal fractures. For patients above 18 years old, there was no significant difference between the two treatment methods for intracapsular fractures; but for condylar neck and basal fractures, surgical treatment was better than conservative treatment. When condylar fracture shift angle was greater than 11 degrees, and mandibular ramus height reduction was greater than 4mm, the patients felt the strongest pain, and their mouths opening was severely restricted. There were 170 surgical cases with condylar fracture shift angel greater than 11 degrees, and 118 of them (69.4%) had good prognosis, 52 of them (30.6%) had complications such as limited mouth opening. There were 173 surgical cases with mandibular ramus height reduction more than 4mm, and 112 of them (64.7%) had good prognosis, 61 of them (35.3%) had complications such as limited mouth opening. Conclusions The establishment of XNAT condylar fracture database is helpful for establishing a digital diagnosis and treatment workflow for mandibular condylar fractures, providing new theoretical foundation and application basis for diagnosis and treatment of condylar fractures. PMID:29432477

A retrospective study of eyeball rupture in patients with or without orbital fracture

PubMed Central

Chen, Xiang; Yao, Yi; Wang, Fengxiang; Liu, Tiecheng; Zhao, Xiao

2017-01-01

Abstract To summarize the clinical features of eyeball rupture with or without orbital fracture and explore the differences between them. In all, 197 patients were observed, and the following data were recorded: sex, age, time of injury, place of injury, cause of trauma, zone of eye injury, intraocular content prolapse, surgical methods and the therapeutic process, visual acuity after injury, and the final best corrected visual acuity. The results were analyzed for statistically significant differences. There was no significant difference (P > .05) in the age, sex, or cause of injury. Patients with eyeball rupture with fracture had poorer vision than did those in the simple eyeball rupture group; eyeball rupture with fracture also had a higher probability of enucleation. In this study, the clinical results show that prognosis of eyeball rupture with orbital fracture is worse than that of eyeball rupture without orbital fracture. PMID:28614230

A retrospective study of eyeball rupture in patients with or without orbital fracture.

PubMed

Chen, Xiang; Yao, Yi; Wang, Fengxiang; Liu, Tiecheng; Zhao, Xiao

2017-06-01

To summarize the clinical features of eyeball rupture with or without orbital fracture and explore the differences between them.In all, 197 patients were observed, and the following data were recorded: sex, age, time of injury, place of injury, cause of trauma, zone of eye injury, intraocular content prolapse, surgical methods and the therapeutic process, visual acuity after injury, and the final best corrected visual acuity. The results were analyzed for statistically significant differences.There was no significant difference (P > .05) in the age, sex, or cause of injury. Patients with eyeball rupture with fracture had poorer vision than did those in the simple eyeball rupture group; eyeball rupture with fracture also had a higher probability of enucleation.In this study, the clinical results show that prognosis of eyeball rupture with orbital fracture is worse than that of eyeball rupture without orbital fracture.

Susceptibility to keel bone fractures in laying hens and the role of genetic variation.

PubMed

Candelotto, Laura; Stratmann, Ariane; Gebhardt-Henrich, Sabine G; Rufener, Christina; van de Braak, Teun; Toscano, Michael J

2017-10-01

Keel bone fractures are a well-known welfare problem in modern commercial laying hen systems. The present study sought to identify genetic variation in relation to keel bone fracture susceptibility of 4 distinct crossbred and one pure line, and by extension, possible breeding traits. Susceptibility to fractures were assessed using an ex vivo impact testing protocol in combination with a study design that minimized environmental variation to focus on genetic differences. The 5 crossbred/pure lines differed in their susceptibility to keel bone fractures with the greatest likelihood of fracture in one of the 3 commercial lines and the lowest susceptibility to fractures in one of the experimental lines. Egg production at the hen-level did not differ between the crossbred/pure lines (P > 0.05), though an increased susceptibility to keel bone fractures was associated with thinner eggshells and reduced egg breaking strength, a pattern consistent among all tested crossbred/pure lines. Our findings suggest an association between egg quality and bone strength which appeared to be independent of crossbred/pure line. The findings indicate the benefit of the impact methodology to identify potential breeding characteristics to reduce incidence of keel fracture as well as the potential relationship with eggshell quality. © 2017 Poultry Science Association Inc.

Numerical Simulation of Permeability Change in Wellbore Cement Fractures after Geomechanical Stress and Geochemical Reactions Using X-ray Computed Tomography Imaging

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

Kabilan, Senthil; Jung, Hun Bok; Kuprat, Andrew P.

X-ray microtomography (XMT) imaging combined with a three-dimensional (3D) computational fluid dynamics (CFD) modeling technique was used to study the effect of geochemical and geomechanical processes on fracture properties in composite Portland cement–basalt caprock core samples. The effect of fluid properties and flow conditions on fracture permeability was numerically studied by using fluids with varying physical properties and simulating different pressure conditions. CFD revealed that the application of geomechanical stress led to increased fluid flow, which resulted in increased fracture permeability. After CO2-reaction, XMT images displayed preferential precipitation of calcium carbonate within the fractures in the cement matrix and lessmore » precipitation in fractures located at the cement–basalt interface. CFD predicted changes in flow characteristics and differences in absolute values of flow properties due to different pressure gradients. CFD was able to highlight the profound effect of fluid properties on flow characteristics and hydraulic properties of fractures. This study demonstrates the applicability of XMT imaging and CFD as powerful tools for characterizing the hydraulic properties of fractures in a number of applications like geologic carbon sequestration and storage, hydraulic fracturing for shale gas production, and enhanced geothermal systems.« less

Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur.

PubMed

Hey, Hwee Weng Dennis; Sng, Weizhong Jonathan; Lim, Joel Louis Zongwei; Tan, Chuen Seng; Gan, Alfred Tau Liang; Ng, Jun Han Charles; Kagda, Fareed H Y

2015-12-01

Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns. This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling. After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively). Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores compared to neck of femur fractures, suggesting that the fracture traversed through the areas with the lowest bone density in the proximal femur. In the absence of reduced T.Troc and T.Inter, neck of femur fractures occurred more commonly. T-Total scores may underestimate the severity of osteoporosis/osteopenia and measuring T-score at the neck of femur may better reflect the severity of osteoporosis and likelihood of a fragility fracture.

The Frank Stinchfield Award : Total Hip Arthroplasty for Femoral Neck Fracture Is Not a Typical DRG 470: A Propensity-matched Cohort Study.

PubMed

Schairer, William W; Lane, Joseph M; Halsey, David A; Iorio, Richard; Padgett, Douglas E; McLawhorn, Alexander S

2017-02-01

Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differences are largely uncharacterized, and the Medicare Severity Diagnosis-Related Groups system does not distinguish between THA performed for fracture and OA. (1) What are the differences in in-hospital and 30-day postoperative clinical outcomes for THA performed for femoral neck fracture versus OA? (2) Is a patient's fracture status, that is whether or not a patient has a femoral neck fracture, associated with differences in in-hospital and 30-day postoperative clinical outcomes after THA? The National Surgical Quality Improvement Program (NSQIP) database, which contains outcomes for surgical patients up to 30 days after discharge, was used to identify patients undergoing THA for OA and femoral neck fracture. OA and fracture cohorts were matched one-to-one using propensity scores based on age, gender, American Society of Anesthesiologists grade, and medical comorbidities. Propensity scores represented the conditional probabilities for each patient having a femoral neck fracture based on their individual characteristics, excluding their actual fracture status. Outcomes of interest included operative time, length of stay (LOS), complications, transfusion, discharge destination, and readmission. There were 42,692 patients identified (41,739 OA; 953 femoral neck fractures) with 953 patients in each group for the matched analysis. For patients with fracture, operative times were slightly longer (98 versus 92 minutes, p = 0.015), they experienced longer LOS (6 versus 4 days, p < 0.001), and the overall frequency of complications was greater compared with patients with OA (16% versus 6%, p < 0.001). Although the frequency of preoperative transfusions was higher in the fracture group (2.0% versus 0.2%, p = 0.002), the frequency of postoperative transfusion was not different between groups (27% versus 24%, p = 0.157). Having a femoral neck fracture versus OA was strongly associated with any postoperative complication (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.1-3.8]; p < 0.001), unplanned readmission (OR, 1.8; 95% CI, 1.0-3.2; p = 0.049), and discharge to an inpatient facility (OR, 1.7; 95% CI, 1.4-2.0; p < 0.001). Compared with THA for OA, THA for femoral neck fracture is associated with greater rates of complications, longer LOS, more likely discharge to continued inpatient care, and higher rates of unplanned readmission. This implies higher resource utilization for patients with a fracture. These differences exist despite matching of other preoperative risk factors. As healthcare reimbursement moves toward bundled payment models, it would seem important to differentiate patients and procedures based on the resource utilization they represent to healthcare systems. These results show different expected resource utilization in these two fundamentally different groups of patients undergoing hip arthroplasty, suggesting a need to modify healthcare policy to maintain access to THA for all patients. Level III, therapeutic study.

Influence of Regional Difference in Bone Mineral Density on Hip Fracture Site in Elderly Females by Finite Element Analysis.

PubMed

Lin, Z L; Li, P F; Pang, Z H; Zheng, X H; Huang, F; Xu, H H; Li, Q L

2015-11-01

Hip fracture is a kind of osteoporotic fractures in elderly patients. Its important monitoring indicator is to measure bone mineral density (BMD) using DXA. The stress characteristics and material distribution in different parts of the bones can be well simulated by three-dimensional finite element analysis. Our previous studies have demonstrated a linear positive correlation between clinical BMD and the density of three-dimensional finite element model of the femur. However, the correlation between the density variation between intertrochanteric region and collum femoris region of the model and the fracture site has not been studied yet. The present study intends to investigate whether the regional difference in the density of three-dimensional finite element model of the femur can be used to predict hip fracture site in elderly females. The CT data of both hip joints were collected from 16 cases of elderly female patients with hip fractures. Mimics 15.01 software was used to reconstruct the model of proximal femur on the healthy side. Ten kinds of material properties were assigned. In Abaqus 6.12 software, the collum femoris region and intertrochanteric region were, respectively, drawn for calculating the corresponding regional density of the model, followed by prediction of hip fracture site and final comparison with factual fracture site. The intertrochanteric region/collum femoris region density was [(1.20 ± 0.02) × 10(6)] on the fracture site and [(1.22 ± 0.03) × 10(6)] on the non-fracture site, and the difference was statistically significant (P = 0.03). Among 16 established models of proximal femur on the healthy side, 14 models were consistent with the actual fracture sites, one model was inconsistent, and one model was unpredictable, with the coincidence rate of 87.5 %. The intertrochanteric region or collum femoris region with lower BMD is more prone to hip fracture of the type on the corresponding site.

Age and sex-related differences in 431 pediatric facial fractures at a level 1 trauma center.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Paik, Angie M; Lee, Edward S; Granick, Mark S

2014-10-01

Age and sex-related changes in the pattern of fractures and concomitant injuries observed in this patient population is helpful in understanding craniofacial development and the treatment of these unique injuries. The goal of this study was to examine all facial fractures occurring in a child and adolescent population (age 18 or less) at a trauma center to determine any age or sex-related variability amongst fracture patterns and concomitant injuries. All facial fractures occurring at a trauma center were collected over a 12-year period based on International Classification of Disease, rev. 9 codes. This was delimited to include only those patients 18 years of age or younger. Age, sex, mechanism, and fracture types were collected and analyzed. During this time period, there were 3147 patients with facial fractures treated at our institution, 353 of which were in children and adolescent patients. Upon further review 68 patients were excluded due to insufficient data for analysis, leaving 285 patients for review, with a total of 431 fractures. The most common etiology of injury was assault for males and motor vehicle accidents (MVA) for females. The most common fracture was of the mandible in males and of the orbit in females. The most common etiology in younger age groups includes falls and pedestrian struck. Older age groups exhibit a higher incidence of assault-related injuries. Younger age groups showed a propensity for orbital fractures as opposed to older age groups where mandibular fractures predominated. Intracranial hemorrhage was the most common concomitant injury across most age groups. The differences noted in etiology of injury, fracture patterns, and concomitant injuries between sexes and different age groups likely reflects the differing activities that each group engages in predominantly. In addition the growing facial skeleton offers varying degrees of protection to the cranial contents as force-absorbing mechanisms develop. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Use of the Photo-Electromyogram to Objectively Diagnose and Monitor Treatment of Post-TBI Light Sensitivity

DTIC Science & Technology

2013-10-01

Eye Clinic are being seen by the PI (Randy Kardon MD PhD) in his VA and University of Iowa neuro -ophthalmology clinics. These patients are being...using the DSI wireless data transmission system. We have implanted a functional transmitter into a subcutaneous pocket beyond the scapulae on the...implant more so than smaller mice. Figure 7. Recovery of mouse chronically implanted with subcutaneous EMG electrodes and transmitter . There was

Interactions of Subsymptomatic Doses of Sarin with Pyridostigmine - Neurochemical, Behavioral, and Physiological Effects

DTIC Science & Technology

2005-03-01

electrocardiogram (ECG) by suturing one of them with 5-0 polyvinyl material to the subcutaneous tissue over the right scapula and the other one at the...bands (Pereira de Souza et al.,2001). Concentrations ofACh, Ch, their deuterated variants, and ACh turnover in brain tissue . Animals were anesthetized...mesencephalon, neocortex, piriform cortex, and striatum. These tissue fragments were homogenized in ice cold 15% IN formic acid, 85% acetone for analysis

Osteoporotic Thoracolumbar Fractures-How Are They Different?-Classification and Treatment Algorithm.

PubMed

Rajasekaran, Shanmuganathan; Kanna, Rishi M; Schnake, Klaus J; Vaccaro, Alexander R; Schroeder, Gregory D; Sadiqi, Said; Oner, Cumhur

2017-09-01

Osteoporotic vertebral fractures constitute at least 50% of the osteoporotic fractures that happen worldwide. Occurrence of osteoporotic fractures make the elderly patient susceptible for further fractures and increases the morbidity due to kyphosis and pain; the mortality risk is also increased in these patients. Most fractures occur in the thoracic and thoracolumbar region and are often stable. Different descriptive and prognostic classification systems have been described, but none are universally accepted. Radiographs, computed tomography, and magnetic resonance imaging are useful in imaging the fracture and evaluating the bone density. In acute stages, the fractures are well treated with conservative measures including short bed rest, analgesics, bracing, and exercises. Although most fractures heal well, up to 30% of fractures can develop painful nonunion, progressive kyphosis, and neurological deficit. For patients who develop severe pain not responding to nonoperative measures and painful nonunion, percutaneous cement augmentation procedures including vertebroplasty or kyphoplasty have been suggested. For fractures with severe collapse and that lead to neurological deficit and increasing kyphosis, instrumented stabilization is advised. Prevention and management of osteoporosis is the key element in the management of osteoporotic fractures in the elderly. Guidelines for essential adequate dietary and supplemental calcium and vitamin D, and antiosteoporotic medications have been described.

A Comprehensive Numerical Model for Simulating Fluid Transport in Nanopores

PubMed Central

Zhang, Yuan; Yu, Wei; Sepehrnoori, Kamy; Di, Yuan

2017-01-01

Since a large amount of nanopores exist in tight oil reservoirs, fluid transport in nanopores is complex due to large capillary pressure. Recent studies only focus on the effect of nanopore confinement on single-well performance with simple planar fractures in tight oil reservoirs. Its impacts on multi-well performance with complex fracture geometries have not been reported. In this study, a numerical model was developed to investigate the effect of confined phase behavior on cumulative oil and gas production of four horizontal wells with different fracture geometries. Its pore sizes were divided into five regions based on nanopore size distribution. Then, fluid properties were evaluated under different levels of capillary pressure using Peng-Robinson equation of state. Afterwards, an efficient approach of Embedded Discrete Fracture Model (EDFM) was applied to explicitly model hydraulic and natural fractures in the reservoirs. Finally, three fracture geometries, i.e. non-planar hydraulic fractures, non-planar hydraulic fractures with one set natural fractures, and non-planar hydraulic fractures with two sets natural fractures, are evaluated. The multi-well performance with confined phase behavior is analyzed with permeabilities of 0.01 md and 0.1 md. This work improves the analysis of capillarity effect on multi-well performance with complex fracture geometries in tight oil reservoirs. PMID:28091599

A Comprehensive Numerical Model for Simulating Fluid Transport in Nanopores

NASA Astrophysics Data System (ADS)

Zhang, Yuan; Yu, Wei; Sepehrnoori, Kamy; di, Yuan

2017-01-01

Since a large amount of nanopores exist in tight oil reservoirs, fluid transport in nanopores is complex due to large capillary pressure. Recent studies only focus on the effect of nanopore confinement on single-well performance with simple planar fractures in tight oil reservoirs. Its impacts on multi-well performance with complex fracture geometries have not been reported. In this study, a numerical model was developed to investigate the effect of confined phase behavior on cumulative oil and gas production of four horizontal wells with different fracture geometries. Its pore sizes were divided into five regions based on nanopore size distribution. Then, fluid properties were evaluated under different levels of capillary pressure using Peng-Robinson equation of state. Afterwards, an efficient approach of Embedded Discrete Fracture Model (EDFM) was applied to explicitly model hydraulic and natural fractures in the reservoirs. Finally, three fracture geometries, i.e. non-planar hydraulic fractures, non-planar hydraulic fractures with one set natural fractures, and non-planar hydraulic fractures with two sets natural fractures, are evaluated. The multi-well performance with confined phase behavior is analyzed with permeabilities of 0.01 md and 0.1 md. This work improves the analysis of capillarity effect on multi-well performance with complex fracture geometries in tight oil reservoirs.

Seismic Characterizations of Fractures: Dynamic Diagnostics

NASA Astrophysics Data System (ADS)

Pyrak-Nolte, L. J.

2017-12-01

Fracture geometry controls fluid flow in a fracture, affects mechanical stability and influences energy partitioning that affects wave scattering. Our ability to detect and monitor fracture evolution is controlled by the frequency of the signal used to probe a fracture system, i.e. frequency selects the scales. No matter the frequency chosen, some set of discontinuities will be optimal for detection because different wavelengths sample different subsets of fractures. The select subset of fractures is based on the stiffness of the fractures which in turn is linked to fluid flow. A goal is obtaining information from scales outside the optimal detection regime. Fracture geometry trajectories are a potential approach to drive a fracture system across observation scales, i.e. moving systems between effective medium and scattering regimes. Dynamic trajectories (such as perturbing stress, fluid pressure, chemical alteration, etc.) can be used to perturb fracture geometry to enhance scattering or give rise to discrete modes that are intimately related to the micro-structural evolution of a fracture. However, identification of these signal features will require methods for identifying these micro-structural signatures in complicated scattered fields. Acknowledgment: This material is based upon work supported by the U.S. Department of Energy, Office of Science, Office of Basic Energy Sciences, Geosciences Research Program under Award Number (DE-FG02-09ER16022).

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

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

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

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

Effects of a continuous lateral turning device on pressure relief.

PubMed

Do, Nam Ho; Kim, Deog Young; Kim, Jung-Hoon; Choi, Jong Hyun; Joo, So Young; Kang, Na Kyung; Baek, Yoon Su

2016-01-01

[Purpose] The purpose of this study was to examine the pressure-relieving effects of a continuous lateral turning device on common pressure ulcer sites. [Subjects] Twenty-four healthy adults participated. [Methods] The design of our continuous lateral turning device was motivated by the need for an adequate pressure-relieving device for immobile and/or elderly people. The procedure of manual repositioning is embodied in our continuous lateral turning device. The interface pressure and time were measured, and comfort grade was evaluated during sessions of continuous lateral turning at 0°, 15°, 30°, and 45°. We quantified the pressure-relieving effect using peak pressure, mean pressure, and pressure time integration. [Results] Participants demonstrated pressure time integration values below the pressure-time threshold at 15°, 30°, and 45° at all the common pressure ulcer sites. Moreover, the most effective angles for pressure relief at the common pressure ulcer sites were 30° at the occiput, 15° at the left scapula, 45° at the right scapula, 45° at the sacrum, 15° at the right heel, and 30° at the left heel. However, angles greater than 30° induced discomfort. [Conclusion] Continuous lateral turning with our specially designed device effectively relieved the pressure of targeted sites. Moreover, the suggested angles of continuous lateral turning can be used to relieve pressure at targeted sites.

Restoration of the orbital aesthetic subunit with the thoracodorsal artery system of flaps in patients undergoing radiation therapy.

PubMed

Chanowski, Eric J P; Casper, Keith A; Eisbruch, Avraham; Heth, Jason A; Marentette, Lawrence J; Prince, Mark E; Moyer, Jeffrey S; Chepeha, Douglas B

2013-10-01

Objectives To demonstrate the advantages of the thoracodorsal artery scapular tip autogenous transplant (Tdast) for patients requiring restoration of the orbital aesthetic subunit. Design Prospective case series. Setting Tertiary center. Participants Ten patients (M:F,6:4) with a mean age of 56 years (range, 21 to 78 years) underwent restoration of the orbital aesthetic subunit and radiation therapy between 2001 and 2008. Main Outcome Measures The two reconstructive advantages of the thoracodorsal artery system of flaps for orbital reconstruction are a long pedicle and the suitability of the scapula tip to meet the three-dimensional requirements of the orbit. Patients were assessed 1 year or more after treatment for cosmetic outcome, work status, and socialization. Results Eight of 10 patients benefited from the three-dimensional nature of the scapula tip bone and 7 of 10 avoided vein grafting. Four of five evaluable patients reported "frequently" socializing outside their home. Four of five evaluable patients working before undergoing their treatment were able to return to work posttreatment. Seven of nine patients with postoperative photographs had minimal or no facial contour deformity. Conclusions The Tdast can restore orbital contour without osteotomy, and the thoracodorsal artery system of flaps has a long vascular pedicle that reduces vein grafting. Patients have an acceptable cosmetic result and return to preoperative work status and socialization.

Shoulder kinematics during the wall push-up plus exercise.

PubMed

Lunden, Jason B; Braman, Jonathan P; Laprade, Robert F; Ludewig, Paula M

2010-03-01

The push-up plus exercise is a common therapeutic exercise for improving shoulder function and treating shoulder pathology. To date, the kinematics of the push-up plus exercise have not been studied. Our hypothesis was that the wall push-up plus exercise would demonstrate increased scapular internal rotation and increased humeral anterior translation during the plus phase of the exercise, thereby potentially impacting the subacromial space. Bone pins were inserted in the humerus and scapula in 12 healthy volunteers with no history of shoulder pathology. In vivo motion during the wall push-up plus exercise was tracked using an electromagnetic tracking system. During the wall push-up plus exercise, from a starting position to the push-up plus position, there was a significant increase in scapular downward rotation (P < .05) and internal rotation (P < .05). The pattern of glenohumeral motion was humeral elevation (P < .05) and movement anterior to the scapular plane (P < .05), with humeral external rotation remaining relatively constant. We found that during a wall push-up plus exercise in healthy volunteers, the scapula was placed in a position potentially associated with shoulder impingement. Because of the shoulder kinematics of the wall push-up plus exercise, utilization of this exercise without modification early on in shoulder rehabilitation, especially in patients with subacromial impingement, should be considered cautiously. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Effective Wettability of Heterogenous Fracture Surfaces Using the Lattice-Boltzmann Method

NASA Astrophysics Data System (ADS)

E Santos, J.; Prodanovic, M.; Landry, C. J.

2017-12-01

Fracture walls in the subsurface are often structured by minerals of different composition (potentially further altered in contact with fluids during hydrocarbon extraction or CO2 sequestration), this yields in a heterogeneous wettability of the surface in contact with the fluids. The focus of our work is to study how surfaces presenting different mineralogy and roughness affect multiphase flow in fractures. Using the Shan-Chen model of the lattice-Boltzmann method (LBM) we define fluid interaction and surface attraction parameters to simulate a system of a wetting and a non-wetting fluid. In this work, we use synthetically created fractures presenting different arrangements of wetting and non-wetting patches, and with or without roughness; representative of different mineralogy, similar workflow can be applied to fractures extracted from X-ray microtomography images of fractures porous media. The results from the LBM simulations provide an insight on how the distribution of mineralogy and surface roughness are related with the observed macroscopic contact angle. We present a comparison between the published analytical models, and our results based on surface areas, spatial distribution and local fracture aperture. The understanding of the variables that affect the contact angle is useful for the comprehension of multiphase processes in naturally fractured reservoirs like primary oil production, enhanced oil recovery and CO2 sequestration. The macroscopic contact angle analytical equations for heterogeneous surfaces with variable roughness are no longer valid in highly heterogeneous systems; we quantify the difference thus offering an alternative to analytical models.

[Torque resistance of three different types of nickel-titanium rotary instruments].

PubMed

Sun, Wei; Hou, Ben-xiang

2010-10-01

To compare torsional fracture of three different types of nickel-titanium rotary instruments ProTaper, Hero642 and Mtwo by making a stimulate models in vitro. Through the establishment of model in vitro, compared the different time with 3 kinds of nickel titanium file in cutting-edge bound occurs, and to observe the section of fractured instruments by scanning electron microscope. The resistence to torque was different from three types of nickel titanium instruments. The time to fracture of Mtwo was significantly longer than ProTaper's and Hero642's, but ProTaper's and Hero642's had no significant difference. Three kinds cross-sectional design were different, a lot of toughness nests were seen in broken surface. Most of them were ductile fracture. Time to fracture was influenced by the quality disfigurement. The resistance to torque of Mtwo was better than ProTaper and Hero642. The lifespan was influenced by the design of cross-section. The quality disfigurement of the files reduced the resistance to flexual fatigue.

Sex-Related Differences in Scapular Kinematics During Elevation of the Arm in Asymptomatic Children and Adults.

PubMed

Habechian, Fernanda Assis Paes; Rosa, Dayana Patricia; Haik, Melina Nevoeiro; Camargo, Paula Rezende

2016-10-01

Recently, it has been suggested that sex may influence scapular kinematics. A more comprehensive analysis of the scapular kinematics in children and adults, including sex as a factor, will help to understand if differences between sexes are present since childhood. The purpose of this study was to compare scapular kinematics between sex in children and adults during elevation of the arm. One-hundred and sixteen asymptomatic adults (58 men and 58 women) and 53 children (28 boys and 25 girls) participated in the study. Three-dimensional scapular kinematics during elevation of the arm were obtained using an electromagnetic tracking device. Women had a more upwardly rotated scapula in the nondominant side (P < .05), with large effects and a more anteriorly tilted position at 60°, 90°, and 120° of arm elevation in the dominant side, and at 90° and 120° in the nondominant side (P < .05) with moderate effects when compared with men. Differences between sexes were not found in the children (P > .05). In conclusion, sex seems to influence scapular kinematics in adulthood, but not in childhood.

Association between findings on palmarodorsal radiographic images and detection of a fracture in the proximal sesamoid bones of forelimbs obtained from cadavers of racing Thoroughbreds.

PubMed

Anthenill, Lucy A; Stover, Susan M; Gardner, Ian A; Hill, Ashley E; Lee, Christina M; Anderson, Mark L; Barr, Bradd C; Read, Deryck H; Johnson, Bill J; Woods, Leslie W; Daft, Barbara M; Kinde, Hailu; Moore, Janet D; Farman, Cynthia A; Odani, Jenee S; Pesavento, Patricia A; Uzal, Francisco A; Case, James T; Ardans, Alex A

2006-05-01

To determine the distribution for limbs and bones in horses with fractures of the proximal sesamoid bones and relationships with findings on palmarodorsal radiographic images. Proximal sesamoid bones obtained from both forelimbs of cadavers of 328 racing Thoroughbreds. Osteophytes; large vascular channels; and fracture location, orientation, configuration, and margin distinctness were categorized by use of high-detail contact palmarodorsal radiographs. Distributions of findings were determined. Relationships between radiographic findings and fracture characteristics were examined by use of chi2 and logistic regression techniques. Fractures were detected in 136 (41.5%) horses. Biaxial fractures were evident in 109 (80%) horses with a fracture. Osteophytes and large vascular channels were evident in 266 (81%) and 325 (99%) horses, respectively. Medial bones typically had complete transverse or split transverse simple fractures, indistinct fracture margins, > 1 vascular channel that was > 1 mm in width, and osteophytes in abaxial wing and basilar middle or basilar abaxial locations. Lateral bones typically had an oblique fracture and distinct fracture margins. Odds of proximal sesamoid bone fracture were approximately 2 to 5 times higher in bones without radiographic evidence of osteophytes or large vascular channels, respectively. Biaxial fractures of proximal sesamoid bones were common in cadavers of racing Thoroughbreds. Differences between medial and lateral bones for characteristics associated with fracture may relate to differences in fracture pathogeneses for these bones. Osteophytes and vascular channels were common findings; however, fractures were less likely to occur in bones with these features.

MINERAL METABOLISM OF FRACTURES OF THE TIBIA IN MAN STUDIED WITH EXTERNAL COUNTING OF Sr$sup 8$$sup 5$

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

Wendberg, B.

1961-01-01

A study was made of 51 adult patients with tibial fractures by external counting with scintillation detectors over the thighs, knees, and tibias during a 14-day period after intravenous injection of 25 to 50 mu c Sr/sup 85/. The pattern of activity curves recorded over the fractured leg compared to those recorded over the control leg varied significantly with the age of the fracture (2 days to 9 yr). Increased uptake of Sr/sup 85/ was observed in all cases. The activity ratio fracture/control tibia obtained 14 days after injection rose during the 1st months after fracture to reach a peakmore » value 6 to 8 months after fracture. The mean 14-day fracture/ control ratios obtained 5 to 10 months after fracture was 15.5 plus or minus 7.2; then it dropped. Even 6 to 9 yr after fracture the counting rate over the fracture was higher than that over the intact tibia. No differences in activity uptake were observed between normally healing fractures and fractures showing delayed or nonunion. Activity curves obtained over the thigh, knee, and tibia of the fractured and intact legs 1 to l4 days after injection of Sr/sup 85/ could be simulated on the basis of a 2-compartment model for the kinetics of Sr in the body. Based on this kinetic analysis the externally recorded Sr/sup 85/ activity values may be interpreted as follows: The activity ratios fractured/intact leg obtained during early intervals after injection are mainly related to differences in the size of the exchangeable mineral spaces under the detector. The 14-day activity ratio of 2 anatomically comparable locations may be used as a relative index of the difference in the accretion rate (rate of irreversible deposition of bone mineral) in these locations, but is somewhat lower than the absolute dfference in the accretion rate. The bone salt laid down in the fracture callus is derived from the body fluids. The accretion rate in the fracture region is increased within a week of the fracture. It rapidly increases during the first months after fracture to reach a peak value at 6 to 8 months after fracture. The accretion rate in the entire fractured leg is increased some months after fracture. The traumatic osteopenia is caused by increased resorption and not by decreased accretion. (H.H.D.)« less

A comparative study of discrete fracture network and equivalent continuum models for simulating flow and transport in the far field of a hypothetical nuclear waste repository in crystalline host rock

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

Hadgu, Teklu; Karra, Satish; Kalinina, Elena

One of the major challenges of simulating flow and transport in the far field of a geologic repository in crystalline host rock is related to reproducing the properties of the fracture network over the large volume of rock with sparse fracture characterization data. Various approaches have been developed to simulate flow and transport through the fractured rock. The approaches can be broadly divided into Discrete Fracture Network (DFN) and Equivalent Continuum Model (ECM). The DFN explicitly represents individual fractures, while the ECM uses fracture properties to determine equivalent continuum parameters. In this paper, we compare DFN and ECM in termsmore » of upscaled observed transport properties through generic fracture networks. The major effort was directed on making the DFN and ECM approaches similar in their conceptual representations. This allows for separating differences related to the interpretation of the test conditions and parameters from the differences between the DFN and ECM approaches. The two models are compared using a benchmark test problem that is constructed to represent the far field (1 × 1 × 1 km 3) of a hypothetical repository in fractured crystalline rock. The test problem setting uses generic fracture properties that can be expected in crystalline rocks. The models are compared in terms of the: 1) effective permeability of the domain, and 2) nonreactive solute breakthrough curves through the domain. The principal differences between the models are mesh size, network connectivity, matrix diffusion and anisotropy. We demonstrate how these differences affect the flow and transport. Finally, we identify the factors that should be taken in consideration when selecting an approach most suitable for the site-specific conditions.« less

A comparative study of discrete fracture network and equivalent continuum models for simulating flow and transport in the far field of a hypothetical nuclear waste repository in crystalline host rock

DOE PAGES

Hadgu, Teklu; Karra, Satish; Kalinina, Elena; ...

2017-07-28

One of the major challenges of simulating flow and transport in the far field of a geologic repository in crystalline host rock is related to reproducing the properties of the fracture network over the large volume of rock with sparse fracture characterization data. Various approaches have been developed to simulate flow and transport through the fractured rock. The approaches can be broadly divided into Discrete Fracture Network (DFN) and Equivalent Continuum Model (ECM). The DFN explicitly represents individual fractures, while the ECM uses fracture properties to determine equivalent continuum parameters. In this paper, we compare DFN and ECM in termsmore » of upscaled observed transport properties through generic fracture networks. The major effort was directed on making the DFN and ECM approaches similar in their conceptual representations. This allows for separating differences related to the interpretation of the test conditions and parameters from the differences between the DFN and ECM approaches. The two models are compared using a benchmark test problem that is constructed to represent the far field (1 × 1 × 1 km 3) of a hypothetical repository in fractured crystalline rock. The test problem setting uses generic fracture properties that can be expected in crystalline rocks. The models are compared in terms of the: 1) effective permeability of the domain, and 2) nonreactive solute breakthrough curves through the domain. The principal differences between the models are mesh size, network connectivity, matrix diffusion and anisotropy. We demonstrate how these differences affect the flow and transport. Finally, we identify the factors that should be taken in consideration when selecting an approach most suitable for the site-specific conditions.« less

A comparative study of discrete fracture network and equivalent continuum models for simulating flow and transport in the far field of a hypothetical nuclear waste repository in crystalline host rock

NASA Astrophysics Data System (ADS)

Hadgu, Teklu; Karra, Satish; Kalinina, Elena; Makedonska, Nataliia; Hyman, Jeffrey D.; Klise, Katherine; Viswanathan, Hari S.; Wang, Yifeng

2017-10-01

One of the major challenges of simulating flow and transport in the far field of a geologic repository in crystalline host rock is related to reproducing the properties of the fracture network over the large volume of rock with sparse fracture characterization data. Various approaches have been developed to simulate flow and transport through the fractured rock. The approaches can be broadly divided into Discrete Fracture Network (DFN) and Equivalent Continuum Model (ECM). The DFN explicitly represents individual fractures, while the ECM uses fracture properties to determine equivalent continuum parameters. We compare DFN and ECM in terms of upscaled observed transport properties through generic fracture networks. The major effort was directed on making the DFN and ECM approaches similar in their conceptual representations. This allows for separating differences related to the interpretation of the test conditions and parameters from the differences between the DFN and ECM approaches. The two models are compared using a benchmark test problem that is constructed to represent the far field (1 × 1 × 1 km3) of a hypothetical repository in fractured crystalline rock. The test problem setting uses generic fracture properties that can be expected in crystalline rocks. The models are compared in terms of the: 1) effective permeability of the domain, and 2) nonreactive solute breakthrough curves through the domain. The principal differences between the models are mesh size, network connectivity, matrix diffusion and anisotropy. We demonstrate how these differences affect the flow and transport. We identify the factors that should be taken in consideration when selecting an approach most suitable for the site-specific conditions.

Assessment of a novel biomechanical fracture model for distal radius fractures

PubMed Central

2012-01-01

Background Distal radius fractures (DRF) are one of the most common fractures and often need surgical treatment, which has been validated through biomechanical tests. Currently a number of different fracture models are used, none of which resemble the in vivo fracture location. The aim of the study was to develop a new standardized fracture model for DRF (AO-23.A3) and compare its biomechanical behavior to the current gold standard. Methods Variable angle locking volar plates (ADAPTIVE, Medartis) were mounted on 10 pairs of fresh-frozen radii. The osteotomy location was alternated within each pair (New: 10 mm wedge 8 mm / 12 mm proximal to the dorsal / volar apex of the articular surface; Gold standard: 10 mm wedge 20 mm proximal to the articular surface). Each specimen was tested in cyclic axial compression (increasing load by 100 N per cycle) until failure or −3 mm displacement. Parameters assessed were stiffness, displacement and dissipated work calculated for each cycle and ultimate load. Significance was tested using a linear mixed model and Wald test as well as t-tests. Results 7 female and 3 male pairs of radii aged 74 ± 9 years were tested. In most cases (7/10), the two groups showed similar mechanical behavior at low loads with increasing differences at increasing loads. Overall the novel fracture model showed a significant different biomechanical behavior than the gold standard model (p < 0,001). The average final loads resisted were significantly lower in the novel model (860 N ± 232 N vs. 1250 N ± 341 N; p = 0.001). Conclusion The novel biomechanical fracture model for DRF more closely mimics the in vivo fracture site and shows a significantly different biomechanical behavior with increasing loads when compared to the current gold standard. PMID:23244634

Chemical Signatures of and Precursors to Fractures Using Fluid Inclusion Stratigraphy

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

Lorie M. Dilley

Enhanced Geothermal Systems (EGS) are designed to recover heat from the subsurface by mechanically creating fractures in subsurface rocks. Open or recently closed fractures would be more susceptible to enhancing the permeability of the system. Identifying dense fracture areas as well as large open fractures from small fracture systems will assist in fracture stimulation site selection. Geothermal systems are constantly generating fractures (Moore, Morrow et al. 1987), and fluids and gases passing through rocks in these systems leave small fluid and gas samples trapped in healed microfractures. These fluid inclusions are faithful records of pore fluid chemistry. Fluid inclusions trappedmore » in minerals as the fractures heal are characteristic of the fluids that formed them, and this signature can be seen in fluid inclusion gas analysis. This report presents the results of the project to determine fracture locations by the chemical signatures from gas analysis of fluid inclusions. With this project we hope to test our assumptions that gas chemistry can distinguish if the fractures are open and bearing production fluids or represent prior active fractures and whether there are chemical signs of open fracture systems in the wall rock above the fracture. Fluid Inclusion Stratigraphy (FIS) is a method developed for the geothermal industry which applies the mass quantification of fluid inclusion gas data from drill cuttings and applying known gas ratios and compositions to determine depth profiles of fluid barriers in a modern geothermal system (Dilley, 2009; Dilley et al., 2005; Norman et al., 2005). Identifying key gas signatures associated with fractures for isolating geothermal fluid production is the latest advancement in the application of FIS to geothermal systems (Dilley and Norman, 2005; Dilley and Norman, 2007). Our hypothesis is that peaks in FIS data are related to location of fractures. Previous work (DOE Grant DE-FG36-06GO16057) has indicated differences in the chemical signature of fluid inclusions between open and closed fractures as well as differences in the chemical signature of open fractures between geothermal systems. Our hypothesis is that open fracture systems can be identified by their FIS chemical signature; that there are differences based on the mineral assemblages and geology of the system; and that there are chemical precursors in the wall rock above open, large fractures. Specific goals for this project are: (1) To build on the preliminary results which indicate that there are differences in the FIS signatures between open and closed fractures by identifying which chemical species indicate open fractures in both active geothermal systems and in hot, dry rock; (2) To evaluate the FIS signatures based on the geology of the fields; (3) To evaluate the FIS signatures based on the mineral assemblages in the fracture; and (4) To determine if there are specific chemical signatures in the wall rock above open, large fractures. This method promises to lower the cost of geothermal energy production in several ways. Knowledge of productive fractures in the boreholes will allow engineers to optimize well production. This information can aid in well testing decisions, well completion strategies, and in resource calculations. It will assist in determining the areas for future fracture enhancement. This will develop into one of the techniques in the 'tool bag' for creating and managing Enhanced Geothermal Systems.« less

Secondary confounders of osteoporotic hip fractures in patients admitted to a geriatric acute care department.

PubMed

Dovjak, Peter; Föger-Samwald, Ursula; Konrad, Maarit; Bichler, Bernhard; Pietschmann, Peter

2015-10-01

With respect to the pathogenesis of osteoporosis, primary and secondary forms of the disease can be distinguished. It has been recognized that the incidence of primary and secondary osteoporosis differs in women and men. The aim of the present study was to assess the incidence and gender distribution of factors contributing to osteoporosis in older hip fracture patients. In this cross-sectional study 404 patients with hip fractures and controls referred to an acute geriatric care department over a period of 15 months were included. The medical history was recorded and blood samples were analyzed for routine laboratory parameters. A total of 249 patients with hip fractures and 155 matched controls were studied. The Tinetti test and the Barthel index were found to show highly significant differences in both groups mainly because of the postoperative state of patients with fractures. Vitamin D deficiency was found in 94.1% of male fracture patients and 94.6% of female fracture patients. On average 2.4 secondary contributors of osteoporosis were present in male fracture patients versus 2.9 in male controls and 2.3 in female fracture patients versus 2.3 in female controls. For most parameters no significant gender differences of possible secondary contributors to osteoporosis were found. Secondary osteoporosis was diagnosed in all male fracture patients and in 56.2% of all female fracture patients. Based on the findings of this study it is recommended that hip fracture patients should be assessed for secondary contributors of osteoporosis. Although the overall distribution of secondary contributors was similar in women and men, the prevalence of secondary osteoporosis was higher in men.

Cost-effectiveness of bazedoxifene incorporating the FRAX® algorithm in a European perspective.

PubMed

Borgström, F; Ström, O; Kleman, M; McCloskey, E; Johansson, H; Odén, A; Kanis, J A

2011-03-01

The cost-effectiveness of bazedoxifene was compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX® for both fracture risks and for treatment efficacy. Cost/QALY differences were explained to a large extent by differences in fracture risk. In cost-effectiveness modelling of osteoporosis treatments, the fracture risk has traditionally been calculated with risk adjustments based on age, bone mineral density and prior fracture. However, knowledge of additional clinical risk factors contributes to fracture risk assessment as demonstrated by the FRAX® tool. Bazedoxifene, a new selective estrogen receptor modulator for the treatment and prevention of osteoporosis, has been shown in a phase III clinical trial to reduce the risk of osteoporotic fractures in women. In an analysis using FRAX®, the efficacy of bazedoxifene was greater in patients with higher fracture risk. The aim of this study was to evaluate the cost-effectiveness of bazedoxifene compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX®. A Markov cohort model was adapted to incorporate the FRAX® risk factors. FRAX® produces relative risks for hip fractures and major osteoporotic fractures. Patients were given a 5-year intervention, reducing the risk of fractures in a risk-dependent manner. The effect of treatment on fractures was assumed to decline linearly over 5 years after the intervention. There are large cost/quality-adjusted life year variations between countries in the European setting studied. The base case values ranged from cost saving (Sweden) to EUR 105,450 (Spain) in 70-year-old women with a T-score of -2.5 SD and a prior fracture. Bazedoxifene can be a cost-effective treatment for postmenopausal osteoporosis. The variability between countries was explained to a large extent by differences in fracture risk, and the estimated cost-effectiveness was highly dependent on the population's FRAX®-estimated probability of major osteoporotic fracture.

Lifestyle factors and site-specific risk of hip fracture in community dwelling older women – a 13-year prospective population-based cohort study

PubMed Central

2012-01-01

Background Several risk factors are associated to hip fractures. It seems that different hip fracture types have different etiologies. In this study, we evaluated the lifestyle-related risk factors for cervical and trochanteric hip fractures in older women over a 13-year follow-up period. Methods The study design was a prospective, population-based study consisting of 1681 women (mean age 72 years). Seventy-three percent (n = 1222) participated in the baseline measurements, including medical history, leisure-time physical activity, smoking, and nutrition, along with body anthropometrics and functional mobility. Cox regression was used to identify the independent predictors of cervical and trochanteric hip fractures. Results During the follow-up, 49 cervical and 31 trochanteric fractures were recorded. The women with hip fractures were older, taller, and thinner than the women with no fractures (p < 0.05). Low functional mobility was an independent predictor of both cervical and trochanteric fractures (HR = 3.4, 95% CI 1.8-6.6, and HR = 5.3, 95% CI 2.5-11.4, respectively). Low baseline physical activity was associated with an increased risk of hip fracture, especially in the cervical region (HR = 2.5, 95% CI 1.3-4.9). A decrease in cervical fracture risk (p = 0.002) was observed with physically active individuals compared to their less active peers (categories: very low or low, moderate, and high). Moderate coffee consumption and hypertension decreased the risk of cervical fractures (HR = 0.4, 95% CI 0.2-0.8, for both), while smoking was a predisposing factor for trochanteric fractures (HR = 3.2, 95% CI 1.1-9.3). Conclusions Impaired functional mobility, physical inactivity, and low body mass may increase the risk for hip fractures with different effects at the cervical and trochanteric levels. PMID:22978821

Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results.

PubMed

Capanna, Rodolfo; Totti, Francesca; Van der Geest, Ingrid C M; Müller, Daniel A

2015-08-01

Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft. The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred. Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Mechanisms of traumatic shoulder injury in elite rugby players

PubMed Central

Crichton, James; Jones, Doug R; Funk, Lennard

2012-01-01

Background Shoulder injuries in rugby players are common, but the mechanisms of injury are less well understood. This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce. Materials and methods Twenty-four elite rugby players, referred to the senior author for diagnosis and management of shoulder injuries, were selected. Videos of the injuries were independently reviewed by rugby-medical experts to describe the mechanisms of injury. The mechanisms reported were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms. Results The authors identified three mechanisms of shoulder injury from the video analysis. These are the ‘Try-Scorer’, characterised by hyperflexion of the outstretched arm such as when scoring a try; the ‘Tackler’, extension of the abducted arm behind the player while tackling; and the ‘Direct Impact’, a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ). These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and superior labrum anterior–posterior tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause acromioclavicular joint dislocation and scapula fractures, injuries that were not seen with the other mechanisms. Conclusion Greater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury-prevention methods. PMID:22510645

The Diagnosis, Management and Complications Associated with Fractures of the Talus

PubMed Central

J.R, Barnett; MA, Ahmad; W, Khan; A., O’ Gorman

2017-01-01

Fractures of the talus are uncommon injuries that can have devastating consequences. The blood supply to the talus is tenuous and injuries are associated with a higher incidence of avascular necrosis and malunion. Talar neck fractures are the most common fractures. This review looks at the different types of fractures of the talus, particularly focusing on talar neck fractures. The diagnosis and management are discussed as well as the complications. PMID:28694883

Reliability of Radiographic Assessments of Adolescent Midshaft Clavicle Fractures by the FACTS Multicenter Study Group.

PubMed

Li, Ying; Donohue, Kyna S; Robbins, Christopher B; Pennock, Andrew T; Ellis, Henry B; Nepple, Jeffrey J; Pandya, Nirav; Spence, David D; Willimon, Samuel Clifton; Heyworth, Benton E

2017-09-01

There is a recent trend toward increased surgical treatment of displaced midshaft clavicle fractures in adolescents. The primary purpose of this study was to evaluate the intrarater and interrater reliability of clavicle fracture classification systems and measurements of displacement, shortening, and angulation in adolescents. The secondary purpose was to compare 2 different measurement methods for fracture shortening. This study was performed by a multicenter study group conducting a prospective, comparative, observational cohort study of adolescent clavicle fractures. Eight raters evaluated 24 deidentified anteroposterior clavicle radiographs selected from patients 10-18 years of age with midshaft clavicle fractures. Two clavicle fracture classification systems were used, and 2 measurements for shortening, 1 measurement for superior-inferior displacement, and 2 measurements for fracture angulation were performed. A minimum of 2 weeks after the first round, the process was repeated. Intraclass correlation coefficients were calculated. Good to excellent intrarater and interrater agreement was achieved for the descriptive classification system of fracture displacement, direction of angulation, presence of comminution, and all continuous variables, including both measurements of shortening, superior-inferior displacement, and degrees of angulation. Moderate agreement was achieved for the Arbeitsgemeinschaft für Osteosynthesefragen classification system overall. Mean shortening by 2 different methods were significantly different from each other (P < 0.0001). Most radiographic measurements performed by investigators in a multicenter, prospective cohort study of adolescent clavicle fractures demonstrated good-to-excellent intrarater and interrater reliability. Future consensus on the most accurate and clinically appropriate measurement method for fracture shortening is critical.

Fractures and mortality in relation to different osteoporosis treatments.

PubMed

Yun, Huifeng; Delzell, Elizabeth; Saag, Kenneth G; Kilgore, Meredith L; Morrisey, Michael A; Muntner, Paul; Matthews, Robert; Guo, Lingli; Wright, Nicole; Smith, Wilson; Colón-Emeric, Cathleen; O'Connor, Christopher M; Lyles, Kenneth W; Curtis, Jeffrey R

2015-01-01

Few studies have assessed the effectiveness of different drugs for osteoporosis (OP). We aimed to determine if fracture and mortality rates vary among patients initiating different OP medications. We used the Medicare 5% sample to identify new users of intravenous (IV) zoledronic acid (n=1.674), oral bisphosphonates (n=32.626), IV ibandronate (n=492), calcitonin (n=2.606), raloxifene (n=1.950), or parathyroid hormone (n=549). We included beneficiaries who were ≥65 years of age, were continuously enrolled in fee-for-service Medicare and initiated therapy during 2007-2009. Outcomes were hip fracture, clinical vertebral fracture, and all-cause mortality, identified using inpatient and physician diagnosis codes for fracture, procedure codes for fracture repair, and vital status information. Cox regression models compared users of each medication to users of IV zoledronic acid, adjusting for multiple confounders. During follow-up (median, 0.8-1.5 years depending on the drug), 787 subjects had hip fractures, 986 had clinical vertebral fractures, and 2.999 died. Positive associations included IV ibandronate with hip fracture (adjusted hazard ratio (HR), 2.37; 95% confidence interval (CI) 1.25-4.51), calcitonin with vertebral fracture (HR=1.59, 95%CI 1.04-2.43), and calcitonin with mortality (HR=1.31; 95%CI 1.02-1.68). Adjusted HRs for other drug-outcome comparisons were not statistically significant. IV ibandronate and calcitonin were associated with higher rates of some types of fracture when compared to IV zolendronic acid. The relatively high mortality associated with use of calcitonin may reflect the poorer health of users of this agent.

Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture.

PubMed

Zhang, Wei; Luo, Cong-Feng; Putnis, Sven; Sun, Hui; Zeng, Zhi-Min; Zeng, Bing-Fang

2012-03-01

The posterolateral shearing tibial plateau fracture is uncommon in the literature, however with the increased usage of computer tomography (CT), the incidence of these fractures is no longer as low as previously thought. Few studies have concentrated on this fracture, least of all using a biomechanical model. The purpose of this study was to compare and analyse the biomechanical characteristics of four different types of internal fixation to stabilise the posterolateral shearing tibial plateau fracture. Forty synthetic tibiae (Synbone, right) simulated the posterolateral shearing fracture models and these were randomly assigned into four groups; Group A was fixed with two anterolateral lag screws, Group B with an anteromedial Limited Contact Dynamic Compression Plate (LC-DCP), Group C with a lateral locking plate, and Group D with a posterolateral buttress plate. Vertical displacement of the posterolateral fragment was measured using three different strengths of axial loading force, and finally loaded until fixation failure. It was concluded that the posterolateral buttress plate is biomechanically the strongest fixation method for the posterolateral shearing tibial plateau fracture. Copyright © 2011 Elsevier B.V. All rights reserved.

Characteristic Fracture Spacing in Primary and Secondary Recovery from Naturally Fractured Reservoirs

NASA Astrophysics Data System (ADS)

Gong, J.; Rossen, W.

2015-12-01

We showed previously (Gong and Rossen, 2014a,b) that, if the fracture aperture distribution is broad enough in a naturally fractured reservoir, even one where the fracture network is well-connected, most fractures can be eliminated without significantly affecting the flow through the fracture network. During a waterflood or enhanced-oil-recovery (EOR) process, the production of oil depends on the supply of injected water or EOR agent. This suggests that the characteristic fracture spacing for the dual-porosity/dual-permeability simulation of waterflood or EOR in a naturally fractured reservoir should account not for all fractures but only the relatively small portion of the fracture network carrying almost all the injected water or EOR agent. In contrast, in primary production even a relatively small fracture represents an effective path for oil to flow to a production well. Thus in primary production the effective fracture spacing should include all the fractures. This distinction means that the "shape factor" in dual-porosity/dual-permeability reservoir simulators and the repeating unit in homogenization should depend on the process involved: specifically, it should be different for primary and secondary or tertiary recovery. We test this hypothesis in a simple representation of a fractured reservoir with a non-uniform distribution of fracture flow conductivities. We compare oil production, flow patterns in matrix, and the pattern of oil recovery around fractures with and without the "unimportant" fractures present. In primary production, all fractures which are much more permeable than matrix play a significant role in production. The shape factor or repeating-unit size should reflect the entire fracture distribution. In secondary or tertiary production, the role of fractures that carry relatively little flow depends on injection rate, the ratio of flow carried by the different fractures, and the permeability of matrix. In some cases, the appropriate shape factor or repeating-unit size for waterflood or EOR should reflect only those fractures that carry most of the flow. References:Gong, and Rossen, 14th ECMOR Conf., Catania, Sicily, 2014(a). Gong, and Rossen, Intl. Discrete Fracture Network Eng. Conf., Vancouver, Canada, 2014(b).

Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

PubMed

Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

2015-12-01

Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two patients with occult injury (of 1,454, 13.9%) had major interventions, 343 of 1,454 (23.6%) had minor interventions, and 909 (62.5%) had no intervention. Patients with occult injury included 514 with pulmonary contusions (of 682 total, 75.4% occult), 405 with pneumothorax (of 597 total, 67.8% occult), 184 with hemothorax (of 230 total, 80.0% occult), those with greater than 2 rib fractures (n=672/1,120, 60.0% occult) or sternal fracture (n=269/281, 95.7% occult), 12 with great vessel injury (of 18 total, 66.7% occult), 5 with diaphragm injury (of 6, 83.3% occult), and 537 with multiple occult injuries. Interventions for patients with occult injury included mechanical ventilation for 31 of 514 patients with pulmonary contusion (6.0%), chest tube for 118 of 405 patients with pneumothorax (29.1%), and 75 of 184 patients with hemothorax (40.8%). Inpatient pain control or observation greater than 24 hours was conducted for 183 of 672 patients with rib fractures (27.2%) and 79 of 269 with sternal fractures (29.4%). Three of 12 (25%) patients with occult great vessel injuries had surgery. Repeated imaging was conducted for 50.6% of patients with occult injury (88.1% chest radiography, 11.9% chest CT, 7.5% both). For patients with occult injury, 90.9% (1,321/1,454) were admitted, with 9.1% observed in the ED for median 6.9 hours. Forty-four percent of observed patients were then admitted (4.0% of patients with occult injury). In a more seriously injured subset of patients with blunt trauma who had both chest radiography and chest CT, occult injuries were found by chest CT in 71% of those with thoracic injuries and one fourth of all those with blunt chest trauma. More than one third of occult injury had intervention (37.5%). Chest tubes composed 76.2% of occult injury major interventions, with observation or inpatient pain control greater than 24 hours in 32.4% of occult fractures. Only 1 in 20 patients with occult injury was discharged home from the ED. For these patients with blunt trauma, chest CT is useful to identify otherwise occult injuries. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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

[Fracture strength of elastic and conventional fibre-reinforced composite intraradicular posts--an in vitro pilot study].

PubMed

Fráter, Mark; Forster, András; Jantyik, Ádám; Braunitzer, Gábor; Nagy, Katalin

2015-12-01

The purpose of this in vitro investigation was to evaluate the reinforcing effect of different fibre-reinforced composite (FRC) posts and insertion techniques in premolar teeth when using minimal invasive post space preparation. Thirty two extracted and endodontically treated premolar teeth were used and divided into four groups (n = 8) depending on the post used (Group 1-4). 1: one single conventional post, 2: one main conventional and one collateral post, 3: one flexible post, 4: one main flexible and one collateral post. After cementation and core build-up the specimens were submitted to static fracture toughness test. Fracture thresholds and fracture patterns were recorded and evaluated. The multi-post techniques (group 2 and 4) showed statistically higher fracture resistance compared to group one. Regarding fracture patterns there was no statistically significant difference between the tested groups. The application of multiple posts seems to be beneficial regarding fracture resistance independent from the used FRC post. Fracture pattern was not influenced by the elasticity of the post.

Comparative fracture strength analysis of Lava and Digident CAD/CAM zirconia ceramic crowns.

PubMed

Kwon, Taek-Ka; Pak, Hyun-Soon; Yang, Jae-Ho; Han, Jung-Suk; Lee, Jai-Bong; Kim, Sung-Hun; Yeo, In-Sung

2013-05-01

All-ceramic crowns are subject to fracture during function. To minimize this common clinical complication, zirconium oxide has been used as the framework for all-ceramic crowns. The aim of this study was to compare the fracture strengths of two computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia crown systems: Lava and Digident. Twenty Lava CAD/CAM zirconia crowns and twenty Digident CAD/CAM zirconia crowns were fabricated. A metal die was also duplicated from the original prepared tooth for fracture testing. A universal testing machine was used to determine the fracture strength of the crowns. THE MEAN FRACTURE STRENGTHS WERE AS FOLLOWS: 54.9 ± 15.6 N for the Lava CAD/CAM zirconia crowns and 87.0 ± 16.0 N for the Digident CAD/CAM zirconia crowns. The difference between the mean fracture strengths of the Lava and Digident crowns was statistically significant (P<.001). Lava CAD/CAM zirconia crowns showed a complete fracture of both the veneering porcelain and the core whereas the Digident CAD/CAM zirconia crowns showed fracture only of the veneering porcelain. The fracture strengths of CAD/CAM zirconia crowns differ depending on the compatibility of the core material and the veneering porcelain.

Exercise prescription after fragility fracture in older adults: a scoping review

PubMed Central

Feehan, Lynne M.; Beck, Charlotte A.; Harris, Susan R.; MacIntyre, Donna L.; Li, Linda C.

2017-01-01

Purpose To identify and chart research literature on safety, efficacy or effectiveness of exercise prescription following fracture in older adults. Methods We conducted a systematic, research-user-informed, scoping review. The population of interest was adults aged ≥ 45 years with any fracture. ‘Exercise prescription’ included post-fracture therapeutic exercise, physical activity or rehabilitation interventions. Eligible designs included knowledge synthesis studies, primary interventional studies and observational studies. Trained reviewers independently evaluated citations for inclusion. Results A total of 9415 citations were reviewed with 134 citations (119 unique studies) identified: 13 knowledge syntheses, 95 randomized or controlled clinical trials, and 11 ‘other’ designs, representing 74 articles on lower extremity fractures, 34 on upper extremity, eight on vertebral, and three on mixed body region fractures. Exercise prescription characteristics were often missing or poorly described. Six general categories emerged describing exercise prescription characteristics: timing post-fracture, person prescribing, program design, functional focus, exercise script parameters and co-interventions. Upper extremity and ankle fracture studies focused on fracture healing or structural impairment outcomes, whereas hip fracture studies focused more on activity limitation outcomes. The variety of different outcome measures used made pooling or comparison of outcomes difficult. Conclusions There was insufficient information to identify evidence-informed parameters for safe and effective exercise prescription for older adults following fracture. Key gaps in the literature include limited numbers of studies on exercise prescription following vertebral fracture, poor delineation of effectiveness of different strategies for early post-fracture mobilization following upper extremity fracture, and inconsistent details of exercise prescription characteristics after lower extremity fracture. PMID:20967425

Extremity Fractures Associated With ATVs and Dirt Bikes: A 6 Year National Epidemiological Study

PubMed Central

Gambone, Andrew; Lombardo, Daniel Joseph; Jelsema, Timothy; Sabesan, Vani

2015-01-01

Objectives: All-terrain vehicle (ATV) and dirt bike use is increasing in the US and is associated with risk of traumatic injury. Extremity fractures are common injures associated with these vehicles. The purpose of this study is to compare and contrast the patterns extremity fractures associated with ATVs and dirt bikes. Our hypothesis is that these different vehicles will result in similar rates of high impact injuries, but differences in vehicle stability will result in greater proportions of upper extremity fractures associated with ATV use. Methods: The National Electronic Injury Surveillance System (NEISS) was used to acquire data for extremity fractures related to ATV (3-wheels, 4-wheels, and number of wheels undefined) and dirt bike use from 2007-2012. Locations were coded as shoulder, upper arm, elbow, lower arm, wrist, hand, upper leg, knee, lower leg, ankle, foot, and toe. The data were stratified according to age and gender for each year. Incidence rates were calculated on a per vehicle basis using previous estimates of the number of ATVs and dirt bikes in the country. Results: The database yielded an estimate of 229,362.52 extremity fractures from 2007-2012. An estimated total of 130,319.20 fractures were associated with ATVs, while 99,043.37 were associated with dirt bikes. The incidence rates of extremity fractures associated with ATV and dirt bike use were 3.87 and 6.85 per 1000 vehicle-years. Most fractures were in patients 10-19 years of age, after which the number of fractures decreased with age. The largest proportion of all fractures occurred in the shoulder (27.19%), followed by the wrist and lower leg (13.77% and 12.36%, respectively). This distribution of fractures was consistent among ATV use for all age groups except in the 0-9 year olds, where the lower arm and wrist were the most commonly fractured locations. Fracture distribution associated with dirt bike use also followed this general pattern, with the exception of 0-9 and 10-19 year olds having increased proportions of lower arm fractures. When comparing the genders, males had much larger proportions of fractures than females at all locations, except for the upper arm. When comparing the specific injury locations for different vehicle types, there were no differences in the distribution of the location of fractures among 4-wheeled or unspecified ATVs. However, 3-wheeled ATVs and dirt bikes had much larger proportion of lower leg, foot and ankle fractures compared to the other vehicle types. Conclusion: Extremity fractures are among the most common type of injury resulting from ATV and dirt bike use. Our results demonstrated a pattern of injury where the shoulder and lower arm were the most commonly injured locations. This pattern was inconsistent among females, the very young, and 3 wheeled ATVs and dirt bikes. These differences could be due to both rider related factors and vehicle design factors. Knowing commonly fractured locations, the use of additional protective equipment specific to these injuries may be beneficial. Additionally, participants should be cautioned of the increased risk of fractures associated with dirt bike use, as well as the unusual pattern of injuries of 3-wheeled ATVs implying instability of these vehicles.

Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study.

PubMed

Chen, Pengbo; Lu, Hua; Shen, Hao; Wang, Wei; Ni, Binbin; Chen, Jishizhan

2017-02-23

Lateral column tibial plateau fracture fixation with a locking screw plate has higher mechanical stability than other fixation methods. The objectives of the present study were to introduce two newly designed locking anatomic plates for lateral tibial plateau fracture and to demonstrate their characteristics of the fixation complexes under the axial loads. Three different 3D finite element models of the lateral tibial plateau fracture with the bone plates were created. Various axial forces (100, 500, 1000, and 1500 N) were applied to simulate the axial compressive load on an adult knee during daily life. The equivalent maps of displacement and stress were output, and relative displacement was calculated along the fracture lines. The displacement and stresses in the fixation complexes increased with the axial force. The equivalent displacement or stress map of each fixation under different axial forces showed similar distributing characteristics. The motion characteristics of the three models differed, and the max-shear stress of trabecula increased with the axial load. These two novel plates could fix lateral tibial plateau fractures involving anterolateral and posterolateral fragments. Motions after open reduction and stable internal fixation should be advised to decrease the risk of trabecular microfracture. The relative displacement of the posterolateral fragments is different when using anterolateral plate and posterolateral plate, which should be considered in choosing the implants for different posterolateral plateau fractures.

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

PubMed Central

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

2016-01-01

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

Metallurgical characterization of the fracture of several high strength aluminum alloys

NASA Technical Reports Server (NTRS)

Bhandarkar, M. D.; Lisagor, W. B.

1977-01-01

The fracture behavior for structural aluminum alloys (2024, 6061, 7075, and 7178) was examined in selected heat treatments. The investigation included tensile, shear, and precracked notch-bend specimens fractured at ambient temperature under monotonic loading. Specimens were obtained from thin sheets and thick plates and were tested in longitudinal and transverse orientations at different strain rates. Microstructures of alloys were examined using the optical microscope and the scanning electron microscope with associated energy dispersive X ray chemical analysis. Several different types of second phase particles, some not reported by other investigators, were identified in the alloys. Fracture morphology was related to microstructural variables, test variables, and type of commercial product. Specimen orientation examined in the present investigation had little effect on fracture morphology. Test strain rate changes resulted in some change in shear fracture morphology, but not in fracture morphology of tensile specimens.

Analysis of seismic sources for different mechanisms of fracture growth for microseismic monitoring applications

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

Duchkov, A. A., E-mail: DuchkovAA@ipgg.sbras.ru; Novosibirsk State University, Novosibirsk, 630090; Stefanov, Yu. P., E-mail: stefanov@ispms.tsc.ru

2015-10-27

We have developed and illustrated an approach for geomechanic modeling of elastic wave generation (microsiesmic event occurrence) during incremental fracture growth. We then derived properties of effective point seismic sources (radiation patterns) approximating obtained wavefields. These results establish connection between geomechanic models of hydraulic fracturing and microseismic monitoring. Thus, the results of the moment tensor inversion of microseismic data can be related to different geomechanic scenarios of hydraulic fracture growth. In future, the results can be used for calibrating hydrofrac models. We carried out a series of numerical simulations and made some observations about wave generation during fracture growth. Inmore » particular when the growing fracture hits pre-existing crack then it generates much stronger microseismic event compared to fracture growth in homogeneous medium (radiation pattern is very close to the theoretical dipole-type source mechanism)« less

Femoral neck shaft angle in men with fragility fractures.

PubMed

Tuck, S P; Rawlings, D J; Scane, A C; Pande, I; Summers, G D; Woolf, A D; Francis, R M

2011-01-01

Introduction. Femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric), symptomatic vertebral (91), and distal forearm (67) fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm(2): lumbar spine, femoral neck, and total femur) measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately), nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P = 0.001), but larger in those with distal forearm fractures (129.8° versus 128.5°: P = 0.01). Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

Analysis of two different surgical approaches for fractures of the mandibular condyle.

PubMed

Kumaran, S; Thambiah, L J

2012-01-01

Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. t- test was used for statistical analysis of the data obtained in the study. Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

Differing approaches to falls and fracture prevention between Australia and Colombia

PubMed Central

Gomez, Fernando; Curcio, Carmen Lucia; Suriyaarachchi, Pushpa; Demontiero, Oddom; Duque, Gustavo

2013-01-01

Falls and fractures are major causes of morbidity and mortality in older people. More importantly, previous falls and/or fractures are the most important predictors of further events. Therefore, secondary prevention programs for falls and fractures are highly needed. However, the question is whether a secondary prevention model should focus on falls prevention alone or should be implemented in combination with fracture prevention. By comparing a falls prevention clinic in Manizales (Colombia) versus a falls and fracture prevention clinic in Sydney (Australia), the objective was to identify similarities and differences between these two programs and to propose an integrated model of care for secondary prevention of fall and fractures. A comparative study of services was performed using an internationally agreed taxonomy. Service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE) and previous reports in the literature. Comparison included organization, administration, client characteristics, and interventions. Several similarities and a number of differences that could be easily unified into a single model are reported here. Similarities included population, a multidisciplinary team, and a multifactorial assessment and intervention. Differences were eligibility criteria, a bone health assessment component, and the therapeutic interventions most commonly used at each site. In Australia, bone health assessment is reinforced whereas in Colombia dizziness assessment and management is pivotal. The authors propose that falls clinic services should be operationally linked to osteoporosis services such as a “falls and fracture prevention clinic,” which would facilitate a comprehensive intervention to prevent falls and fractures in older persons. PMID:23378748

Are bi-axial proximal sesamoid bone fractures in the British Thoroughbred racehorse a bone fatigue related fracture? A histological study.

PubMed

Kristoffersen, M; Hetzel, U; Parkin, T D H; Singer, E R

2010-01-01

To investigate whether microfractures and alterations in the trabecular bone area are associated with catastrophic bi-axial proximal sesamoid bone fractures (PSBF). Proximal sesamoid bones (PSB) from 10 racehorses with PSBF and from 10 control racehorses without musculoskeletal injury were examined using the bulk basic fuchsin method. Bone histomorphometric and microfracture analysis was performed, and cases and controls compared using two-sample t-test, paired t-test, and Mann-Whitney U test. There was no significant difference in the microfracture density and the trabecular bone area between bones from case and control horses, and between fractured and non-fractured bones in case horses. Microfracture density was low in the areas of the PSB examined. Microfracture density was not significantly different between groups, indicating that propagation of micro-cracks is an unlikely predisposing pathologic alteration in PSBF in British racehorses. There was no significant difference in the bone surface area between groups, which one would expect if modelling, adaptation and an increase in bone density were associated with PSBF fracture in the case horses. Therefore, PSBF in the British racehorse does not appear to be associated with microfractures of the trabecular bone of the PSB. The PSB fractures might represent an acute monotonic fracture; however, the aetiology of the fractures remains unknown with additional research required.

Hydraulic Fracture Extending into Network in Shale: Reviewing Influence Factors and Their Mechanism

PubMed Central

Ren, Lan; Zhao, Jinzhou; Hu, Yongquan

2014-01-01

Hydraulic fracture in shale reservoir presents complex network propagation, which has essential difference with traditional plane biwing fracture at forming mechanism. Based on the research results of experiments, field fracturing practice, theory analysis, and numerical simulation, the influence factors and their mechanism of hydraulic fracture extending into network in shale have been systematically analyzed and discussed. Research results show that the fracture propagation in shale reservoir is influenced by the geological and the engineering factors, which includes rock mineral composition, rock mechanical properties, horizontal stress field, natural fractures, treating net pressure, fracturing fluid viscosity, and fracturing scale. This study has important theoretical value and practical significance to understand fracture network propagation mechanism in shale reservoir and contributes to improving the science and efficiency of shale reservoir fracturing design. PMID:25032240

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.

FRACOR-software toolbox for deterministic mapping of fracture corridors in oil fields on AutoCAD platform

NASA Astrophysics Data System (ADS)

Ozkaya, Sait I.

2018-03-01

Fracture corridors are interconnected large fractures in a narrow sub vertical tabular array, which usually traverse entire reservoir vertically and extended for several hundreds of meters laterally. Fracture corridors with their huge conductivities constitute an important element of many fractured reservoirs. Unlike small diffuse fractures, actual fracture corridors must be mapped deterministically for simulation or field development purposes. Fracture corridors can be identified and quantified definitely with borehole image logs and well testing. However, there are rarely sufficient image logs or well tests, and it is necessary to utilize various fracture corridor indicators with varying degrees of reliability. Integration of data from many different sources, in turn, requires a platform with powerful editing and layering capability. Available commercial reservoir characterization software packages, with layering and editing capabilities, can be cost intensive. CAD packages are far more affordable and may easily acquire the versatility and power of commercial software packages with addition of a small software toolbox. The objective of this communication is to present FRACOR, a software toolbox which enables deterministic 2D fracture corridor mapping and modeling on AutoCAD platform. The FRACOR toolbox is written in AutoLISPand contains several independent routines to import and integrate available fracture corridor data from an oil field, and export results as text files. The resulting fracture corridor maps consists mainly of fracture corridors with different confidence levels from combination of static and dynamic data and exclusion zones where no fracture corridor can exist. The exported text file of fracture corridors from FRACOR can be imported into an upscaling programs to generate fracture grid for dual porosity simulation or used for field development and well planning.

Reduced Bone Material Strength is Associated with Increased Risk and Severity of Osteoporotic Fractures. An Impact Microindentation Study.

PubMed

Sosa, Daysi Duarte; Eriksen, Erik Fink

2017-07-01

The aim of the study was to test, whether bone material strength differs between different subtypes of osteoporotic fracture and assess whether it relates to vertebral fracture severity. Cortical bone material strength index (BMSi) was measured by impact microindentation in 66 women with osteoporotic fracture and 66 age- and sex-matched controls without fracture. Bone mineral density (BMD) and bone turnover markers were also assessed. Vertebral fracture severity was graded by semiquantitative (SQ) grading. Receiver operator characteristic (ROC) curves were used to examine the ability of BMSi to discriminate fractures. Subjects with osteoporotic fractures exhibited lower BMSi than controls (71.5 ± 7.3 vs. 76.4 ± 6.2, p < 0.001). After adjusting for age and hip BMD, a significant negative correlation was seen between BMSi and vertebral fracture severity (r 2  = 0.19, p = 0.007). A decrease of one standard deviation (SD) in BMSi was associated with increased risk of fracture (OR 2.62; 95% CI 1.35, 5.10, p = 0.004). ROC curve areas under the curve (AUC) for BMSi in subjects with vertebral fracture (VF), hip fracture (HF), and non-vertebral non-hip fracture (NVNHFx), (mean; 95% CI) were 0.711 (0.608; 0.813), 0.712 (0.576; 0.843), 0.689 (0.576; 0.775), respectively. Combining BMSi and BMD provided further improvement in the discrimination of fractures with AUC values of 0.777 (0.695; 0.858), 0.789 (0.697; 0.882), and 0.821 (0.727; 0.914) for VFx, HFx, and NVNHFx, respectively. Low BMSi of the tibial cortex is associated with increased risk of all osteoporotic fractures and severity of vertebral fractures.

Fractures in Rock: An Annotated Bibliography

DTIC Science & Technology

1990-01-01

different mechanisms. Fractures in the thicker beds are thought due to hydraulic fracturing . The actual mechanism is discussed. They suggest that...increase in grain size would be asso- ciated with increase in spacing with reference to hydraulic fracturing . Lee, F.T., Miller, D.R. and Nichols, T.C., Jr

Multiscale analysis of the fracture pattern in granite, example of Tamariu's granite, Catalunya.

NASA Astrophysics Data System (ADS)

Bertrand, L.; LeGarzic, E.; Géraud, Y.; Diraison, M.

2012-04-01

Crystalline rocks can be the host of important fluid flow and therefore they can provide a good reservoir potential. In this kind of rocks, the matrice porosity is in general low and a large part of the permeability is governed by the fracture pattern. Thus, they are the first interest of studies in order to characterize and model the fluid flows. Actual reservoirs are underground, and the only access to the fracture pattern is with boreholes and seismic lines. Those methods are investigating different scales and dimensions: seismic is in 3D at a global scale whereas boreholes are 1D at a localized scale. To make the link between the different data, it is necessary to study field analogues where such fractured rocks are outcropping. Tamariu's granite, in Catalunya, has recently been studied as a field analogue of a fractured reservoir. The previous studies have lead to define structural blocks at different scales, linked to the regional deformation. This study's aim is to characterize the internal fracturation of a single structural block with a statistical analysis. We used one dimension scan lines at the scale of a block and 2 dimensions mapping at a more precise scale until the grain scale. The data highlighted that the fracture and fault lengths have a power law relation in 8 orders of scales. So this power law is stretching between seismic and borehole scales. Therefore, the data fit with a very good trust in the power law exponent, which is very well defined. The link between the reservoir scale faults and the internal block fracturation has also been defined in term of the structures orientation. Finally, a comparison between the 1D and 2D measurement could be done. The 1D scan lines show correctly the different fractures families but samples incompletely a part the fracture pattern, whereas the 2D maps which show more the global trends of the fractures and could lose some minor trends orientations.

The incidence of secondary vertebral fracture of vertebral augmentation techniques versus conservative treatment for painful osteoporotic vertebral fractures: a systematic review and meta-analysis.

PubMed

Song, Dawei; Meng, Bin; Gan, Minfeng; Niu, Junjie; Li, Shiyan; Chen, Hao; Yuan, Chenxi; Yang, Huilin

2015-08-01

Percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) are minimally invasive and effective vertebral augmentation techniques for managing osteoporotic vertebral compression fractures (OVCFs). Recent meta-analyses have compared the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques or conservative treatment; however, the inclusions were not thorough and rigorous enough, and the effects of each technique on the incidence of secondary vertebral fractures remain unclear. To perform an updated systematic review and meta-analysis of the studies with more rigorous inclusion criteria on the effects of vertebral augmentation techniques and conservative treatment for OVCF on the incidence of secondary vertebral fractures. PubMed, MEDLINE, EMBASE, SpringerLink, Web of Science, and the Cochrane Library database were searched for relevant original articles comparing the incidence of secondary vertebral fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (NRCTs) were identified. The methodological qualities of the studies were evaluated, relevant data were extracted and recorded, and an appropriate meta-analysis was conducted. A total of 13 articles were included. The pooled results from included studies showed no statistically significant differences in the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques and conservative treatment. Subgroup analysis comparing different study designs, durations of symptoms, follow-up times, races of patients, and techniques were conducted, and no significant differences in the incidence of secondary fractures were identified (P > 0.05). No obvious publication bias was detected by either Begg's test (P = 0.360 > 0.05) or Egger's test (P = 0.373 > 0.05). Despite current thinking in the field that vertebral augmentation procedures may increase the incidence of secondary fractures, we found no differences in the incidence of secondary fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. © The Foundation Acta Radiologica 2014.

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.

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.

Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures

PubMed Central

Krinner, Sebastian; Oppel, Pascal; Grupp, Sina; Schulz-Drost, Melanie; Hennig, Friedrich F.; Langenbach, Andreas

2018-01-01

Background Sternum fractures are mostly located on the sternal corpus, seldom on the manubrium. Fractures of the sternal manubrium are, however, more frequently associated with severe concomitant injuries of thoracic organs, and therefore deserve special attention. In addition, in its function as a capstone in between the anterior chest wall and the shoulder girdle, it is exposed to a multiplicity of forces. Therefore the questions arise what types of fractures are observed in today’s clinical practice, how to classify them and which treatment options are available. This study reports on different types of fractures which involve the manubrium sterni. Methods Between January 2012 and October 2014, data was collected from all severely injured patients (ISS ≥16), which received a CT scan of the thorax in our Level-I-Trauma Center and retrospectively analyzed concerning sternal fractures. Fracture type, collateral injuries, age, and information about the circumstances of the accident were noted. Results Of 890 evaluable patients, 154 (17.3%) had a fracture of the sternum and 23 (2.6%) of the manubrium. Fractures of the manubrium appeared in following types: A-type—transverse fracture (n=11) in 1st intercostal space by direct blunt trauma or flexion of the torso with sagittal instability; B-type—oblique fracture (n=9) by seat belt injury with rotatory instability; C-type—combined, more fragmentary fracture (n=3) by direct blunt trauma with simultaneous flexion of the torso and multi directional instability. Fractures only little dislocation were treated conservatively, and unstable fractures were surgically stabilized (n=10). Conclusions In summary, three main types of fractures could be found. A-type fractures were stabilized with a longitudinal plate osteosynthesis and B-type fractures with transverse positioned plates. To treat complex C-type fractures, plates with a T- or H-form could be a good solution. Level of evidence: Level III retrospective prognostic cohort study PMID:29707289

Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study.

PubMed

Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P J; Dijkgraaf, Marcel G W; Verleisdonk, Egbert Jan; Leenen, Luke P H; Hietbrink, Falco

Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and polytrauma and low- and high-energy trauma patients with an ankle fracture. We performed a single-center retrospective cohort study. Fractures were classified according to the Lauge-Hansen classification and a descriptive classification. High-energy trauma (HET) was defined using triage criteria. All other patients were classified as having experienced low-energy trauma (LET). The patients were divided into 2 groups according to the injury severity score (ISS). Monotrauma patients were defined as patients with an ISS of 4 to 11 with an isolated ankle fracture or an ankle fracture with a minor contusion or laceration. Polytrauma patients were defined as patients with an ISS of ≥16 with ≥2 body regions involved. Patients with an ISS from 12 to 15 were excluded. A total of 96 patients were eligible for analysis. Of the 96 patients, 62 had experienced monotrauma and 34 had experienced polytrauma. A significant difference was found between the mono- and polytrauma patients in the Lauge-Hansen classification (p < .001). Monotrauma patients had a high incidence of an isolated supination external rotation injury. Supination adduction and pronation abduction injuries were more often observed in polytrauma patients. The same pattern was observed for ankle fractures after HET compared with LET (p < .001), because all pronation abduction and supination adduction injuries were observed after a HET mechanism. The results of the present study indicate that polytrauma patients sustain different types of ankle fractures than patients with an isolated ankle fracture. This difference likely results from the high-energy transfer associated with polytrauma, because pronation abduction and supination adduction injuries were only observed after HET. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Recovery of decreased bone mineral mass after lower-limb fractures in adolescents.

PubMed

Ceroni, Dimitri; Martin, Xavier E; Delhumeau, Cécile; Farpour-Lambert, Nathalie J; De Coulon, Geraldo; Dubois-Ferrière, Victor; Rizzoli, René

2013-06-05

Loss of bone mineral mass, muscle atrophy, and functional limitations are predictable consequences of immobilization and subsequent weight-bearing restriction due to leg or ankle fractures. The aim of this study was to prospectively determine whether decreased bone mineral mass following lower-limb fractures recovers at follow-up durations of six and eighteen months in adolescents. In the present study, we included fifty adolescents who underwent cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of four different sites (total hip, femoral neck, entire lower limb, and calcaneus) were performed at the time of the fracture, at cast removal, and at follow-ups of six and eighteen months. Patients with fractures were paired with healthy controls according to sex, age, and ethnicity. Dual x-ray absorptiometry values were compared between groups and between injured and non-injured legs in adolescents with fractures. Among those with fractures, lower-limb bone mineral variables were significantly lower at the injured side compared with the non-injured side at cast removal, with differences ranging from 6.2% to 31.7% (p < 0.0001). Similarly, injured adolescents had significantly lower bone mineral values at the level of the injured lower limb compared with healthy controls (p < 0.0001). At the six-month follow-up, there were still significant residual differences between injured and non-injured legs in adolescents with fractures (p < 0.0001). However, a significant residual difference between healthy controls and injured adolescents was present only for femoral neck bone mineral density (p = 0.011). At the eighteen-month follow-up, no significant difference was observed at any lower-limb site. Bone mineral loss following a fracture of the lower limb in adolescents is highly significant and affects the lower limb both proximal to and distal to the fracture site. In contrast to observations in adults, a rapid bone mass reversal occurs with full bone recovery by eighteen months. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: the Study of Osteoporotic Fractures

PubMed Central

Fink, Howard A.; Harrison, Stephanie L.; Taylor, Brent C.; Cummings, Steven R.; Schousboe, John T.; Kuskowski, Michael A.; Stone, Katie L.; Ensrud, Kristine E.

2009-01-01

To examine the fracture pattern in older women whose bone mineral density (BMD) T-score criteria for osteoporosis at hip and spine disagree, hip and spine BMD were measured in Study of Osteoporotic Fractures participants using dual energy x-ray absorptiometry (DXA). Hip osteoporosis was defined as T-score ≤-2.5 at femoral neck or total hip, and spine osteoporosis as T-score ≤-2.5 at lumbar spine. Incident clinical fractures were self-reported and centrally adjudicated. Incident radiographic spine fractures were defined morphometrically. Compared to women with osteoporosis at neither hip nor spine, those osteoporotic only at hip had a 3.0-fold age and weight-adjusted increased risk for hip fracture (95%CI 2.4-3.6), and smaller increases in risk of nonhip nonspine (HR=1.6), clinical spine (OR=2.2), and radiographic spine fractures (OR=1.5). Women osteoporotic only at spine had a 2.8-fold increased odds of radiographic spine fracture (95%CI 2.1-3.8), and smaller increases in risk of clinical spine (OR=1.4), nonhip nonspine (HR=1.6), and hip fractures (HR=1.2). Discordant BMD results predict different fracture patterns. DXA fracture risk estimation in these patients should be site-specific. Women osteoporotic only at spine would not have been identified from hip BMD measurement alone, and may have a sufficiently high fracture risk to warrant preventive treatment. PMID:18296090

The Longitudinal Health Study: A Multiphasic Medical Surveillance Program for U. S. Navy Submarine and Diving Personnel

DTIC Science & Technology

1974-05-31

olecranon (triceps), (2) at the infer- ior tip of the scapula (subscapular), and (3) at the right midaxillary line at the level of the umbilicus...reliable character- ization of color vision patterns. " The Pseudo-Isochromic Plates provide a quick screening device. The more sen- sitive...Isochromatic Plates Famsworth 100 - Hue Test Hecht - Schlaer Anomaloscope 13 MKNSWOtTH-MUNSfU IOO-HUI T«T ft Calef Viti«n MUNSIU COLO« COMPANT

Mechanical Properties of Spinal Ligaments for Rhesus Monkey, Baboon and Chimpanzee.

DTIC Science & Technology

1981-06-01

isolate the spine, to grossly elevate the scapulae , and to expose the dorsal aspect of the rib cage. Using a Stryker saw, the rib,: were cut at least 2...Figure 10. The upper gripping plate was attached to the actuator of the testing machine and the lower plate to the load cell. The ligament sample was held...against these plates with stainless steel bands. On the surfaces of both the plates and the bands, a waterproof abrasive mesh (silicon carbide 120

An interface finite element model can be used to predict healing outcome of bone fractures.

PubMed

Alierta, J A; Pérez, M A; García-Aznar, J M

2014-01-01

After fractures, bone can experience different potential outcomes: successful bone consolidation, non-union and bone failure. Although, there are a lot of factors that influence fracture healing, experimental studies have shown that the interfragmentary movement (IFM) is one of the main regulators for the course of bone healing. In this sense, computational models may help to improve the development of mechanical-based treatments for bone fracture healing. Hence, based on this fact, we propose a combined repair-failure mechanistic computational model to describe bone fracture healing. Despite being a simple model, it is able to correctly estimate the time course evolution of the IFM compared to in vivo measurements under different mechanical conditions. Therefore, this mathematical approach is especially suitable for modeling the healing response of bone to fractures treated with different mechanical fixators, simulating realistic clinical conditions. This model will be a useful tool to identify factors and define targets for patient specific therapeutics interventions. © 2013 Published by Elsevier Ltd.

The Influence of Specimen Type on Tensile Fracture Toughness of Rock Materials

NASA Astrophysics Data System (ADS)

Aliha, Mohammad Reza Mohammad; Mahdavi, Eqlima; Ayatollahi, Majid Reza

2017-03-01

Up to now, several methods have been proposed to determine the mode I fracture toughness of rocks. In this research, different cylindrical and disc shape samples, namely: chevron bend (CB), short rod (SR), cracked chevron notched Brazilian disc (CCNBD), and semi-circular bend (SCB) specimens were considered for investigating mode I fracture behavior of a marble rock. It is shown experimentally that the fracture toughness values of the tested rock material obtained from different test specimens are not consistent. Indeed, depending on the geometry and loading type of the specimen, noticeable discrepancies can be observed for the fracture toughness of a same rock material. The difference between the experimental mode I fracture resistance results is related to the magnitude and sign of T-stress that is dependent on the geometry and loading configuration of the specimen. For the chevron-notched samples, the critical value of T-stress corresponding to the critical crack length was determined using the finite element method. The CCNBD and SR specimens had the most negative and positive T-stress values, respectively. The dependency of mode I fracture resistance to the T-stress was shown using the extended maximum tangential strain (EMTSN) criterion and the obtained experimental rock fracture toughness data were predicted successfully with this criterion.

Quantifying opening-mode fracture spatial organization in horizontal wellbore image logs, core and outcrop: Application to Upper Cretaceous Frontier Formation tight gas sandstones, USA

NASA Astrophysics Data System (ADS)

Li, J. Z.; Laubach, S. E.; Gale, J. F. W.; Marrett, R. A.

2018-03-01

The Upper Cretaceous Frontier Formation is a naturally fractured gas-producing sandstone in Wyoming. Regionally, random and statistically more clustered than random patterns exist in the same upper to lower shoreface depositional facies. East-west- and north-south-striking regional fractures sampled using image logs and cores from three horizontal wells exhibit clustered patterns, whereas data collected from east-west-striking fractures in outcrop have patterns that are indistinguishable from random. Image log data analyzed with the correlation count method shows clusters ∼35 m wide and spaced ∼50 to 90 m apart as well as clusters up to 12 m wide with periodic inter-cluster spacings. A hierarchy of cluster sizes exists; organization within clusters is likely fractal. These rocks have markedly different structural and burial histories, so regional differences in degree of clustering are unsurprising. Clustered patterns correspond to fractures having core quartz deposition contemporaneous with fracture opening, circumstances that some models suggest might affect spacing patterns by interfering with fracture growth. Our results show that quantifying and identifying patterns as statistically more or less clustered than random delineates differences in fracture patterns that are not otherwise apparent but that may influence gas and water production, and therefore may be economically important.

No difference in the level of physical activity between children who have or have never sustained a fracture.

PubMed

Randsborg, P-H; Røtterud, J H

2017-12-01

This study investigates whether children with an acute fracture have a different level of physical activity compared to children who have never sustained a fracture, as measured by the Physical Activity Questionnaire for older children (PAQ-C). The PAQ-C scores of 683 children (295 girls) aged 6-12 years (mean age 9.4 years) who presented to our institution with an acute fracture were compared to the PAQ-C scores of 151 random children (81 girls) aged 6-12 years (mean 9.1 years) in the same area who had never sustained a fracture. Multivariate regression analysis was employed, controlling for age and gender. The mean PAQ-C score of the children who presented to the institution with an acute fracture was 2.85 (95% confidence interval [CI], 2.80-2.91). For the children who had never sustained a fracture, the mean PAQ-C score was 2.78 (95% CI, 2.69-2.87). If there is a true difference in the level of physical activity between children who have or have never sustained a fracture, the PAQ-C questionnaire is not sensitive enough to identify it. © 2016 The Authors. Scandinavian Journal of Medicine & Science in Sports Published by John Wiley & Sons Ltd.

Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability

PubMed Central

Baek, Hye Jin; Kim, Dong Wook; Ryu, Ji Hwa; Lee, Yoo Jin

2013-01-01

Background There has been no study to compare the diagnostic accuracy of an experienced radiologist with a trainee in nasal bone fracture. Objectives To compare the diagnostic accuracy between conventional radiography and computed tomography (CT) for the identification of nasal bone fractures and to evaluate the interobserver reliability between a staff radiologist and a trainee. Patients and Methods A total of 108 patients who underwent conventional radiography and CT after acute nasal trauma were included in this retrospective study. Two readers, a staff radiologist and a second-year resident, independently assessed the results of the imaging studies. Results Of the 108 patients, the presence of a nasal bone fracture was confirmed in 88 (81.5%) patients. The number of non-depressed fractures was higher than the number of depressed fractures. In nine (10.2%) patients, nasal bone fractures were only identified on conventional radiography, including three depressed and six non-depressed fractures. CT was more accurate as compared to conventional radiography for the identification of nasal bone fractures as determined by both readers (P <0.05), all diagnostic indices of an experienced radiologist were similar to or higher than those of a trainee, and κ statistics showed moderate agreement between the two diagnostic tools for both readers. There was no statistical difference in the assessment of interobserver reliability for both imaging modalities in the identification of nasal bone fractures. Conclusion For the identification of nasal bone fractures, CT was significantly superior to conventional radiography. Although a staff radiologist showed better values in the identification of nasal bone fracture and differentiation between depressed and non-depressed fractures than a trainee, there was no statistically significant difference in the interpretation of conventional radiography and CT between a radiologist and a trainee. PMID:24348599

Assessment of Sex Differences in Fracture Risk among Patients with Anorexia Nervosa: A Population-Based Cohort Study using The Health Improvement Network

PubMed Central

Nagata, Jason M.; Golden, Neville H.; Leonard, Mary B.; Copelovitch, Lawrence; Denburg, Michelle R.

2017-01-01

Though previous studies have demonstrated an increased fracture risk in females with anorexia nervosa (AN), fracture risk in males is not well characterized. The objective of this study was to examine sex differences in fracture risk and site-specific fracture incidence in AN. We performed a population-based retrospective cohort study using The Health Improvement Network. The median calendar year for the start of the observation period was 2004–5. We identified 9,239 females and 556 males <60 years of age with AN, and 97,889 randomly selected sex-, age-, and practice-matched participants without eating disorders (92,329 females and 5560 males). Multivariable Cox regression was used to estimate the hazard ratio (HR) for incident fracture. Median age at start of observation was 29.8 years in females and 30.2 years in males. The HR for fracture associated with AN differed by sex and age (interaction p = 0.002). Females with AN had an increased fracture risk at all ages (HR 1.59; 95% confidence interval [95% CI], 1.45–1.75). AN was associated with a higher risk of fracture among males >40 years of age (HR 2.54, 95% CI 1.32–4.90; p = 0.005) but not among males ≤40 years. Females with AN had a higher risk of fracture at nearly all anatomic sites. The greatest excess fracture risk was noted at the hip/femur (HR 5.59; 95% CI, 3.44–9.09) and pelvis (HR 4.54; 95% CI 2.42–8.50) in females and at the vertebrae (HR 7.25; 95% CI, 1.21–43.45) for males with AN. AN was associated with higher incident fracture risk in females across all age groups and in males >40 years old. Sites of highest fracture risk include the hip/femur and pelvis in females and vertebrae in males with AN. PMID:28019700

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

PubMed

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

2011-01-01

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

Pediatric nasoorbitoethmoid fractures.

PubMed

Liau, James Y; Woodlief, Justin; van Aalst, John A

2011-09-01

The pediatric craniofacial trauma literature largely focuses on the management of mandible fractures, with very little information focusing on pediatric midface fractures, specifically nasoorbitethmoid (NOE) fractures. Because the diagnosis and surgical treatment plan for adult NOE fractures is well established in the literature, the treatment algorithms for NOE are essentially a transfer of adult practices to pediatric patients. This article reviews the differences between the pediatric and adult facial skeleton and the pathology and presentation of NOE fractures in the pediatric craniomaxillofacial skeleton. It also presents the effects of NOE fractures on the growth and development of the pediatric facial skeleton and describes the current surgical management for NOE fractures.

Depression following fracture in women: a study of age-matched cohorts

PubMed Central

Williams, Lana J; Berk, Michael; Henry, Margaret J; Stuart, Amanda L; Brennan, Sharon L; Jacka, Felice N; Pasco, Julie A

2014-01-01

Objectives High levels of disability, functional impairment and mortality are independently associated with fracture and depression, however the relationship between fracture and depression is uncertain. The aim of this study was to investigate whether fracture is associated with subsequent depressive symptoms in a population-based sample of women. Design A study of age-matched fracture versus non-fracture cohorts of women. Setting Barwon Statistical Division, southeastern Australia. Participants Two samples of women aged ≥35 years were drawn from the Geelong Osteoporosis Study (GOS). The fracture cohort included women with incident fracture identified from radiology reports and the non-fracture cohort were randomly selected from the electoral roll during 1994–1996. Outcome measure Symptoms of depression for women with and without fracture during the 12-month period 2000–2001 were identified by self-report questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Results A total of 296 women with fracture (12 hip, 48 vertebral, 91 wrist/forearm, 17 upper arm, 7 pelvis, 11 rib, 62 lower leg and 48 other fractures) and 590 women without fracture were included. Associations between fracture and depression differed between younger (≤65 years) and older (>65 years) women. Age and weight-adjusted odds ratio for depression following fracture among younger women was 0.62 (0.35 to 1.11, p=0.12) and 3.33 (1.24 to 8.98, p=0.02) for older women. Further adjustment for lifestyle factors did not affect the results. Conclusions This study demonstrated that differences in mood status exist between older and younger women following fracture and that fracture is associated with increased depression in older women. Assessment of mood status in both the short and long term following fracture in the elderly seems justified, with early detection and treatment likely to result in improved outcomes. PMID:24561497

Ethnic Differences in Bone Health

PubMed Central

Zengin, Ayse; Prentice, Ann; Ward, Kate Anna

2015-01-01

There are differences in bone health between ethnic groups in both men and in women. Variations in body size and composition are likely to contribute to reported differences. Most studies report ethnic differences in areal bone mineral density (aBMD), which do not consistently parallel ethnic patterns in fracture rates. This suggests that other parameters beside aBMD should be considered when determining fracture risk between and within populations, including other aspects of bone strength: bone structure and microarchitecture, as well as muscle strength (mass, force generation, anatomy) and fat mass. We review what is known about differences in bone-densitometry-derived outcomes between ethnic groups and the extent to which they account for the differences in fracture risk. Studies are included that were published primarily between 1994 and 2014. A “one size fits all approach” should definitely not be used to understand better ethnic differences in fracture risk. PMID:25852642

Prediction of incident hip fracture by femoral neck bone mineral density and neck-shaft angle: a 5-year longitudinal study in post-menopausal females.

PubMed

Gnudi, S; Sitta, E; Pignotti, E

2012-08-01

To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. In a 5 year follow-up study, the hip fracture incidence in 729 post-menopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck-shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture.

Prediction of incident hip fracture by femoral neck bone mineral density and neck–shaft angle: a 5-year longitudinal study in post-menopausal females

PubMed Central

Gnudi, S; Sitta, E; Pignotti, E

2012-01-01

Objective To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. Methods In a 5 year follow-up study, the hip fracture incidence in 729 post-menopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck–shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. Results The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). Conclusion Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture. PMID:22096224

How Do Le Fort-Type Fractures Present in a Pediatric Cohort?

PubMed

Macmillan, Alexandra; Lopez, Joseph; Luck, J D; Faateh, Muhammad; Manson, Paul; Dorafshar, Amir H

2018-05-01

Le Fort-type fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. The purpose of this study was to determine the etiology, frequency, and fracture patterns of children with severe facial trauma associated with pterygoid plate fractures in a pediatric cohort. We performed a retrospective cohort study of all children aged younger than 16 years with pterygoid plate and facial fractures who presented to our institute between 1990 and 2010. Patient charts and radiologic records were reviewed for demographic and fracture characteristics. Patients were categorized into 2 groups as per facial fracture pattern: non-Le Fort-type fractures (group A) and Le Fort-type fractures (group B). Other variables including dentition age, frontal sinus development, mechanism of injury, injury severity, and concomitant injuries were recorded. Univariate methods were used to compare groups. We identified 24 children; 25% were girls, and 20.8% were of nonwhite race. Most presented with Le Fort-type fracture patterns (group B, 66.7%). Age was significantly different between group A and group B (mean, 5.9 years and 9.9 years, respectively; P = .009). No significant differences in Injury Severity Score, rate of operative repair, and length of stay were found between groups. Most children with severe facial fractures and pterygoid plate fractures presented with Le Fort-type fracture patterns in our cohort. The mean age of children with Le Fort-type fractures was greater than in those with non-Le Fort-type patterns. However, Le Fort-type fractures did occur in younger children with deciduous and mixed dentition. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[LiLa classification for paediatric long bone fractures. Intraobserver and interobserver reliability].

PubMed

Kamphaus, A; Rapp, M; Wessel, L M; Buchholz, M; Massalme, E; Schneidmüller, D; Roeder, C; Kaiser, M M

2015-04-01

There are two child-specific fracture classification systems for long bone fractures: the AO classification of pediatric long-bone fractures (PCCF) and the LiLa classification of pediatric fractures of long bones (LiLa classification). Both are still not widely established in comparison to the adult AO classification for long bone fractures. During a period of 12 months all long bone fractures in children were documented and classified according to the LiLa classification by experts and non-experts. Intraobserver and interobserver reliability were calculated according to Cohen (kappa). A total of 408 fractures were classified. The intraobserver reliability for location in the skeletal and bone segment showed an almost perfect agreement (K = 0.91-0.95) and also the morphology (joint/shaft fracture) (K = 0.87-0.93). Due to different judgment of the fracture displacement in the second classification round, the intraobserver reliability of the whole classification revealed moderate agreement (K = 0.53-0.58). Interobserver reliability showed moderate agreement (K = 0.55) often due to the low quality of the X-rays. Further differences occurred due to difficulties in assigning the precise transition from metaphysis to diaphysis. The LiLa classification is suitable and in most cases user-friendly for classifying long bone fractures in children. Reliability is higher than in established fracture specific classifications and comparable to the AO classification of pediatric long bone fractures. Some mistakes were due to a low quality of the X-rays and some due to difficulties to classify the fractures themselves. Improvements include a more precise definition of the metaphysis and the kind of displacement. Overall the LiLa classification should still be considered as an alternative for classifying pediatric long bone fractures.

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.

The causes and prognoses of different types of fractures in wild koalas submitted to wildlife hospitals.

PubMed

Henning, Joerg; Hannon, Christabel; McKinnon, Allan; Larkin, Rebecca; Allavena, Rachel

2015-12-01

Fractures are a major problem in wild koalas of great veterinary and conservation importance as their occurrence in different locations of the body might result in varying healing success. The aim of this study was to determine the fracture types (defined by location of the fracture) occurring in wild koalas, temporal patterns, possible causes and risk factors of fracture types, and the prognosis for successfully releasing kolas with healed fracture types into the wild. Data from a total of 2031 wild koalas submitted to wildlife hospitals in South-East Queensland, Australia, over a period of 13 years were analysed. Approximately 56.7% of koalas experienced head fractures, 13.4% had torso fractures, 14.9% had limb fractures and 15% had combination fractures. A total of 84.1% of fractures were caused by vehicle collisions, 9.1% by dog attacks, 3.3% by falls from trees, 1.3% by train collisions, 0.2% by livestock trampling and 1.8% due to unknown causes. Multinominal logistic regression was used to identify risk factors (cause of fracture, age category, sex, year, three-year admission period and season of fracture event) by fracture type. The type of fracture was associated with both the cause of the fracture and the season when it occurred: for example torso fractures (compared to combination fractures) were associated with dog attacks (OR=10.98; 95% CI6.03, 20.01) and falls from trees (OR=4.79; 95% CI2.26, 10.19) relative to vehicle collisions. More submissions of koalas with head fractures due to vehicle collisions occurred in spring compared to autumn and winter, coinciding with the breeding season of koalas and increased animal movement. Prognosis for koalas with fractures was poor, with approximately 63.8% of koalas admitted dead on arrival, 34.2% euthanised, and only 2.0% of koalas able to be released. Given this data, further research into mitigation strategies to decrease the risk of fractures and to increase the observed low recovery rate should be considered. Copyright © 2015 Elsevier B.V. All rights reserved.

Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures

PubMed Central

Yaligod, Vishwanath; Rudrappa, Girish H.; Nagendra, Srinivas; Shivanna, Umesh M.

2013-01-01

Background The complications of intramedullary nailing of distal third tibial shaft and metaphyseal fractures have a direct impact on ankle and hind foot function. Methods We retrospectively evaluated 28 patients. Unreamed nail was negotiated across the well reduced fracture till subchondral bone and fixed with 2 to 3 distal locking screws in different planes. Results Fracture union rate was 85%. Three out of 28 patients had malalignment. Mean ankle, hindfoot functional score was 85. Conclusion Complications can be minimized by impacting the unreamed nail till the subchondral bone while maintaining the fracture well reduced and by using multiple distal locking screws in different planes. PMID:24719527

Resistance to fracture of roots filled with different sealers.

PubMed

Sağsen, Burak; Ustün, Yakup; Pala, Kanşad; Demırbuğa, Sezer

2012-01-01

The aim of this study was to compare the fracture resistance of roots filled with gutta percha (GP) and different root canal sealers.Fifty-five human maxillary central incisors were selected and randomly divided into three experimental groups (Groups 1-3) and two control groups (Groups 4 and 5). They were Group 1-15 root canals filled with an epoxy resin-based sealer (AH Plus) and GP, Group 2 -15 root canals filled with a calcium silicate-based sealer (iRoot SP) and GP, Group 3: 15 root canals filled with another calcium silicate-based sealer (MTA Fillapex) and GP, Group 4: five roots were instrumented but not filled, and Group 5: five roots were neither instrumented nor filled. Compressive loading was carried out using a universal testing machine until fracture occurred. Force applied at time of fracture was recorded as fracture strength of specimen in Newtons. There were no significant differences in fracture strength among the three experimental groups (p>0.05), whose results were significantly superior to that of Group 4 (p<0.05). In conclusion, all the root canal sealers used in the present study increased the fracture resistance of instrumented root canals.

Impact of eliminating fracture intersection nodes in multiphase compositional flow simulation

NASA Astrophysics Data System (ADS)

Walton, Kenneth M.; Unger, Andre J. A.; Ioannidis, Marios A.; Parker, Beth L.

2017-04-01

Algebraic elimination of nodes at discrete fracture intersections via the star-delta technique has proven to be a valuable tool for making multiphase numerical simulations more tractable and efficient. This study examines the assumptions of the star-delta technique and exposes its effects in a 3-D, multiphase context for advective and dispersive/diffusive fluxes. Key issues of relative permeability-saturation-capillary pressure (kr-S-Pc) and capillary barriers at fracture-fracture intersections are discussed. This study uses a multiphase compositional, finite difference numerical model in discrete fracture network (DFN) and discrete fracture-matrix (DFM) modes. It verifies that the numerical model replicates analytical solutions and performs adequately in convergence exercises (conservative and decaying tracer, one and two-phase flow, DFM and DFN domains). The study culminates in simulations of a two-phase laboratory experiment in which a fluid invades a simple fracture intersection. The experiment and simulations evoke different invading fluid flow paths by varying fracture apertures as oil invades water-filled fractures and as water invades air-filled fractures. Results indicate that the node elimination technique as implemented in numerical model correctly reproduces the long-term flow path of the invading fluid, but that short-term temporal effects of the capillary traps and barriers arising from the intersection node are lost.

Fractures in Kidney Transplant Recipients: A Comparative Study Between England and New York State.

PubMed

Arnold, Julia; Mytton, Jemma; Evison, Felicity; Gill, Paramjit S; Cockwell, Paul; Sharif, Adnan; Ferro, Charles J

2017-11-15

Fractures are associated with high morbidity and are a major concern for kidney transplant recipients. No comparative analysis has yet been conducted between countries in the contemporary era to inform future international prevention trials. Data were obtained from the Hospital Episode Statistics and the Statewide Planning and Research Cooperative databases on all adult kidney transplants performed in England and New York State from 2003 to 2013, respectively, and on posttransplant fracture-related hospitalization from 2003 to 2014. Our analysis included 18 493 English and 11 602 New York State kidney transplant recipients. Overall, 637 English recipients (3.4%) and 398 New York State recipients (3.4%) sustained a fracture, giving an unadjusted event rate of 7.0 and 5.9 per 1000 years, respectively (P = .948). Of these, 147 English (0.8%) and 101 New York State recipients (0.9%) sustained a hip fracture, giving an unadjusted event rate of 1.6 and 1.5 per 1000 years, respectively (P = .480). There were no differences in the cumulative incidence of all fractures or hip fractures. One-year mortality rates after any fracture (9% and 11%) or after a hip fracture (15% and 17%) were not different between cohorts. Contemporaneous English and New York State kidney transplant recipients have similar fracture rates and mortality rates postfracture.

Comparative fracture strength analysis of Lava and Digident CAD/CAM zirconia ceramic crowns

PubMed Central

Kwon, Taek-Ka; Pak, Hyun-Soon; Han, Jung-Suk; Lee, Jai-Bong; Kim, Sung-Hun

2013-01-01

PURPOSE All-ceramic crowns are subject to fracture during function. To minimize this common clinical complication, zirconium oxide has been used as the framework for all-ceramic crowns. The aim of this study was to compare the fracture strengths of two computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia crown systems: Lava and Digident. MATERIALS AND METHODS Twenty Lava CAD/CAM zirconia crowns and twenty Digident CAD/CAM zirconia crowns were fabricated. A metal die was also duplicated from the original prepared tooth for fracture testing. A universal testing machine was used to determine the fracture strength of the crowns. RESULTS The mean fracture strengths were as follows: 54.9 ± 15.6 N for the Lava CAD/CAM zirconia crowns and 87.0 ± 16.0 N for the Digident CAD/CAM zirconia crowns. The difference between the mean fracture strengths of the Lava and Digident crowns was statistically significant (P<.001). Lava CAD/CAM zirconia crowns showed a complete fracture of both the veneering porcelain and the core whereas the Digident CAD/CAM zirconia crowns showed fracture only of the veneering porcelain. CONCLUSION The fracture strengths of CAD/CAM zirconia crowns differ depending on the compatibility of the core material and the veneering porcelain. PMID:23755332

Atlas Fractures and Atlas Osteosynthesis: A Comprehensive Narrative Review.

PubMed

Kandziora, Frank; Chapman, Jens R; Vaccaro, Alexander R; Schroeder, Gregory D; Scholz, Matti

2017-09-01

Most atlas fractures are the result of compression forces. They are often combined with fractures of the axis and especially with the odontoid process. Multiple classification systems for atlas fractures have been described. For an adequate diagnosis, a computed tomography is mandatory. To distinguish between stable and unstable atlas injury, it is necessary to evaluate the integrity of the transverse atlantal ligament (TAL) by magnetic resonance imaging and to classify the TAL lesion. Studies comparing conservative and operative management of unstable atlas fractures are unfortunately not available in the literature; neither are studies comparing different operative treatment strategies. Hence all treatment recommendations are based on low level evidence. Most of atlas fractures are stable and will be successfully managed by immobilization in a soft/hard collar. Unstable atlas fractures may be treated conservatively by halo-fixation, but nowadays more and more surgeons prefer surgery because of the potential discomfort and complications of halo-traction. Atlas fractures with a midsubstance ligamentous disruption of TAL or severe bony ligamentous avulsion can be treated by a C1/2 fusion. Unstable atlas fractures with moderate bony ligamentous avulsion may be treated by atlas osteosynthesis. Although the evidence for the different treatment strategies of atlas fractures is low, atlas osteosynthesis has the potential to change treatment philosophies. The reasons for this are described in this review.

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

PubMed

Sagsoz, N Polat; Yanıkoglu, N

2018-04-01

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

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

Stress analysis of implant-bone fixation at different fracture angle

NASA Astrophysics Data System (ADS)

Izzawati, B.; Daud, R.; Afendi, M.; Majid, MS Abdul; Zain, N. A. M.; Bajuri, Y.

2017-10-01

Internal fixation is a mechanism purposed to maintain and protect the reduction of a fracture. Understanding of the fixation stability is necessary to determine parameters influence the mechanical stability and the risk of implant failure. A static structural analysis on a bone fracture fixation was developed to simulate and analyse the biomechanics of a diaphysis shaft fracture with a compression plate and conventional screws. This study aims to determine a critical area of the implant to be fractured based on different implant material and angle of fracture (i.e. 0°, 30° and 45°). Several factors were shown to influence stability to implant after surgical. The stainless steel, (S. S) and Titanium, (Ti) screws experienced the highest stress at 30° fracture angle. The fracture angle had a most significant effect on the conventional screw as compared to the compression plate. The stress was significantly higher in S.S material as compared to Ti material, with concentrated on the 4th screw for all range of fracture angle. It was also noted that the screws closest to the intense concentration stress areas on the compression plate experienced increasing amounts of stress. The highest was observed at the screw thread-head junction.

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.

Are distal radius fractures due to fragility or to falls? A consecutive case-control study of bone mineral density, tendency to fall, risk factors for osteoporosis, and health-related quality of life.

PubMed

Nordvall, Helena; Glanberg-Persson, Gunhild; Lysholm, Jack

2007-04-01

A fracture of the distal radius is considered to indicate an increased risk of future fractures, especially a hip fracture. The main causes may be osteoporosis or a tendency to fall, separately or in combination. 93 women and 5 men with a recent radius fracture and the same number of controls were measured with a heel-DXL and asked to complete one questionnaire on their quality of life (SF-36), and one on risk factors. The mean T-score of the patients was -2.1, and for the controls it was -1.9 (p = 0.3). The patients aged over 64 years had a history of falling more often than the corresponding controls (p = 0.01), but there was no difference in T-score. By contrast, patients 45-64 years of age showed a non-significant, lower T-score (p = 0.09), but there was no difference concerning their history of falling. For all other risk factors, no differences were found between the patients and the controls. There were significant differences between the patients and the controls in some of the functions in the SF-36, due to the radius fracture. This study indicates that the underlying cause of a distal radius fracture may be different in patients aged 45-64 years and those who are more than 64 years old.

Amyloidoma, an Unusual Cause of Fracture

PubMed Central

Prati, Clément; Wendling, Daniel

2014-01-01

We report a case of a spontaneous hip fracture in a context of dysglobulinemia. The bone histologic examination found amyloidoma. Amyloidoma is an overload pathology and an unusual cause of fracture. In most of the cases, it is associated with myeloma and the difference between bone invasion of myeloma and amyloidoma in an osteolytic radiographic picture is not easy but is of importance because prognosis and treatment may be totally different. Thus, in the context of dysglobulinemia, one must keep in mind that spontaneous bone fracture may be due to amyloidoma with another prognosis. PMID:24744947

Biomechanical principles and mechanobiologic aspects of flexible and locked plating.

PubMed

Claes, Lutz

2011-02-01

The goal of minimally invasive surgery in extramedullary internal fixation has led to the development of flexible plates, bridging plates, and locked internal fixators. The change from conventional compression plates to these new implants, however, resulted in different biomechanics of fixation and different mechanobiologic processes for fracture healing. The aim of a flexible fixation is the stimulation of fracture healing by callus formation. Fracture healing follows mechanobiologic rules based mainly on interfragmentary strain, which is dependent on the stability of the fixation construct and the type of fracture. Knowledge of the mechanobiologic processes and the factors influencing the stability of fracture fixation are necessary for the surgeon to choose the correct technique for fracture fixation. Problems in the selection of the correct technique and limitations with the available implants as well as possible future developments are discussed.

Surrogate-based optimization of hydraulic fracturing in pre-existing fracture networks

NASA Astrophysics Data System (ADS)

Chen, Mingjie; Sun, Yunwei; Fu, Pengcheng; Carrigan, Charles R.; Lu, Zhiming; Tong, Charles H.; Buscheck, Thomas A.

2013-08-01

Hydraulic fracturing has been used widely to stimulate production of oil, natural gas, and geothermal energy in formations with low natural permeability. Numerical optimization of fracture stimulation often requires a large number of evaluations of objective functions and constraints from forward hydraulic fracturing models, which are computationally expensive and even prohibitive in some situations. Moreover, there are a variety of uncertainties associated with the pre-existing fracture distributions and rock mechanical properties, which affect the optimized decisions for hydraulic fracturing. In this study, a surrogate-based approach is developed for efficient optimization of hydraulic fracturing well design in the presence of natural-system uncertainties. The fractal dimension is derived from the simulated fracturing network as the objective for maximizing energy recovery sweep efficiency. The surrogate model, which is constructed using training data from high-fidelity fracturing models for mapping the relationship between uncertain input parameters and the fractal dimension, provides fast approximation of the objective functions and constraints. A suite of surrogate models constructed using different fitting methods is evaluated and validated for fast predictions. Global sensitivity analysis is conducted to gain insights into the impact of the input variables on the output of interest, and further used for parameter screening. The high efficiency of the surrogate-based approach is demonstrated for three optimization scenarios with different and uncertain ambient conditions. Our results suggest the critical importance of considering uncertain pre-existing fracture networks in optimization studies of hydraulic fracturing.

The three-zone composite productivity model for a multi-fractured horizontal shale gas well

NASA Astrophysics Data System (ADS)

Qi, Qian; Zhu, Weiyao

2018-02-01

Due to the nano-micro pore structures and the massive multi-stage multi-cluster hydraulic fracturing in shale gas reservoirs, the multi-scale seepage flows are much more complicated than in most other conventional reservoirs, and are crucial for the economic development of shale gas. In this study, a new multi-scale non-linear flow model was established and simplified, based on different diffusion and slip correction coefficients. Due to the fact that different flow laws existed between the fracture network and matrix zone, a three-zone composite model was proposed. Then, according to the conformal transformation combined with the law of equivalent percolation resistance, the productivity equation of a horizontal fractured well, with consideration given to diffusion, slip, desorption, and absorption, was built. Also, an analytic solution was derived, and the interference of the multi-cluster fractures was analyzed. The results indicated that the diffusion of the shale gas was mainly in the transition and Fick diffusion regions. The matrix permeability was found to be influenced by slippage and diffusion, which was determined by the pore pressure and diameter according to the Knudsen number. It was determined that, with the increased half-lengths of the fracture clusters, flow conductivity of the fractures, and permeability of the fracture network, the productivity of the fractured well also increased. Meanwhile, with the increased number of fractures, the distance between the fractures decreased, and the productivity slowly increased due to the mutual interfere of the fractures.

Facial Fractures.

PubMed

Ghosh, Rajarshi; Gopalkrishnan, Kulandaswamy

2018-06-01

The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

Basic concepts regarding fracture healing and the current options and future directions in managing bone fractures.

PubMed

Bigham-Sadegh, Amin; Oryan, Ahmad

2015-06-01

Fracture healing is a complex physiological process, which involves a well-orchestrated series of biological events. Repair of large bone defects resulting from trauma, tumours, osteitis, delayed unions, non-unions, osteotomies, arthrodesis and multifragmentary fractures is a current challenge of surgeons and investigators. Different therapeutic modalities have been developed to enhance the healing response and fill the bone defects. Different types of growth factors, stem cells, natural grafts (autografts, allografts or xenografts) and biologic- and synthetic-based tissue-engineered scaffolds are some of the examples. Nevertheless, these organic and synthetic materials and therapeutic agents have some significant limitations, and there are still no well-approved treatment modalities to meet all the expected requirements. Bone tissue engineering is a newer option than the traditional grafts and may overcome many limitations of the bone graft. To select an appropriate treatment strategy in achieving a successful and secure healing, more information concerning injuries of bones, their healing process and knowledge of the factors involved are required. The main goals of this work are to present different treatment modalities of the fractured bones and to explain how fractures normally heal and what factors interfere with fracture healing. This study provides an overview of the processes of fracture healing and discusses the current therapeutic strategies that have been claimed to be effective in accelerating fracture healing. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

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.

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

PubMed

Augat, P; Claes, L; Suger, G

1995-10-01

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

Detection of Fractured Endodontic Instruments in Root Canals: Comparison between Different Digital Radiography Systems and Cone-beam Computed Tomography.

PubMed

Ramos Brito, Ana Caroline; Verner, Francielle Silvestre; Junqueira, Rafael Binato; Yamasaki, Mayra Cristina; Queiroz, Polyane Mazucato; Freitas, Deborah Queiroz; Oliveira-Santos, Christiano

2017-04-01

This study compared the detection of fractured instruments in root canals with and without filling by periapical radiographs from 3 digital systems and cone-beam computed tomographic (CBCT) images with different resolutions. Thirty-one human molars (80 canals) were used. Root canals were divided into the following groups: the control group, without fillings; the fracture group, without fillings and with fractured files; the fill group, filled; and the fill/fracture group, filled and with fractured files. Digital radiographs in ortho-, mesio-, and distoradial directions were performed in 2 semidirect systems (VistaScan [Dürr Dental, Beitigheim-Bissinger, Germany] and Express [Instrumentarium Imaging, Tuusula, Finland]) and a direct system (SnapShot [Instrumentarium Imaging]). CBCT images were acquired with 0.085-mm and 0.2-mm voxel sizes. All images were assessed and reassessed by 4 observers for the presence or absence of fractured files on a 5-point scale. The sensitivity, specificity, and accuracy were calculated. In the absence of filling, accuracy values were high, and there were no statistical differences among the radiographic techniques, different digital systems, or the different CBCT voxels sizes. In the presence of filling, the accuracy of periapical radiographs was significantly higher than CBCT images. In general, SnapShot showed higher accuracy than VistaScan and Express. Periapical radiographs in 1 incidence were accurate for the detection of fractured endodontic instruments inside the root canal in the absence or presence of filling, suggesting that this technique should be the first choice as well as the direct digital radiographic system. In the presence of filling, the decision to perform a CBCT examination must take into consideration its low accuracy. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

PubMed Central

Belland, Laura; Rivera-Reyes, Laura; Handel, Daniel; Yadav, Kabir; Heard, Kennon; Eisenberg, Amanda; Khelemsky, Yury

2017-01-01

Objectives. To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients. Design. Secondary analysis of retrospective cohort study. Setting. Five EDs (four academic, one community) in the United States. Participants. Patients (1,664) who presented in January, March, July, and October 2009 with a final diagnosis of fracture (774 long bone [LBF], 890 shorter bone [SBF]). Measurements. Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type. Results. A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR = 2.03; 95 CI = 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate = 0.268; 95 CI = 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55–163] vs. 76 [35–149] minutes, P = 0.057), but no other differences in process outcomes were found. Conclusion. Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research. PMID:27245631

Geographic variation in secondary fracture prevention after a hip fracture during 1999-2013: a UK study.

PubMed

Shah, A; Prieto-Alhambra, D; Hawley, S; Delmestri, A; Lippett, J; Cooper, C; Judge, A; Javaid, M K

2017-01-01

Fragility fractures of the hip have a major impact on the lives of patients and their families. This study highlights significant geographical variation in secondary fracture prevention with even the highest performing regions failing the majority of patients despite robust evidence supporting the benefits of diagnosis and treatment. The purpose of the study is to describe the geographic variation in anti-osteoporosis drug therapy prescriptions before and after a hip fracture during 1999-2013 in the UK. We used primary care data (Clinical Practice Research Datalink) to identify patients with a hip fracture and primary care prescriptions of any anti-osteoporosis drugs prior to the index hip fracture and up to 5 years after. Geographic variations in prescribing before and after availability of generic oral bisphosphonates were analysed. Multivariable logistic regression models were adjusted for gender, age and body mass index (BMI). Thirteen thousand sixty-nine patients (76 % female) diagnosed with a hip fracture during 1999-2013 were identified. Eleven per cent had any anti-osteoporosis drug prescription in the 6 months prior to the index hip fracture. In the 0-4 months following a hip fracture, 5 % of patients were prescribed anti-osteoporosis drugs in 1999, increasing to 51 % in 2011 and then decreasing to 39 % in 2013. The independent predictors (OR (95 % CI)) of treatment initiation included gender (male 0.42 (0.36-0.49)), BMI (0.98 per kg/m 2 increase (0.97-1.00)) and geographic region (1.29 (0.89-1.87) North East vs. 0.56 (0.43-0.73) South Central region). Geographic differences in prescribing persisted over the 5-year follow-up. If all patients were treated at the rate of the highest performing region, then nationally, an additional 3214 hip fracture patients would be initiated on therapy every year. Significant geographic differences exist in prescribing of anti-osteoporosis drugs after hip fracture despite adjustment for potential confounders. Further work examining differences in health care provision may inform strategies to improve secondary fracture prevention after hip fracture.

The effect of shape on the fracture of a soft elastic gel subjected to shear load.

PubMed

Kundan, Krishna Kant; Ghatak, Animangsu

2018-02-21

For brittle solids, the fracture energy is the energy required to create a unit area of new surface through the process of division. For crosslinked materials, it is a function of the intrinsic properties like crosslinking density and bond strength of the crosslinks. Here we show that the energy released due to fracture can depend also on the shape of a joint made of this material. Our experiment involves two gel blocks connected via a thin gel disk. The disk is formed into different regular and exotic shapes, but with identical areas of cross-section. When one of the blocks is sheared with respect to the other, the shear load increases with vertical displacement, eventually causing a fracture at a threshold load. The maximum fracture load is different for different disks and among different regularly shaped disks, it is at a maximum for pentagon and hexagon shapes. The fracture energy release rate of the joint depends also on the aspect ratio (height/width) of the shapes. Our experiments also throw light on possible reasons for such a dependence on the shape of the joints.

Integrating a gender dimension into osteoporosis and fracture risk research.

PubMed

Geusens, Piet; Dinant, Geertjan

2007-01-01

Sex (referring to the strict biological sense) and gender (referring to the sociocultural dimension) are major determinants of health and disease. This review examines similarities and differences between the sexes in the prevalence of osteoporosis and fractures, bone- and fall-related risk factors for incident fractures, and the possibilities of fracture prevention, as well as gender differences in the perception of osteoporosis. We reviewed recent English-language publications on sex and gender differences in the context of osteoporosis and fracture risk. We refer to several reviews that provide extensive reference lists on the topics discussed. The incidence of fractures is higher in boys than in girls. The burden of fractures in adults increases with age, and it starts earlier and is higher in adult women than in adult men. With life expectancy increasing, the annual number of fractures is likely to increase substantially. Fractures in adults contribute to increased mortality (more in men than in women), increased morbidity (equal in men and women), and high costs (greater for women than for men). Adult men experience fewer fractures than women do. Men build larger bones with better microarchitecture while they are growing and thereafter have less increase in bone remodeling. Furthermore, they develop bone loss at a later age. Compared with their female counterparts, fewer older men are hypogonadic, and life expectancy is shorter for men than for women. There are multiple reasons for the differences in the incidences of fractures between men and women, related to the many factors associated with both bone and falls that influence fracture risk from the molecular and cellular level to the organ level. Sex hormones play a central and essential role in the physiology of bone by direct and indirect mechanisms (eg, by interfering with the growth hormone and insulin-like growth factor-1 axis). Case-finding strategies to identify patients at highest risk for fractures, including bone densitometry and clinical risk factors, are much better documented at the population level in women than in men. Drug therapies that reduce the risk of a broad spectrum of fractures, even in the short term, are more clearly demonstrated in randomized controlled studies in women than in men. Drug therapy is more widely available for women with osteoporosis,but it is rarely given to men with osteoporosis. Differences in the perception of osteoporosis between men and women are even less well documented. In general, osteoporosis is underdiagnosed and undertreated in women but even more so in men, and is related to limits in the patient's and the physician's awareness at all clinical stages, from case finding to compliance with and persistence of therapy. Furthermore, the lay perception of a healthy lifestyle, the level of social isolation, networking within the health care system, and opportunities for screening appear to contribute to gender differences in participating in osteoporosis prevention and therapy. These aspects of health care deserve further attention and research.

A biomechanical comparison of four fixed-angle dorsal plates in a finite element model of dorsally-unstable radius fracture.

PubMed

Knežević, Josip; Kodvanj, Janoš; Čukelj, Fabijan; Pamuković, Frane; Pavić, Arsen

2017-11-01

To compare the finite element models of two different composite radius fracture patterns, reduced and stabilised with four different fixed-angle dorsal plates during axial, dorsal and volar loading conditions. Eight different plastic models representing four AO/ASIF type 23-A3 distal radius fractures and four AO/ASIF 23-C2 distal radius fractures were obtained and fixed each with 1 of 4 methods: a standard dorsal non-anatomical fixed angle T-plate (3.5mm Dorsal T-plate, Synthes), anatomical fixed-angle double plates (2.4mm LCP Dorsal Distal Radius, Synthes), anatomical fixed angle T-plate (2.4mm Acu-Loc Dorsal Plate, Acumed) or anatomical variable-angle dorsal T-plate (3.5mm, Dorsal Plate, Zrinski). Composite radius with plate and screws were scanned with a 3D optical scanner and later processed in Abaqus Software to generate the finite element model. All models were axially loaded at 3 points (centrally, volarly and dorsally) with 50 N forces to avoid the appearance of plastic deformations of the models. Total displacements at the end of the bone and the stresses in the bones and plates were determined and compared. Maximal von Mises stress in bone for 3-part fracture models was very similar to that in 2-part fracture models. The biggest difference between models and the largest displacements were seen during volar loading. The stresses in all models were the highest above the fracture gap. The best performance in all parameters tested was with the Zrinski plate and the most modest results were with the Synthes T-plate. There was no significant difference between 2-part (AO/ASIF type 23-A3) and 3-part (AO/ASIF 23-C2) fracture models. Maximal stresses in the plates appeared above the fracture gap; therefore, it is worth considering the development of plates without screw holes above the gap. © 2017 Elsevier Ltd. All rights reserved.

[Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options].

PubMed

Unglaub, F; Langer, M F; Hahn, P; Müller, L P; Ahrens, C; Spies, C K

2016-02-01

Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.

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.

Fracture mode during cyclic loading of implant-supported single-tooth restorations.

PubMed

Hosseini, Mandana; Kleven, Erik; Gotfredsen, Klaus

2012-08-01

Fracture of veneering ceramics in zirconia-based restorations has frequently been reported. Investigation of the fracture mode of implant-supported ceramic restorations by using clinically relevant laboratory protocols is needed. This study compared the mode of fracture and number of cyclic loads until veneering fracture when ceramic and metal ceramic restorations with different veneering ceramics were supported by implants. Thirty-two implant-supported single-tooth restorations were fabricated. The test group was composed of 16 ceramic restorations of zirconia abutment-retained crowns with zirconia copings veneered with glass-ceramics (n=8) and feldspathic ceramics (n=8). The control group was composed of 16 metal ceramic restorations of titanium abutment-retained crowns with gold alloy copings veneered with glass (n=8) and feldspathic ceramics (n=8). The palatal surfaces of the crowns were exposed to cyclic loading of 800 N with a frequency of 2 Hz, which continued to 4.2 million cycles or until fracture of the copings, abutments, or implants. The number of cycles and the fracture modes were recorded. The fracture modes were analyzed by descriptive analysis and the Mann-Whitney test (α=.05). The differences in loading cycles until veneering fracture were estimated with the Cox proportional hazards analysis. Veneering fracture was the most frequently observed fracture mode. The severity of fractures was significantly more in ceramic restorations than in metal ceramic restorations. Significantly more loading cycles until veneering fracture were estimated with metal ceramic restorations veneered with glass-ceramics than with other restorations. The metal ceramic restorations demonstrated fewer and less severe fractures and resisted more cyclic loads than the ceramic restorations, particularly when the metal ceramic crowns were veneered with glass-ceramics. Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Review of hydraulic fracture mapping using advanced accelerometer-based receiver systems

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

Warpinski, N.R.; Uhl, J.E.; Engler, B.P.

Hydraulic fracturing is an important tool for natural gas and oil exploitation, but its optimization has been impeded by an inability to observe how the fracture propagates and what its overall dimensions are. The few experiments in which fractures have been exposed through coring or mineback have shown that hydraulic fractures are complicated multi-stranded structures that may behave much differently than currently predicted by models. It is clear that model validation, fracture optimization, problem identification and solution, and field development have all been encumbered by the absence of any ground truth information on fracture behavior in field applications. The solutionmore » to this problem is to develop techniques to image the hydraulic fracture in situ from either the surface, the treatment well, or offset wells. Several diagnostic techniques have been available to assess individual elements of the fracture geometry, but most of these techniques have limitations on their usefulness. For example, tracers and temperature logs can only measure fracture height at the wellbore, well testing and production history matching provide a productive length which may or may not be different from the true fracture length, and tiltmeters can provide accurate information on azimuth and type of fracture (horizontal or vertical), but length and height can only be extracted from a non-unique inversion of the data. However, there is a method, the microseismic technique, which possesses the potential for imaging the entire hydraulic fracture and, more importantly, its growth history. This paper discusses application of advanced technology to the microseismic method in order to provide detailed accurate images of fractures and their growth processes.« less

Reliability of fracture appearance measurement in the Charpy test

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

Dixon, B.F.

1994-12-31

Despite conventional wisdom, the Charpy fracture appearance transition curve does not always coincide with the energy transition curve. Furthermore, unlike Charpy energy, fracture appearance tells how a specimen failed. It can therefore be used to meaningfully relate the results of Charpy testing to results of other toughness tests which may employ different geometries and loading rates. In order to address the question of consistency, a set of 20 specimens was prepared and used in a `round robin` survey. Results showed that agreement was greatest when operators are experienced, samples are close to fracture appearance transition, and simple, two-dimensional diagrams aremore » sued for assessment. It was also found that certain inconsistencies exist between various assessment techniques for Charpy fracture appearance. As a part of this work, fracture appearance curves were compared to energy impact curves for the Charpy test and a similar test, the Schnadt K{sub o} test, which uses a sharp pressed notch. It was found that energy and fracture appearance transition may differ by as much as 50{degrees}C in the Charpy test while the two curves coincided in the Schnadt test. In series of toughness tests on 132 steels, the average difference between Charpy energy transition and Schnade K{sub o} energy transition was about 27{degrees}C. This is believed to represent the difference in toughness between blunt and sharp notches in Charpy size specimens.« less

Evaluation of retention and fracture resistance of different fiber reinforced posts: An in vitro study.

PubMed

Pruthi, Varun; Talwar, Sangeeta; Nawal, Ruchika Roongta; Pruthi, Preeti Jain; Choudhary, Sarika; Yadav, Seema

2018-01-01

The aim of this study was to evaluate retention & fracture resistance of different fibre posts. 90 extracted human permanent maxillary central incisors were used in this study. For retention evaluation, after obturation, post space preparation was done in all root canals and posts were cemented under three groups. Later, the posts were grasped & pulled out from the roots with the help of a three-jaw chuck at a cross-head speed of 5mm/min. Force required to dislodge each post was recorded in Newtons. To evaluate the fracture behavior of posts, artificial root canals were drilled into aluminium blocks and posts were cemented. Load required to fracture each post was recorded in Newtons. The results of the present study show the mean retention values for Fibrekleer Parallel post were significantly greater than those for Synca Double tapered post & Bioloren Tapered post. The mean retention values of the Double tapered post & the tapered post were not statistically different. The Synca Double tapered post had the highest mean load to fracture, and this value was significantly higher than those of FibreKleer Parallel & Bioloren Tapered post. The mean fracture resistance values of Parallel & tapered post were not statistically different. This study showed parallel posts to have better retention than tapered and double tapered posts. Regarding the fracture resistance, double tapered posts were found to be better than parallel and tapered posts.

Fat embolism syndrome in an adolescent before surgical treatment of an isolated closed tibial shaft fracture.

PubMed

Nawaf, Cayce B; Kelly, Derek M; Warner, William C; Beaty, James H; Rhodes, Leslie; Sawyer, Jeffrey R

2012-12-01

Fat embolism syndrome (FES) occurs most commonly in adults with high-energy trauma, especially fractures of the long-bones and pelvis. Because of unique age-related physiologic differences in the immature skeleton, as well as differences in fracture management in pediatric patients, FES is rare in children. To our knowledge, this is the first case report of FES occurring before surgical fixation of a closed tibial shaft fracture in an adolescent. A 16-year-old, 109 kg, Caucasian adolescent boy developed FES after closed diaphyseal fractures of the distal tibia and fibula, showing signs of respiratory distress and mental status changes. The FES resolved with supportive respiratory care and intramedullary nailing of the fracture was done without further respiratory compromise. FES is uncommon in children and adolescents. A high index of suspicion is required to make the diagnosis promptly and institute appropriate treatment. Intramedullary nailing of a long-bone fracture can be done safely and successfully after resolution of the FES.

A review of the effect of a/W ratio on fracture toughness (II) —experimental investigation in LEFM

NASA Astrophysics Data System (ADS)

Li, Qing-Fen; Fu, Yu-Dong; Xu, Xiao-Xue

2005-06-01

In part I of this series, experimental investigation in EPFM (elastic-plastic fracture mechanics) had been discussed. In this paper, experimental investigation in LEFM (linear elastic fracture mechanics) is given. Fracture toughness tests had been carried out on three different strength steels, using both through-cracked specimens with different a/W ratio and semi-elliptical cracked specimens with variable crack size and shape. Results show that the fracture toughness K IC increases with decreasing a/W when a/W<0.3 for three-point-bend specimens, and that for a/W>0.3, it is independent of a/W. Shallow crack specimens, both through-cracked and surface-cracked, gave markedly higher values than deeply notched specimens. However, the effect of crack shape on fracture toughness is negligible. Results also show that the LEFM approach to fracture is not tenable for design stresses where a c is often very small, far less than 2.5(K IC/σ y )2.

In situ studies of velocity in fractured crystalline rocks.

USGS Publications Warehouse

Moos, D.; Zoback, M.D.

1983-01-01

A study of the effects of macroscopic fractures on P and S wave velocities has been conducted in four wells drilled in granitic rock to depths between 0.6 and 1.2km. The effect of macroscopic fractures is to decrease both Vp and Vs and increase Vp/Vs. In wells with a relatively low density of macroscopic fractures, the in situ velocity is similar to that of saturated core samples under confining pressure in the laboratory, and there is a clear correlation between zones with macroscopic fractures and anomalously low velocities. In wells with numerous macroscopic fractures, the in situ velocity is lower than that of intact samples under pressure, and there is a correlation between the rate at which in situ velocity increases with depth and the rate at which the velocity of laboratory samples increases with pressure. Differences in in situ P wave velocity between wells cannot be explained solely by differences in the degree of macroscopic fracturing, thus emphasizing the importance of composition and microcracks on velocity.-from Authors

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

PubMed

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

2017-10-01

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

Skeletal structure in postmenopausal women with osteopenia and fractures is characterized by abnormal trabecular plates and cortical thinning.

PubMed

Stein, Emily M; Kepley, Anna; Walker, Marcella; Nickolas, Thomas L; Nishiyama, Kyle; Zhou, Bin; Liu, X Sherry; McMahon, Donald J; Zhang, Chiyuan; Boutroy, Stephanie; Cosman, Felicia; Nieves, Jeri; Guo, X Edward; Shane, Elizabeth

2014-01-01

The majority of fragility fractures occur in women with osteopenia rather than osteoporosis as determined by dual‐energy X‐ray absorptiometry (DXA). However, it is difficult to identify which women with osteopenia are at greatest risk. We performed this study to determine whether osteopenic women with and without fractures had differences in trabecular morphology and biomechanical properties of bone. We hypothesized that women with fractures would have fewer trabecular plates, less trabecular connectivity, and lower stiffness. We enrolled 117 postmenopausal women with osteopenia by DXA (mean age 66 years; 58 with fragility fractures and 59 nonfractured controls). All had areal bone mineral density (aBMD) measured by DXA. Trabecular and cortical volumetric bone mineral density (vBMD), trabecular microarchitecture, and cortical porosity were measured by high‐resolution peripheral computed tomography (HR‐pQCT) of the distal radius and tibia. HR‐pQCT scans were subjected to finite element analysis to estimate whole bone stiffness and individual trabecula segmentation (ITS) to evaluate trabecular type (as plate or rod), orientation, and connectivity.Groups had similar age, race, body mass index (BMI), and mean T‐scores. Fracture subjects had lower cortical and trabecular vBMD, thinner cortices, and thinner, more widely separated trabeculae. By ITS, fracture subjects had fewer trabecular plates, less axially aligned trabeculae, and less trabecular connectivity. Whole bone stiffness was lower in women with fractures. Cortical porosity did not differ. Differences in cortical bone were found at both sites, whereas trabecular differences were more pronounced at the radius.In summary, postmenopausal women with osteopenia and fractures had lower cortical and trabecular vBMD; thinner, more widely separated and rodlike trabecular structure; less trabecular connectivity; and lower whole bone stiffness compared with controls,despite similar aBMD by DXA. Our results suggest that in addition to trabecular and cortical bone loss, changes in plate and rod structure may be important mechanisms of fracture in postmenopausal women with osteopenia.

Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or calcium phosphate cement: biomechanical evaluation of the cadaveric spine.

PubMed

Nouda, Shinya; Tomita, Seiji; Kin, Akihiro; Kawahara, Kunihiko; Kinoshita, Mitsuo

2009-11-15

A biomechanical study using human cadaveric thoracolumbar spinal columns. To compare the effect of treatment by vertebroplasty (VP) with polymethylmethacrylate cement and VP with calcium phosphate cement on the creation of adjacent vertebral body fracture following VP. Adjacent vertebral body fractures have been reported as a complication following VP. Twenty-four spinal columns (T10-L2) from human cadavers were subjected to dual energy radiograph absorptiometry to assess bone mineral density. They were divided into the P group and C group, and experimental vertebral compression fractures were created at T12 vertebrae. T12 vertebrae were augmented with polymethylmethacrylate and calcium phosphate cement in the P group and C group, respectively. Each spinal column was compressed until a new fracture occurred at any vertebra, and the location of newly fractured vertebra and failure load was investigated. There was no significant difference in bone mineral density at each level within each group. In the P group, a new fracture occurred at T10 in 2 specimens, T11 in 8, and L1 in 2. In the C group, it occurred at T10 in 1 specimen, T11 in 2, L1 in 1, and T12 (treated vertebra) in 8. The failure loads of the spinal column were 1774.8+/-672.3 N and 1501.2+/-556.5 N in the P group and C group, respectively. There was no significant difference in the failure load of the spinal column between each group. New vertebral fractures occurred at the vertebra adjacent to augmented vertebrae in the P group and in the augmented vertebrae in the C group. The difference in the fractured site may be because of the difference in strength between the 2 bone filler materials. Therefore, the strength of bone filler materials is considered a risk factor in developing adjacent vertebral body fractures after VP.

Seismic refraction and electrical resistivity tests for fracture induced hydraulic anisotropy in a mountain watershed.

NASA Astrophysics Data System (ADS)

Mendieta, A. L.; Bradford, J.; Liberty, L. M.; McNamara, J. P.

2016-12-01

Granitic based terrains often have complex hydrogeological systems. It is often assumed that the bedrock is impermeable, unless it is fractured. If the bedrock is fractured this can greatly affect fluid flow, depending on fracture density and orientation. Recently there has been a substantial increase in the number of geophysical studies designed to investigate hydrologic processes in mountain watersheds, however few of these studies have taken fracture induced geophysical and hydraulic anisotropy into consideration. Vertically oriented fractures with a preferred orientation produce azimuthal anisotropy in the electrical resistivity, the seismic primary wave (P-wave) velocity, and the hydraulic permeability. By measuring the electrical and seismic anisotropy we can estimate fracture orientation and density which improves our understanding of hydraulic properties. Despite numerous previous studies of the hydrologic system, the subsurface hydraulic system at the Dry Creek Experimental Watershed (DCEW), located near Boise, Idaho, is not completely understood. This is particularly true of the deep (>5m) system which is difficult to study using conventional hydrologic measurements, particularly in rugged and remote mountain environments. From previous studies, it is hypothesized that there is a system of fractures that may be aligned according to the local stress field. To test for the preferential alignment, ergo the direction of preferential water flow, we collected seismic and electrical resistivity profiles along different azimuths. The preliminary results show an azimuthal dependence of the P-wave velocities in the bedrock, at depths greater than 18 m; P-wave velocities range from 3500 to 4100 m/s, which represents a 17.5 % difference. We interpret this difference to be caused by fractures present in the bedrock. At the same location, we measured an electric resistivity value of 29 ohm-m, and we expect a difference of 37 %, if the fractures are fully saturated. Future studies will include coincident multi-azimuthal electrical resistivity surveys both to verify the results of the seismic study and to improve our understanding of the hydraulic properties.

Interface test series: An in situ study of factors affecting the containment of hydraulic fractures

NASA Astrophysics Data System (ADS)

Warpinski, N. R.; Finley, S. J.; Vollendorf, W. C.; Obrien, M.; Eshom, E.

1982-02-01

In situ experiments, which are accessible for direct observation by mineback, were conducted to determine the effect that material-property interfaces and in situ stress differences have on hydraulic fracture propagation and the resultant overall geometry. These experiments show conclusively that a difference in elastic modulus at a geologic interface has little or no effect on crack growth and, therefore, is not a feature which would promote containment of fractures within a specified reservoir zone. However, differences in the in situ stress between adjacent layers is shown to have a considerable influence on fracture propagation. Experiments were conducted in a low modulus ash-fall tuff which contained two layers of high minimum principal in situ stress and which was overlain by a formation with at least a factor of 5 increase in elastic modulus. Fractures were observed to terminate in regions of high minimum principal in situ stress in nearly every case.

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.

On the temperature independence of statistical model parameters for cleavage fracture in ferritic steels

NASA Astrophysics Data System (ADS)

Qian, Guian; Lei, Wei-Sheng; Niffenegger, M.; González-Albuixech, V. F.

2018-04-01

The work relates to the effect of temperature on the model parameters in local approaches (LAs) to cleavage fracture. According to a recently developed LA model, the physical consensus of plastic deformation being a prerequisite to cleavage fracture enforces any LA model of cleavage fracture to observe initial yielding of a volume element as its threshold stress state to incur cleavage fracture in addition to the conventional practice of confining the fracture process zone within the plastic deformation zone. The physical consistency of the new LA model to the basic LA methodology and the differences between the new LA model and other existing models are interpreted. Then this new LA model is adopted to investigate the temperature dependence of LA model parameters using circumferentially notched round tensile specimens. With the published strength data as input, finite element (FE) calculation is conducted for elastic-perfectly plastic deformation and the realistic elastic-plastic hardening, respectively, to provide stress distributions for model calibration. The calibration results in temperature independent model parameters. This leads to the establishment of a 'master curve' characteristic to synchronise the correlation between the nominal strength and the corresponding cleavage fracture probability at different temperatures. This 'master curve' behaviour is verified by strength data from three different steels, providing a new path to calculate cleavage fracture probability with significantly reduced FE efforts.

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation.

PubMed

Zacherl, Max; Gruber, Gerald; Glehr, Mathias; Ofner-Kopeinig, Petra; Radl, Roman; Greitbauer, Manfred; Vecsei, Vilmos; Windhager, Reinhard

2011-10-01

Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

Bone mineral density at different sites and vertebral fractures in Serbian postmenopausal women.

PubMed

Ilic Stojanovic, O; Vuceljic, M; Lazovic, M; Gajic, M; Radosavljevic, N; Nikolic, D; Andjic, M; Spiroski, D; Vujovic, S

2017-02-01

This randomized study aimed to evaluate the correlation between bone mineral densities (BMD) measured at different sites and the frequency of vertebral fractures in a group of Serbian postmenopausal women. BMD was measured in 130 naïve postmenopausal women by dual X-ray absorptiometry (DXA) at the ultra-distal part of the forearms, at the hip and at the lumbar spine. At each of the measurement sites, the patients were categorized as osteoporotic, or osteopenic, or in the reference range. Vertebral fractures were examined using thoracic and lumbar spine radiography. A T-score at different skeletal sites showed discordance in the site-specific region. Vertebral fractures were found in 58.82% of patients with hip osteopenia, in 45% with forearm osteopenia and in 54.54% with lumbar spine osteoporosis. The study confirmed that the reduction of BMD depends on age and choice of measurement site. The best correlation was obtained in the women with osteopenia at all measurement sites. The discovery of vertebral fractures by lateral thoracic and lumbar spine radiography improves prompt treatment. Reference values of BMD do not exclude vertebral fractures. Of vertebral fractures, 72.5% were asymptomatic and thus spine radiographies are obligatory. Currently discussed is the position of DXA for measuring BMD as a method of detection for patients at risk of fracture.

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.

Effect of autoclave postpolymerization treatments on the fracture toughness of autopolymerizing dental acrylic resins.

PubMed

Durkan, Rukiye; Gürbüz, Ayhan; Yilmaz, Burak; Özel, M Birol; Bağış, Bora

2012-06-26

Microwave and water bath postpolymerization have been suggested as methods to improve the mechanical properties of heat and autopolymerizing acrylic resins. However, the effects of autoclave heating on the fracture properties of autopolymerizing acrylic resins have not been investigated. The aim of this study was to assess the effectiveness of various autoclave postpolymerization methods on the fracture properties of 3 different autopolymerizing acrylic resins. Forty-two specimens of 3 different autopolymerizing acrylic resins (Orthocryl, Paladent RR and Futurajet) were fabricated (40x8x4mm), and each group was further divided into 6 subgroups (n=7). Control group specimens remained as processed (Group 1). The first test group was postpolymerized in a cassette autoclave at 135°C for 6 minutes and the other groups were postpolymerized in a conventional autoclave at 130°C using different time settings (5, 10, 20 or 30 minutes). Fracture toughness was then measured with a three-point bending test. Data were analyzed by ANOVA followed by the Duncan test (α=0.05). The fracture toughness of Orthocryl and Paladent-RR acrylic resins significantly increased following conventional autoclave postpolymerization at 130°C for 10 minutes (P<.05). However, the fracture toughness of autoclave postpolymerized Futurajet was not significantly different than its control specimens (P<.05). The fracture toughness of Futurajet was significantly less than Paladent RR and Orthocryl specimens when autoclaved at 130°C for 10 minutes. Within the limitations of this study, it can be suggested that autoclave postpolymerization is an effective method for increasing the fracture toughness of tested autoploymerized acrylic resins.

Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis.

PubMed

Sharma, Gaurav; Gn, Kiran Kumar; Khatri, Kavin; Singh, Ravijot; Gamanagatti, Shivanand; Sharma, Vijay

2017-02-01

In this study we describe the morphology of the posteromedial fragment in pertrochanteric fractures using 3D CT scans and answer two questions 1) Do differences exist between the 3D CT appearances of posteromedial fragments and the depictions made in the AO classification 2) Does the posteromedial fragment affect stability in pertrochanteric fractures, in terms of fracture collapse? Preoperative CT scans of eight 31-A1 and fifty 31-A2 fractures were analysed. The presence of PM fragment, its fragmentation, greater trochanter (GT) involvement, lesser trochanter (LT) fragment size (in terms of its posterior and medial extent as well as LT length), LT fragment displacement (in terms of medial displacement and rotation) were determined. All fractures were treated with a DHS. Fracture collapse was determined on postoperative radiographs. The relationship between fracture collapse and patient factors including age, gender, fracture type (A1 versus A2), characteristics of the posteromedial fragment, and the presence of a lateral wall fracture were determined. Three out of eight 31-A1 fractures demonstrated a separate GT fragment (three part fracture). Out of the 50 31-A2 fractures, 12 had a single PM fragment, which included the LT and GT in continuity. The more common four part fractures seem to form by further fragmentation of this basic form. In A2 fractures, the GT was almost always broken and the broken fragment comprised a mean 56% of normal GT. The LT fragment involved an average of 74% of the posterior wall, and an average of 36% of the medial wall of the proximal femur. Larger LT fragments were less displaced as compared to smaller fragments. Univariate regression analyses revealed that fracture collapse was significantly correlated with fracture type (A1 versus A2, p 0.036), GT size (p 0.002) and the presence of a lateral wall fracture (p<0.001). This study revealed some important differences between the 3D CT appearances and AO classification of pertrochanteric fractures. Further, neither fragmentation of the posteromedial fragment, nor the size of the lesser trochanter fragment was found to predict stability in pertrochanteric fractures. A perioperative lateral wall fracture is the main determinant of stability in these fractures. Copyright © 2016 Elsevier Ltd. All rights reserved.

Melorheostosis in the upper extremity.

PubMed

Yildirim, Cengiz; Ozyürek, Selahattin; Ciçek, Engin Ilker; Kuskucu, Mesih

2009-04-01

Melorheostosis is a rare mesodermal disease affecting the skeleton and adjacent soft tissues. Often it is incidentally detected on radiographs. In the standard radiology and orthopedics literature, melorheostosis is described as a "flowing hyperostosis, resembling dripping candle wax as an incidental radiographic finding." A 22-year-old man presented with a 2-year history of right-hand pain. Radiologic evaluation of the hand showed massive sclerotic changes in the first and second metacarpal and phalangeal bones on the right side. Further radiographic evaluation of the right upper extremity revealed the same sclerotic changes in the right scapula, humerus, radius, and scaphoid. Computed tomography (CT) scans showed a high attenuation undulating cortical hyperostosis with a "dripping candle wax appearance" involving the radial and/or dorsal aspects of humerus, radius, scaphoid, and first and second ray bones of the hand. Radionuclide triphasic bone scintigraphy showed diffuse homogenous radiotracer uptake within the entire right upper extremity involving the scapula, humerus, radius, scaphoid, and first and second metacarpals and phalangeal bones of the hand. The patient was followed conservatively, and 1-year follow-up revealed no change in the clinical, laboratory, or radiological findings. The diagnosis of melorheostosis was made on the basis of the characteristic distribution, location, and combined radiographic, CT, and radionuclide imaging features of the abnormalities. Conservative treatment was recommended for the patient. After 26 months of follow-up, despite the persistence of the radiologic findings, the patient is currently well, with no painful symptoms unless he performs forceful exercise.

A Prospective Analysis on Functional Outcomes Following Extended Latissimus Dorsi Flap Breast Reconstruction.

PubMed

Eyjolfsdottir, H; Haraldsdottir, B; Ragnarsdottir, M; Asgeirsson, K S

2017-06-01

To prospectively assess the functional effect of using the extended latissimus dorsi flap in immediate breast reconstructions. A total of 15 consecutive patients undergoing breast reconstruction with extended latissimus dorsi flap participated. Shoulder range of motion, muscle strength, lateral flexion of the torso, and position of scapula were measured pre-operatively and 1, 6, and 12 months post-operatively, in addition to donor-site post-operative complications. At 12 months post-operatively, patients had achieved full range of shoulder movement, when compared to pre-operative values. Lateral flexion of the torso was, however, significantly reduced bilaterally at 1 and 6 months post-operatively (p = 0.001, p = 0.01) and to the not operated side at 12 months (p = 0.01). Muscle strength in flexion-extension-internal rotation was significantly (p = 0.01) reduced on the operated side 12 months post-operatively. All but one patient had numbness around the donor-site scar 12 months post-operatively, 33% had slight adhesions but all were pain free. Although invariably, patients having extended latissimus dorsi flap may expect to achieve full range of shoulder movement, they should be informed of possible functional consequences and the time and effort it takes to recover. Further research is needed to investigate the potential long-term functional implications that extended latissimus dorsi flap may have as a result of changes in the lateral flexion of the torso and scapula position.

The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)--quality of life during the first 4 months after fracture.

PubMed

Borgström, F; Lekander, I; Ivergård, M; Ström, O; Svedbom, A; Alekna, V; Bianchi, M L; Clark, P; Curiel, M D; Dimai, H P; Jürisson, M; Kallikorm, R; Lesnyak, O; McCloskey, E; Nassonov, E; Sanders, K M; Silverman, S; Tamulaitiene, M; Thomas, T; Tosteson, A N A; Jönsson, B; Kanis, J A

2013-03-01

The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.

Acetabular fractures: anatomic and clinical considerations.

PubMed

Lawrence, David A; Menn, Kirsten; Baumgaertner, Michael; Haims, Andrew H

2013-09-01

Classifying acetabular fractures can be an intimidating topic. However, it is helpful to remember that there are only three basic types of acetabular fractures: column fractures, transverse fractures, and wall fractures. Within this framework, acetabular fractures are classified into two broad categories: elementary or associated fractures. We will review the osseous anatomy of the pelvis and provide systematic approaches for reviewing both radiographs and CT scans to effectively evaluate the acetabulum. Although acetabular fracture classification may seem intimidating, the descriptions and distinctions discussed and shown in this article hopefully make the topic simpler to understand. Approach the task by recalling that there are only three basic types of acetabular fractures: column fractures (coronally oriented on CT images), transverse fractures (sagittally oriented on CT images), and wall fractures (obliquely oriented on CT images). We have provided systematic approaches for reviewing both conventional radiographs and CT scans to effectively assess the acetabulum. The clinical implications of the different fracture patterns have also been reviewed because it is critically important to include pertinent information for our clinical colleagues to provide the most efficient and timely clinical care.

Measurement of Malrotation on Direct Radiography in Pediatric Distal Radius Fractures

PubMed Central

Duymus, Tahir Mutlu; Mutlu, Serhat; Komur, Baran; Mutlu, Harun; Yucel, Bulent; Parmaksizoglu, Atilla Sancar

2016-01-01

Abstract The aim of this prospective study was to test a mathematical method of measuring the malrotation of pediatric distal radius fractures (PDRFs) from direct radiographs. A total of 70 pediatric patients who presented at the Emergency Department with a distal radius fracture were evaluated. For 38 selected patients conservative treatment for PDRF was planned. Anteroposterior and lateral radiographs were taken of all of the patients for comparison before and after reduction. Radius bone diameters were measured in the coronal and sagittal planes on the healthy and fractured sides. Using the diameter values on the healthy side and the new diameter values on the fractured side in the rotation formula, the degree of malrotation between the fracture ends was calculated. The mean follow-up period was 13.5 months. Patients’ mean age was 10.00 ± 3.19 years (range, 4–12 years). The rotation degree in the sagittal plane significantly differed between the proximal (26.52°±2.84°) and distal fracture ends (20.96°±2.73°) (P = 0.001). The rotation degree in the coronal plane significantly differed between the proximal (26.70°±2.38°) and distal fracture ends (20.26°±2.86°) (P = 0.001). The net rotation deformity of the fracture line was determined to be 5.55°± 3.54° on lateral radiographs and 5.44°± 3.35° on anteroposterior radiographs, no significant difference was observed between measurements (P >0.05). The malrotation deformity in PDRF occurs with greater rotation in the proximal fragment than in the distal fragment. The net rotation deformity created between the fracture ends can be calculated on direct radiographs. Level of Evidence: Diagnostic, Level II PMID:27149480

High incidence of intraoperative calcar fractures with the cementless CLS Spotorno stem.

PubMed

Timmer, Carla; Gerhardt, Davey M J M; de Visser, Enrico; de Kleuver, Marinus; van Susante, Job L C

2018-05-07

This study reports on the incidence of intraoperative calcar fractures with the cementless Spotorno (CLS) stem, and the potential role of a learning curve and implant positioning is investigated. After introduction of the CLS stem, 800 consecutive cementless total hip arthroplasties (THA) were analyzed. The incidence of calcar fracture in the first 400 THA was compared with the second 400 THA, in order to study a potential learning curve effect. According to the instruction for users, varus positioning of the stem was avoided and a femoral neck osteotomy was aimed relatively close to the lesser trochanter since these are assumed to be correlated with calcar fractures. Implant positioning (neck-shaft angle, femoral offset and osteotomy-lesser trochanter distance) was measured on postoperative pelvic radiographs of all THA with calcar fractures and 100 randomly selected uncomplicated control cases. Seventeen (2.1%) intraoperative calcar fractures were recorded. The incidence of calcar fracture differed between the first 400 THA (n = 11) and the second 400 THA (n = 6). This difference was not statistically significant (p = 0.220); however, these numbers indicate a trend toward a learning effect. No significant difference in stem positioning nor the height of the femoral neck osteotomy was measured between THA with a calcar fracture (n = 17) and the control cases (n = 100). We report on a high incidence of intraoperative calcar fractures with the use of a CLS stem. The risk for calcar fractures remains clinically significant even after adequate implant positioning in the hands of experienced hip surgeons. Surgeons should be aware of this implant related phenomenon and be alert on this phenomenon intraoperatively.

Porous media fracturing dynamics: stepwise crack advancement and fluid pressure oscillations

NASA Astrophysics Data System (ADS)

Cao, Toan D.; Hussain, Fazle; Schrefler, Bernhard A.

2018-02-01

We present new results explaining why fracturing in saturated porous media is not smooth and continuous but is a distinct stepwise process concomitant with fluid pressure oscillations. All exact solutions and almost all numerical models yield smooth fracture advancement and fluid pressure evolution, while recent experimental results, mainly from the oil industry, observation from geophysics and a very few numerical results for the quasi-static case indeed reveal the stepwise phenomenon. We summarize first these new experiments and these few numerical solutions for the quasi-static case. Both mechanical loading and pressure driven fractures are considered because their behaviours differ in the direction of the pressure jumps. Then we explore stepwise crack tip advancement and pressure fluctuations in dynamic fracturing with a hydro-mechanical model of porous media based on the Hybrid Mixture Theory. Full dynamic analyses of examples dealing with both hydraulic fracturing and mechanical loading are presented. The stepwise fracture advancement is confirmed in the dynamic setting as well as in the pressure fluctuations, but there are substantial differences in the frequency contents of the pressure waves in the two loading cases. Comparison between the quasi-static and fully dynamic solutions reveals that the dynamic response gives much more information such as the type of pressure oscillations and related frequencies and should be applied whenever there is a doubt about inertia forces playing a role - the case in most fracturing events. In the absence of direct relevant dynamic tests on saturated media some experimental results on dynamic fracture in dry materials, a fast hydraulic fracturing test and observations from geophysics confirm qualitatively the obtained results such as the type of pressure oscillations and the substantial difference in the behaviour under the two loading cases.

Transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures: A randomized controlled study with patient-reported outcome.

PubMed

Galal, Sherif; Safwat, Wael

2017-01-01

The 5th metacarpal fractures accounts for 38% of all hand fractures given that the neck is the weakest point in metacarpals, so neck fracture is the most common metacarpal fracture. Surgical fixation is also advocated for such fractures to prevent mal-rotation of the little finger which will lead to fingers overlap in a clenched fist. Various methods are available for fixation of such fractures, like intramedullary & transverse pinning. There are very few reports in the literature comparing both techniques. Authors wanted to compare outcomes and complications of transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures. A single-center, parallel group, prospective, randomized study was conducted at an academic Level 1 Trauma Center from October 2014 to December 2016. A total of 80 patients with 5th metacarpal's neck fractures were randomized to pinning using either transverse pinning (group A) or intramedullary pinning (group B). Patients were assessed clinically on range of motion, patient-reported outcome using the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire & radiographically. Two blinded observers assessed outcomes. At final follow up for each patient (12 months) the statistically significant differences were observed in operative time, the transverse pinning group showed shorter operative time, as well as complication rate as complications were observed only in intramedullary pinning group. No differences were found in range of motion or the Quick -DASH score. Both techniques are equally safe and effective treatment option for 5th metacarpal's neck fractures. The only difference was shorter operative time & less incidence of complications in transverse pinning group. Level II, Therapeutic study.

Fracture risk and bone mineral density in metabolic syndrome: a meta-analysis.

PubMed

Esposito, Katherine; Chiodini, Paolo; Capuano, Annalisa; Colao, Annamaria; Giugliano, Dario

2013-08-01

The risk of bone fractures in subjects with the metabolic syndrome is unknown. We did a meta-analysis to assess the association between metabolic syndrome, risk of fractures, and bone mineral density (BMD). We did searches on electronic databases (Medline, Scopus, and ISI Web of Knowledge) until December 2012 and searched reports to identify studies in humans on bone fractures and BMD at different sites. Two independent reviewers collected the relevant reports. We did random-effects meta-analyses to determine the risk of fractures and BMD values associated with metabolic syndrome. A total of 17 studies, with 35 datasets, were included. In 10 articles (14 datasets) including 1350 incident and 1628 prevalent fractures, metabolic syndrome was associated with a reduced fracture risk (risk ratio = 0.85, 95% confidence interval, 0.71-1.00; high heterogeneity: I(2) = 55%, P = .006). Omission of 2 outlier studies resulted in a significant negative association (risk ratio = 0.85, P = .012; I(2) = 34%, P = .130). Most of the reduced fracture risk was seen in cohort studies (18% reduced risk), suggesting a direction of causality; sex, site of fracture, and definition of the syndrome did not affect the estimates. In 16 articles, including 29 341 subjects, there was no difference in spine, femoral neck, or calcaneus BMD values between subjects with or without metabolic syndrome; mean differences ranged from 0.001 to 0.012 g/cm(2) (P > .10). This article shows a reduced risk of bone fractures associated with metabolic syndrome, without modification of BMD. The clinical significance of these findings remains uncertain and should be addressed in future prospective studies.

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement.

PubMed

Samuel, Andre M; Webb, Matthew L; Lukasiewicz, Adam M; Basques, Bryce A; Bohl, Daniel D; Varthi, Arya G; Lane, Joseph M; Grauer, Jonathan N

2016-06-01

Medicare currently reimburses hospitals for inpatient admissions with "bundled" payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs. The purposes of the study were to determine whether (1) inpatient length of stay; (2) intensive care unit stay; and (3) ventilator time differ among subpopulations with Medicare DRG 536. A total of 56,683 patients, 65 years or older, with fractures of the hip or pelvis were identified in the 2011 and 2012 National Trauma Data Bank. This clinical registry contains data on trauma cases from more than 900 participating trauma centers, allowing analysis of resource utilization in centers across the United States. Patients were grouped in the following subgroups: hip fractures (n = 35,119), nonoperative pelvic fractures (n = 15,506), acetabulum fractures, operative and nonoperative, (n = 7670), and operative pelvic fractures (n = 682). Total inpatient length of stay, intensive care unit (ICU) stay, and ventilator time were compared across groups using multivariate analysis that controlled for hospital factors. After controlling for patient and hospital factors, difference in inpatient length of stay was -0.2 days for patients with nonoperative pelvis fractures compared with inpatient length of stay for patients with hip fractures (95% CI, -0.4 to -0.1 days; p = 0.001); 1.7 days for patient with acetabulum fractures (95% CI, 1.4-1.9 days; p < 0.001); and 7.7 days for patients with operative pelvic fractures (95% CI, 7.0-8.4 days; p < 0.001). The difference in ICU length of stay for patients with nonoperative pelvis fractures was 0.8 days compared with ICU length of stay for patients with hip fractures (95% CI, 0.7-0.9 days; p < 0.001); 1.9 days for patients with acetabulum fractures (95% CI, 1.8-2.1 days; p < 0.001); and 6.3 days for patients with operative pelvic fractures (95% CI, 5.9-6.7 days; p < 0.001). The difference in mechanical ventilation time for patients with nonoperative fractures was 0.5 days compared with ventilation time for patients with hip fractures (95% CI, 0.4-0.6 days; p < 0.001); 1.1 days for patients with acetabulum fractures (95% CI, 1.0-1.2 days; p < 0.001); and 3.9 days for patients with operative fractures (95% CI, 2.5-3.2 days; p < 0.001). In our current multitiered trauma system, certain centers will see higher proportions of patients with acetabulum and operative pelvic fractures. Because hospitals are reimbursed equally for these subgroups of Medicare DRG 536, centers that care for a greater proportion of patients with more-complex pelvic trauma will experience lower financial margins per trauma patient, limiting their potential for growth and investment compared with competing institutions that may not routinely see patients with high-energy trauma. Because of this, we believe reevaluation of this Medicare Prospective Payment System DRG is warranted. Level IV, economic and decision analysis.

Anomalous transport in fracture networks: field scale experiments and modelling

NASA Astrophysics Data System (ADS)

Kang, P. K.; Le Borgne, T.; Bour, O.; Dentz, M.; Juanes, R.

2012-12-01

Anomalous transport is widely observed in different settings and scales of transport through porous and fractured geologic media. A common signature of anomalous transport is the late-time power law tailing in breakthrough curves (BTCs) during tracer tests. Various conceptual models of anomalous transport have been proposed, including multirate mass transfer, continuous time random walk, and stream tube models. Since different conceptual models can produce equally good fits to a single BTC, tracer test interpretation has been plagued with ambiguity. Here, we propose to resolve such ambiguity by analyzing BTCs obtained from both convergent and push-pull flow configurations at two different fracture planes. We conducted field tracer tests in a fractured granite formation close to Ploemeur, France. We observe that BTC tailing depends on the flow configuration and the injection fracture. Specifically the tailing disappears under push-pull geometry, and when we injected at a fracture with high flux (Figure 1). This indicates that for this fractured granite, BTC tailing is controlled by heterogeneous advection and not by matrix diffusion. To explain the change in tailing behavior for different flow configurations, we employ a simple lattice network model with heterogeneous conductivity distribution. The model assigns random conductivities to the fractures and solves the Darcy equation for an incompressible fluid, enforcing mass conservation at fracture intersections. The mass conservation constraint yields a correlated random flow through the fracture system. We investigate whether BTC tailing can be explained by the spatial distribution of preferential flow paths and stagnation zones, which is controlled by the conductivity variance and correlation length. By combining the results from the field tests and numerical modeling, we show that the reversibility of spreading is a key mechanism that needs to be captured. We also demonstrate the dominant role of the injection fracture on the tailing behavior: where we inject makes the difference in the tailing. Blue line is a BTC with injection into a slow velocity zone under convergent flow configuration. The late-time tailing observed for the convergent test diminished for push-pull experiment performed in the same zone(red line). Black line is a BTC with injection into a high velocity zone under convergent flow configuration. Insets: illustration of convergent and push-pull tracer tests using a double packer system.

Recent hip fracture trends in Sweden and Denmark with age-period-cohort effects.

PubMed

Rosengren, B E; Björk, J; Cooper, C; Abrahamsen, B

2017-01-01

This study used nationwide hip fracture data from Denmark and Sweden during 1987-2010 to examine effects of (birth) cohort and period. We found that time trends, cohort, and period effects were different in the two countries. Results also indicated that hip fracture rates may increase in the not so far future. The reasons for the downturn in hip fracture rates remain largely unclear but circumstances earlier in life seem important. We ascertained hip fractures in the populations ≥50 years in Denmark and Sweden in national discharge registers. Country- and sex-specific age-period-cohort (APC) effects during 1987-2010 were evaluated by log-likelihood estimates in Poisson regression models presented as incidence rate ratios (IRR). There were 399,596 hip fractures in SE and 248,773 in DK. Age-standardized hip fracture rate was stable in SE men but decreased in SE women and in DK. Combined period + cohort effects were generally stronger in SE than DK and in women than men. IRR per period ranged from 1.05 to 1.30 in SE and 0.95 to 1.21 in DK. IRR per birth cohort ranged from 1.07 to 3.13 in SE and 0.77 to 1.67 in DK. Relative period effects decreased with successive period in SE and described a convex curve in DK. Relative cohort effects increased with successive birth cohort in both countries but with lower risks for DK women and men and SE women born around the 1930s (age 75-86 years today and responsible for most hip fractures) partly explaining the recent downturn. Men and women born thereafter however seem to have a higher hip fracture risk, and we expect a reversal of the present decline in rates, with increasing hip fracture rates in both Denmark and Sweden during the upcoming decade. Time trends, cohort, and period effects were different in SE and DK. This may reflect differences in general health as evident in known differences in life expectancy, healthcare organization, and prevention such as use of anti-osteoporosis drugs. Analyses indicate that hip fracture rates may increase in the not so far future.

Fracture toughness of ultrashort pulse-bonded fused silica

NASA Astrophysics Data System (ADS)

Richter, S.; Naumann, F.; Zimmermann, F.; Tünnermann, A.; Nolte, S.

2016-02-01

We determined the bond interface strength of ultrashort pulse laser-welded fused silica for different processing parameters. To this end, we used a high repetition rate ultrashort pulse laser system to inscribe parallel welding lines with a specific V-shaped design into optically contacted fused silica samples. Afterward, we applied a micro-chevron test to measure the fracture toughness and surface energy of the laser-inscribed welding seams. We analyzed the influence of different processing parameters such as laser repetition rate and line separation on the fracture toughness and fracture surface energy. Welding the entire surface a fracture toughness of 0.71 {MPa} {m}^{1/2}, about 90 % of the pristine bulk material ({≈ } 0.8 {MPa} {m}^{1/2}), is obtained.

Fracture load and failure analysis of zirconia single crowns veneered with pressed and layered ceramics after chewing simulation.

PubMed

Stawarczyk, Bogna; Ozcan, Mutlu; Roos, Malgorzata; Trottmann, Albert; Hämmerle, Christoph H F

2011-01-01

This study determined the fracture load of zirconia crowns veneered with four overpressed and four layered ceramics after chewing simulation. The veneered zirconia crowns were cemented and subjected to chewing cycling. Subsequently, the specimens were loaded at an angle of 45° in a Universal Testing Machine to determine the fracture load. One-way ANOVA, followed by a post-hoc Scheffé test, t-test and Weibull statistic were performed. Overpressed crowns showed significantly lower fracture load (543-577 N) compared to layered ones (805-1067 N). No statistical difference was found between the fracture loads within the overpressed group. Within the layered groups, LV (1067 N) presented significantly higher results compared to LC (805 N). The mean values of all other groups were not significantly different. Single zirconia crowns veneered with overpressed ceramics exhibited lower fracture load than those of the layered ones after chewing simulation.

The corrosion fatigue fractography of Ti-24Al-11Nb

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

Zhang, Y.; Wang, Y.B.; Chu, W.Y.

1994-03-01

Many researchers have studied the fracture behaviors and fractography of the Ti-24Al-11Nb alloy. While hydrogen induced delayed fracture could occur in this titanium aluminide in hydrogen gas at temperatures above 300[degree]C, there was no obvious difference in fractography of the alloy in hydrogen or air. The fractography of stress corrosion cracking in a solution was also similar to that of overloaded fracture in air. The recent work showed that hydrogen induced delayed fracture for a notched sample could occur during dynamic cathodic charging at the temperature. There were a lot of small dimples on the fracture surface near the notchmore » tip when K[sub I] neared the threshold k[sub IH]. This differed from that of an overloaded fracture. The fractography of corrosion fatigue in methanol or during dynamic charging for the Ti-24Al-11Nb alloy was studied in this paper.« less

The influence of different cementation modes on the fracture resistance of feldspathic ceramic crowns.

PubMed

Groten, M; Pröbster, L

1997-01-01

One hundred twenty pressed feldspathic ceramic crowns were luted to 20 steel dies using six different cementation modes. Fracture resistance was tested under an angle of 45 degrees and was determined as the maximal fracture load. Crowns were tested with luting agent only (groups A and C) and after etching with hydrofluoric acid, silanating, and the application of a bonding agent (groups B, D, E, and F). The resulting means were: phosphate cement 294.3 (A) and 282.2 (B); glass-ionomer cement 217.2 (C) and 255.4 (D); resin composite 382.2 (E) and 687.6 (F). Statistical analysis revealed significantly greater fracture resistance (P < .01) of resin luted crowns. Bonding to the die almost doubled the fracture resistance. Conditioning of the inner surfaces of the crowns did not improve the fracture resistance of crowns luted using zinc phosphate or glass-ionomer cements.

[Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture].

PubMed

Shi, Weixiang; Luo, Xiaozhong; Wu, Gang; Ding, Yong; Zhou, Xin

2018-02-01

To explore the effectiveness and advantage of three-dimensional (3D) printing technology in treatment of internal or external ankle distal avulsed fracture. Between January 2015 and January 2017, 20 patients with distal avulsed fracture of internal or external ankle were treated with the 3D guidance of shape-blocking steel plate fixation (group A), and 18 patients were treated with traditional plaster external fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, fracture side, and fracture type between 2 groups ( P >0.05). Recording the fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, residual ankle pain, and evaluating ankle function recovery of both groups by the American Orthopaedic Foot and Ankle Society (AOFAS) score. All patients were followed up 8-24 months, with an average of 15.5 months. In group A: all incisions healed by first intention, the time of starting to ankle functional exercise was (14±3) days, fracture healing rate was 100%, and the fracture healing time was (10.15±2.00) weeks. At 6 months, the AOFAS score was 90.35±4.65. Among them, 13 patients were excellent and 7 patients were good. All patients had no post-operative incision infection, residual ankle pain, or dysfunction during the follow-up. In group B: the time of starting to ankle functional exercise was (40±10) days, the fracture healing rate was 94.44%, and the fracture healing time was (13.83±7.49) weeks. At 6 months, the AOFAS score was 79.28±34.28. Among them, 15 patients were good, 2 patients were medium, and 1 patient was poor. During the follow-up, 3 patients (16.67%) had pain of ankle joint with different degrees. There were significant differences in the postoperative fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, and postoperative AOFAS score between 2 groups ( P <0.05). Application of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.

Inclusion-based effective medium models for the field-scale permeability of 3D fractured rock masses

NASA Astrophysics Data System (ADS)

Ebigbo, Anozie; Lang, Philipp S.; Paluszny, Adriana; Zimmerman, Robert W.

2016-04-01

Fractures that are more permeable than their host rock can act as preferential, or at least additional, pathways for fluid to flow through the rock. The additional transmissivity contributed by these fractures will be of great relevance in several areas of earth science and engineering, such as radioactive waste disposal in crystalline rock, exploitation of fractured hydrocarbon and geothermal reservoirs, or hydraulic fracturing. In describing or predicting flow through fractured rock, the effective permeability of the rock mass, comprising both the rock matrix and a network of fractures, is a crucial parameter, and will depend on several geometric properties of the fractures/networks, such as lateral extent, aperture, orientation, and fracture density. This study investigates the ability of classical inclusion-based effective medium models (following the work of Sævik et al., Transp. Porous Media, 2013) to predict this permeability. In these models, the fractures are represented as thin, spheroidal inclusions, the interiors of which are treated as porous media having a high (but finite) permeability. The predictions of various effective medium models, such as the symmetric and asymmetric self-consistent schemes, the differential scheme, and Maxwell's method, are tested against the results of explicit numerical simulations of mono- and polydisperse isotropic fracture networks embedded in a permeable rock matrix. Comparisons are also made with the Hashin-Shrikman bounds, Snow's model, and Mourzenko's heuristic model (Mourzenko et al., Phys. Rev. E, 2011). This problem is characterised mathematically by two small parameters, the aspect ratio of the spheroidal fractures, α, and the ratio between matrix and fracture permeability, κ. Two different regimes can be identified, corresponding to α/κ < 1 and α/κ > 1. The lower the value of α/κ, the more significant is flow through the matrix. Due to differing flow patterns, the dependence of effective permeability on fracture density differs in the two regimes. When α/κ > 1, a distinct percolation threshold is observed, whereas for α/κ < 1, the matrix is sufficiently transmissive that a percolation-like transition is not observed. The self-consistent effective medium methods show good accuracy for both mono- and polydisperse isotropic fracture networks. Mourzenko's equation is also found to be very accurate, particularly for monodisperse networks. Finally, it is shown that Snow's model essentially coincides with the Hashin-Shtrikman upper bound.

Effect of Age of Self-Reported, Non-Surgical Menopause on Time to First Fracture and Bone Mineral Density in the Women’s Health Initiative Observational Study

PubMed Central

Lehman, Amy; Thomas, Fridtjof; Johnson, Karen C.; Jackson, Rebecca; Wactawski-Wende, Jean; Ko, Marcia; Chen, Zhao; Curb, J David; Howard, Barbara V.

2015-01-01

Objective Menopause is a risk factor for fracture, thus menopause age may affect bone mass and fracture rates. We compared Bone Mineral Density (BMD) and fracture rates among healthy postmenopausal women with varying ages of self-reported non-surgical menopause. Methods Hazard ratios for fracture and differences in BMD among 21,711 postmenopausal women from the Women’s Health Initiative Observational cohort without prior hysterectomy, oophorectomy, or hormone therapy, who reported age of menopause of <40, 40–49, or ≥50 years, were compared. Results Prior to multivariable adjustments, we found no differences in absolute fracture risk among menopausal age groups. After multivariable adjustments for known risk factors for fracture, women undergoing menopause <40 had a higher fracture risk at any site compared to women undergoing menopause ≥50 years (HR=1.21, 95% CI: 1.02, 1.44; p=0.03). In a subset with BMD measurements (n=1,351), whole body BMD was lower in women who reported menopause <40 compared to 40–49 years (estimated difference= −0.034 g/cm2; 95% CI: −0.07, −0.004; p=0.03) and compared to ≥50 years (estimated difference= −0.05 g/cm2; 95% CI; −0.08, −0.02; p<0.01). Left hip BMD was lower in women with menopause <40 compared to ≥50 years (estimated difference= −0.05 g/cm2; 95% CI: −0.08, −0.01; p=0.01), and total spine BMD was lower in women with menopause <40 compared to ≥50 and 40–49 years (estimated differences= −0.11 g/cm2; 95% CI; −0.16, −0.06; p<0.01 and −0.09 g/cm2; 95% CI; −0.15, −0.04; p<0.01, respectively). Conclusions In the absence of hormone therapy, earlier menopause age may be a risk factor contributing to decreased BMD and increased fracture risk in healthy postmenopausal women. Our data suggest that menopause age should be taken into consideration, along with other osteoporotic risk factors, when estimating fracture risk in postmenopausal women. PMID:25803670

The effect of a microscale fracture on dynamic capillary pressure of two-phase flow in porous media

NASA Astrophysics Data System (ADS)

Tang, Mingming; Lu, Shuangfang; Zhan, Hongbin; Wenqjie, Guo; Ma, Huifang

2018-03-01

Dynamic capillary pressure (DCP) effects, which is vital for predicting multiphase flow behavior in porous media, refers to the injection rate dependence capillary pressure observed during non-equilibrium displacement experiments. However, a clear picture of the effects of microscale fractures on DCP remains elusive. This study quantified the effects of microscale fractures on DCP and simulated pore-scale force and saturation change in fractured porous media using the multiphase lattice Boltzmann method (LBM). Eighteen simulation cases were carried out to calculate DCP as a function of wetting phase saturation. The effects of viscosity ratio and fracture orientation, aperture and length on DCP and DCP coefficient τ were investigated, where τ refers to the ratio of the difference of DCP and static capillary pressure (SCP) over the rate of wetting-phase saturation change versus time. Significant differences in τ values were observed between unfractured and fractured porous media. The τ values of fractured porous media were 1.1  × 104 Pa ms to 5.68 × 105 Pa ms, which were one or two orders of magnitude lower than those of unfractured porous media with a value of 4 × 106 Pa. ms. A horizontal fracture had greater effects on DCP and τ than a vertical fracture, given the same fracture aperture and length. This study suggested that a microscale fracture might result in large magnitude changes in DCP for two-phase flow.

Models of tibial fracture healing in normal and Nf1-deficient mice.

PubMed

Schindeler, Aaron; Morse, Alyson; Harry, Lorraine; Godfrey, Craig; Mikulec, Kathy; McDonald, Michelle; Gasser, Jürg A; Little, David G

2008-08-01

Delayed union and nonunion are common complications associated with tibial fractures, particularly in the distal tibia. Existing mouse tibial fracture models are typically closed and middiaphyseal, and thus poorly recapitulate the prevailing conditions following surgery on a human open distal tibial fracture. This report describes our development of two open tibial fracture models in the mouse, where the bone is broken either in the tibial midshaft (mid-diaphysis) or in the distal tibia. Fractures in the distal tibial model showed delayed repair compared to fractures in the tibial midshaft. These tibial fracture models were applied to both wild-type and Nf1-deficient (Nf1+/-) mice. Bone repair has been reported to be exceptionally problematic in human NF1 patients, and these patients can also spontaneously develop tibial nonunions (known as congenital pseudarthrosis of the tibia), which are recalcitrant to even vigorous intervention. pQCT analysis confirmed no fundamental differences in cortical or cancellous bone in Nf1-deficient mouse tibiae compared to wild-type mice. Although no difference in bone healing was seen in the tibial midshaft fracture model, the healing of distal tibial fractures was found to be impaired in Nf1+/- mice. The histological features associated with nonunited Nf1+/- fractures were variable, but included delayed cartilage removal, disproportionate fibrous invasion, insufficient new bone anabolism, and excessive catabolism. These findings imply that the pathology of tibial pseudarthrosis in human NF1 is complex and likely to be multifactorial.

Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies.

PubMed

Houwert, Roderick M; Smeeing, Diederik P J; Ahmed Ali, Usama; Hietbrink, Falco; Kruyt, Moyo C; van der Meijden, Olivier A

2016-07-01

The last decade has shown a shift toward operative treatment of a subset of midshaft clavicle fractures. However, it is unclear whether there are differences between plate fixation and intramedullary fixation regarding complications and functional outcome. The aim of this systematic review and meta-analysis was to compare plate fixation and intramedullary fixation for midshaft clavicle fractures. The Medline, Embase, and Cochrane databases were searched for both randomized controlled trials and observational studies. The methodologic quality of all included studies was assessed using the Methodological Index for Non-Randomized Studies. Twenty studies were included. Ten of the 20 included studies used a fracture classification. Seven of these studies reported exclusion of patients with comminuted fractures. No difference in the total re-intervention rate was found (odds ratio [OR], 1.21; 95% confidence interval [CI], 0.71 to 2.04). Major re-interventions occurred more often after plate fixation (OR, 1.88; 95% CI, 1.02 to 3.46). The mean implant removal rates were 38% after plate fixation and 73% after intramedullary fixation. Re-fracture after implant removal occurred more often after plate fixation (OR, 3.42; 95% CI, 1.12 to 10.42). The Constant-Murley scores showed no differences at both short term (mean difference, -1.18; 95% CI, -13.41 to 11.05) and long term (mean difference, 0.15; 95% CI, -1.57 to 1.87). No differences were observed regarding nonunion (OR, 1.50; 95% CI, 0.82 to 2.75). The rate of infections showed no differences when outlier studies were excluded (OR, 1.54; 95% CI, 0.88 to 2.69). Major re-intervention and re-fracture after implant removal occurred more frequently after plate fixation of non-comminuted, displaced midshaft clavicle fractures. No differences in terms of function and nonunion between plate fixation and intramedullary fixation were observed. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Characterization of Sheet Fracture Patterns in Polygonal-Jointed Lavas at Kokostick Butte, OR, and Mazama Ridge, WA: Investigation and Interpretation of Their Formation and Significance

NASA Astrophysics Data System (ADS)

Lodge, R. W.; Lescinsky, D. T.

2006-12-01

Polygonal joints in lava flows ("columns") are commonly equant leading to a model of formation associated with cooling in an isotropic stress field. This model, however, does not explain rectangular columns, sheet-like fractures, fractures with crosscutting relationships, and fractures with orientations other than perpendicular to the cooling surface. These fracture patterns are often observed at glaciated volcanoes. The presence of preferential fracture orientations suggests an applied stress component likely due to environmental conditions such as the presence of glaciers or flow dynamics such as down-slope settling or flow margin inflation. During this study we investigated the formation and significance of these non-equant fracture patterns to propose a model for their formation. These `abnormal' fracture patterns have not been discussed in the literature and may be important to better understanding the cooling conditions of such lava flows. To test these possibilities we studied Kokostick Butte dacite flow, OR (near South Sister), and Mazama Ridge andesite flow at Mount Rainier, WA. Both of these flows have well developed sheet-like fractures and display evidence of ice-contact during eruption and emplacement. Sheet fractures are long and continuous fractures that have perpendicular connecting fractures forming rectangular columns. The sheet-like fractures are largely parallel to each other on the exposure surface and the connecting fractures vary locally from primary fractures (associated with cooling toward flow interior) to secondary fractures (associated with cooling by water infiltration). Detailed measurements of fracture orientations and spacing were collected at Kokostick Butte and Mazama Ridge to examine the relationship between the sheet fractures and flow geometry. Preliminary results support this relationship and suggest these patterns likely form due to shear associated with small amounts of flow advance by the rapidly cooling lava. Laboratory studies have been undertaken to complement the field observations and measurements. Starch- water experiments have been proven a useful analogue for lava column formation. Various experimental setups involving different mixture thicknesses and compression of the mixture were utilized to simulate the stresses acting during ponding of lava against glacial ice and to produce different fracture morphologies and patterns. Initial results show that compression of the starch slurry results in non-equant fracture patterns with some sheet-like fracturing present.

[Analysis of a three-dimensional finite element model of atlas and axis complex fracture].

PubMed

Tang, X M; Liu, C; Huang, K; Zhu, G T; Sun, H L; Dai, J; Tian, J W

2018-05-22

Objective: To explored the clinical application of the three-dimensional finite element model of atlantoaxial complex fracture. Methods: A three-dimensional finite element model of cervical spine (FEM/intact) was established by software of Abaqus6.12.On the basis of this model, a three-dimensional finite element model of four types of atlantoaxial complex fracture was established: C(1) fracture (Jefferson)+ C(2) fracture (type Ⅱfracture), Jefferson+ C(2) fracture(type Ⅲfracture), Jefferson+ C(2) fracture(Hangman), Jefferson+ stable C(2) fracture (FEM/fracture). The range of motion under flexion, extension, lateral bending and axial rotation were measured and compared with the model of cervical spine. Results: The three-dimensional finite element model of four types of atlantoaxial complex fracture had the same similarity and profile.The range of motion (ROM) of different segments had different changes.Compared with those in the normal model, the ROM of C(0/1) and C(1/2) in C(1) combined Ⅱ odontoid fracture model in flexion/extension, lateral bending and rotation increased by 57.45%, 29.34%, 48.09% and 95.49%, 88.52%, 36.71%, respectively.The ROM of C(0/1) and C(1/2) in C(1) combined Ⅲodontoid fracture model in flexion/extension, lateral bending and rotation increased by 47.01%, 27.30%, 45.31% and 90.38%, 27.30%, 30.0%.The ROM of C(0/1) and C(1/2) in C(1) combined Hangman fracture model in flexion/extension, lateral bending and rotation increased by 32.68%, 79.34%, 77.62% and 60.53%, 81.20%, 21.48%, respectively.The ROM of C(0/1) and C(1/2) in C(1) combined axis fracture model in flexion/extension, lateral bending and rotation increased by 15.00%, 29.30%, 8.47% and 37.87%, 75.57%, 8.30%, respectively. Conclusions: The three-dimensional finite element model can be used to simulate the biomechanics of atlantoaxial complex fracture.The ROM of atlantoaxial complex fracture is larger than nomal model, which indicates that surgical treatment should be performed.

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

PubMed Central

Hohenwarter, A.; Pippan, R.

2012-01-01

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

Fracture healing with alendronate treatment in the Brtl/+ mouse model of osteogenesis imperfecta

PubMed Central

Meganck, J.A.; Begun, D.L.; McElderry, J.D.; Swick, A.; Kozloff, K.M.; Goldstein, S.A.; Morris, M.D.; Marini, J.C.; Caird, M.S.

2014-01-01

Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by increased skeletal fragility. Patients are often treated with bisphosphonates to attempt to reduce fracture risk. However, bisphosphonates reside in the skeleton for many years and long-term administration may impact bone material quality. Acutely, there is concern about risk of non-union of fractures that occur near the time of bisphosphonate administration. This study investigated the effect of alendronate, a potent aminobisphosphonate, on fracture healing. Using the Brtl/+ murine model of type IV OI, tibial fractures were generated in 8-week-old mice that were untreated, treated with alendronate before fracture, or treated before and after fracture. After 2, 3, or 5 weeks of healing, tibiae were assessed using microcomputed tomography (μCT), torsion testing, quantitative histomorphometry, and Raman microspectroscopy. There were no morphologic, biomechanical or histomorphometric differences in callus between untreated mice and mice that received alendronate before fracture. Alendronate treatment before fracture did not cause a significant increase in cartilage retention in fracture callus. Both Brtl/+ and WT mice that received alendronate before and after fracture had increases in the callus volume, bone volume fraction and torque at failure after 5 weeks of healing. Raman microspectroscopy results did not show any effects of alendronate in wild-type mice, but calluses from Brtl/+ mice treated with alendronate during healing had a decreased mineral-to-matrix ratio, decreased crystallinity and an increased carbonate-to-phosphate ratio. Treatment with alendronate altered the dynamics of healing by preventing callus volume decreases later in the healing process. Fracture healing in Brtl/+ untreated animals was not significantly different from animals in which alendronate was halted at the time of fracture. PMID:23774443

Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures.

PubMed

Knutsen, Ashleen; Avoian, Tigran; Borkowski, Sean L; Ebramzadeh, Edward; Zionts, Lewis E; Sangiorgio, Sophia N

2014-02-01

Determining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap. A non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement). During pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05). Overall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.

Environmentally Friendly, Rheoreversible, Hydraulic-fracturing Fluids for Enhanced Geothermal Systems

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

Shao, Hongbo; Kabilan, Senthil; Stephens, Sean A.

Cost-effective creation of high-permeability reservoirs inside deep crystalline bedrock is the primary challenge for the feasibility of enhanced geothermal systems (EGS). Current reservoir stimulation entails adverse environmental impacts and substantial economic costs due to the utilization of large volumes of water “doped” with chemicals including rheology modifiers, scale and corrosion inhibitors, biocides, friction reducers among others where, typically, little or no information of composition and toxicity is disclosed. An environmentally benign, CO2-activated, rheoreversible fracturing fluid has recently been developed that significantly enhances rock permeability at effective stress significantly lower than current technology. We evaluate the potential of this novel fracturingmore » fluid for application on geothermal sites under different chemical and geomechanical conditions, by performing laboratory-scale fracturing experiments with different rock sources under different confining pressures, temperatures, and pH environments. The results demonstrate that CO2-reactive aqueous solutions of environmentally amenable Polyallylamine (PAA) represent a highly versatile fracturing fluid technology. This fracturing fluid creates/propagates fracture networks through highly impermeable crystalline rock at significantly lower effective stress as compared to control experiments where no PAA was present, and permeability enhancement was significantly increased for PAA compared to conventional hydraulic fracturing controls. This was evident in all experiments, including variable rock source/type, operation pressure and temperature (over the entire range for EGS applications), as well as over a wide range of formation-water pH values. This versatile novel fracturing fluid technology represents a great alternative to industrially available fracturing fluids for cost-effective and competitive geothermal energy production.« less

PREVALENCE OF HEALED LONG-BONE FRACTURES IN WILD CARNIVORES FROM THE NORTHEASTERN UNITED STATES.

PubMed

Argyros, George C; Roth, Aaron J

2016-09-01

Museum specimens representing 12 species of terrestrial carnivores from the northeastern United States were inspected for evidence of healed long-bone fractures. Of 413 individuals, 18 (4.4%) exhibited healed fractures. Thirteen (72.2%) occurred in hind limbs; five (27.8%) occurred in forelimbs. Mustelids had the highest prevalence of healed long-bone fractures (38.8%) of all observed fractures. Within family, 5.6% of Canidae and 2.8% of Mustelidae exhibited healed fractures. Bobcats had the highest taxon prevalence of fractures, 18%. Observational data to assess use of and behavior near roads could provide insight to causes of fracture. Capture in combination with noninvasive examination techniques could be employed to determine incidence of healed fractures in wild populations. Individuals with healed fractures could then be tracked via radio telemetry to determine if these animals behave differently than uninjured conspecifics, and assess long-term survivability and fitness.

A comparison of three different surgical procedures in the treatment of type A thoracolumbar fractures: a randomized controlled trial.

PubMed

Lyu, Jianhua; Chen, Kai; Tang, Zhaohui; Chen, Yu; Li, Ming; Zhang, Qiulin

2016-06-01

The aim of the study was to evaluate the efficacy of three different surgical procedures in the treatment of type A thoracolumbar fractures. Between September 2012 and January 2015, a total of 90 patients with type A thoracolumbar fractures were randomly assigned into three groups of 30 each. Patients in group A, B, and C were treated with three-level percutaneous fixation, two-level percutaneous fixation, and three-level open fixation, respectively. Blood loss, duration of surgery, VAS scores, Cobb angles, and anterior height ratios of fractured vertebrae were collected for statistical analysis. The average follow-up was 17.7 months. Post-operative Cobb angles were significantly corrected and anterior height ratios of fractured vertebrae were well restored in all three groups (p < 0.01). Back pain was efficiently relieved according to VAS score change (p < 0.01). There were significant differences in values of blood loss and post-operative VAS scores (at three months) between group A and group C (p < 0.01). No significant difference concerning post-operative anterior height ratios of fractured vertebrae, Cobb angles and correction losses was observed between group A and group B (p = 0.580, 0.840, 0.215, respectively). Percutaneous fixation not only provides the same reduction effect as open fixation, but also has an advantage of causing less operation related trauma which is beneficial to post-operative rehabilitation. The efficacy of three-level percutaneous fixation and two-level percutaneous fixation in the treatment of type A thoracolumbar fractures is not significantly different.

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.

Fracture toughness of plasma-sprayed thermal barrier ceramics: Influence of processing, microstructure, and thermal aging

DOE PAGES

Dwivedi, Gopal; Viswanathan, Vaishak; Sampath, Sanjay; ...

2014-06-09

Fracture toughness has become one of the dominant design parameters that dictates the selection of materials and their microstructure to obtain durable thermal barrier coatings (TBCs). Much progress has been made in characterizing the fracture toughness of relevant TBC compositions in bulk form, and it has become apparent that this property is significantly affected by process-induced microstructural defects. In this investigation, a systematic study of the influence of coating microstructure on the fracture toughness of atmospheric plasma sprayed (APS) TBCs has been carried out. Yttria partially stabilized zirconia (YSZ) coatings were fabricated under different spray process conditions inducing different levelsmore » of porosity and interfacial defects. Fracture toughness was measured on free standing coatings in as-processed and thermally aged conditions using the double torsion technique. Results indicate significant variance in fracture toughness among coatings with different microstructures including changes induced by thermal aging. Comparative studies were also conducted on an alternative TBC composition, Gd 2Zr 2O 7 (GDZ), which as anticipated shows significantly lower fracture toughness compared to YSZ. Furthermore, the results from these studies not only point towards a need for process and microstructure optimization for enhanced TBC performance but also a framework for establishing performance metrics for promising new TBC compositions.« less

Biomechanical comparison of straight DCP and helical plates for fixation of transverse and oblique bone fractures.

PubMed

Aksakal, Bunyamin; Gurger, Murat; Say, Yakup; Yilmaz, Erhan

2014-01-01

Biomechanical comparison of straight DCP and helical plates for fixation of transversal and oblique tibial bone fractures were analyzed and compared to each other by axial compression, bending and torsion tests. An in vitro osteosynthesis of transverse (TF) and oblique bone fracture (OF) fixations have been analysed on fresh sheep tibias by using the DCP and helical compression plates (HP). Statistically significant differences were found for both DCP and helical plate fixations under axial compression, bending and torsional loads. The strength of fixation systems was in favor of DC plating with exception of the TF-HP fixation group under compression loads and torsional moments. The transvers fracture (TF) stability was found to be higher than that found in oblique fracture (OF) fixed by helical plates (HP). However, under torsional testing, compared to conventional plating, the helical plate fixations provided a higher torsional resistance and strength. The maximum stiffness at axial compression loading and maximum torsional strength was achieved in torsional testing for the TF-HP fixations. From in vitro biomechanical analysis, fracture type and plate fixation system groups showed different responses under different loadings. Consequently, current biomechanical analyses may encourage the usage of helical HP fixations in near future during clinical practice for transverse bone fractures.

A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients.

PubMed

Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Olsha, Oded; Givon, Adi; Kessel, Boris

2017-03-01

Pelvic fractures are a marker of severe injury, mandating a thorough investigation for the presence of associated injuries. Anatomical and physiological differences between adults and children may lead to a different impact of pelvic fractures on these populations. The purpose of this study is to compare pelvic fractures between pediatric and adult blunt trauma victims, mainly regarding their severity and associated intraabdominal injuries. A retrospective study involving blunt trauma patients suffering pelvic fractures, according to the records of the Israeli National Trauma Registry. Patients included children, aged 0-14years, and adults between 15 and 64years. The presence and severity of associated injuries were assessed. Overall, 7621 patients aged 0-64years were identified with pelvic fractures following blunt trauma. The incidence of pelvic fractures in children was (0.8%), as compared to 4.3% in adults, p <0.0001. The most common mechanism of injury was motor vehicle accident (MVA) in adults, and pedestrian hit by car (PHBC) in children. About a quarter of the patients in both groups had an ISS >25. Adults sustained significantly more moderate to severe pelvic fractures (AIS≥3) than children (26.7% vs. 17.4%, p<0.0001). The overall mortality rate was similar among the two groups (5.4% in adults, 5.2% in children, p=0.7554). The only associated injury with statistically significant difference in incidence among the two groups was rectal injury (1.2% among children, 0.2% among adults, p<0.0001). Among adult patients, there was a clear correlation between the severity of pelvic fractures and the severity of concomitant splenic and hepatic injuries (p=0.026, p=0.0004, respectively). Among children, a similar correlation was not demonstrated. Adults involved in blunt trauma are more likely to sustain pelvic fractures, and these are generally more severe fractures, as compared to children suffering from blunt trauma. Nonetheless, mortality rates were found similar in both groups. The only associated injury with statistically significant difference in incidence among the two groups was rectal injury. In adults, but not in children, higher grade pelvic fractures correlated with more severe concomitant splenic or hepatic injuries. The level of evidence for this study is III (3). Copyright © 2016 Elsevier Inc. All rights reserved.

Relationships between fractures

NASA Astrophysics Data System (ADS)

Peacock, D. C. P.; Sanderson, D. J.; Rotevatn, A.

2018-01-01

Fracture systems comprise many fractures that may be grouped into sets based on their orientation, type and relative age. The fractures are often arranged in a network that involves fracture branches that interact with one another. Interacting fractures are termed geometrically coupled when they share an intersection line and/or kinematically coupled when the displacements, stresses and strains of one fracture influences those of the other. Fracture interactions are characterised in terms of the following. 1) Fracture type: for example, whether they have opening (e.g., joints, veins, dykes), closing (stylolites, compaction bands), shearing (e.g., faults, deformation bands) or mixed-mode displacements. 2) Geometry (e.g., relative orientations) and topology (the arrangement of the fractures, including their connectivity). 3) Chronology: the relative ages of the fractures. 4) Kinematics: the displacement distributions of the interacting fractures. It is also suggested that interaction can be characterised in terms of mechanics, e.g., the effects of the interaction on the stress field. It is insufficient to describe only the components of a fracture network, with fuller understanding coming from determining the interactions between the different components of the network.

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

PubMed

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

2018-01-06

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

Physical simulation study on the hydraulic fracture propagation of coalbed methane well

NASA Astrophysics Data System (ADS)

Wu, Caifang; Zhang, Xiaoyang; Wang, Meng; Zhou, Longgang; Jiang, Wei

2018-03-01

As the most widely used technique to modify reservoirs in the exploitation of unconventional natural gas, hydraulic fracturing could effectively raise the production of CBM wells. To study the propagation rules of hydraulic fractures, analyze the fracture morphology, and obtain the controlling factors, a physical simulation experiment was conducted with a tri-axial hydraulic fracturing test system. In this experiment, the fracturing sample - including the roof, the floor, and the surrounding rock - was prepared from coal and similar materials, and the whole fracturing process was monitored by an acoustic emission instrument. The results demonstrated that the number of hydraulic fractures in coal is considerably higher than that observed in other parts, and the fracture morphology was complex. Vertical fractures were interwoven with horizontal fractures, forming a connected network. With the injection of fracturing fluid, a new hydraulic fracture was produced and it extended along the preexisting fractures. The fracture propagation was a discontinuous, dynamic process. Furthermore, in-situ stress plays a key role in fracture propagation, causing the fractures to extend in a direction perpendicular to the minimum principal stress. To a certain extent, the different mechanical properties of the coal and the other components inhibited the vertical propagation of hydraulic fractures. Nonetheless, the vertical stress and the interfacial property are the major factors to influence the formation of the "T" shaped and "工" shaped fractures.

Gender-specific hip fracture risk in community-dwelling and institutionalized seniors age 65 years and older.

PubMed

Finsterwald, M; Sidelnikov, E; Orav, E J; Dawson-Hughes, B; Theiler, R; Egli, A; Platz, A; Simmen, H P; Meier, C; Grob, D; Beck, S; Stähelin, H B; Bischoff-Ferrari, H A

2014-01-01

In this study of acute hip fracture patients, we show that hip fracture rates differ by gender between community-dwelling seniors and seniors residing in nursing homes. While women have a significantly higher rate of hip fracture among the community-dwelling seniors, men have a significantly higher rate among nursing home residents. Differences in gender-specific hip fracture risk between community-dwelling and institutionalized seniors have not been well established, and seasonality of hip fracture risk has been controversial. We analyzed detailed data from 1,084 hip fracture patients age 65 years and older admitted to one large hospital center in Zurich, Switzerland. In a sensitivity analysis, we extend to de-personalized data from 1,265 hip fracture patients from the other two large hospital centers in Zurich within the same time frame (total n = 2,349). The denominators were person-times accumulated by the Zurich population in the corresponding age/gender/type of dwelling stratum in each calendar season for the period of the study. In the primary analysis of 1,084 hip fracture patients (mean age 85.1 years; 78% women): Among community-dwelling seniors, the risk of hip fracture was twofold higher among women compared with men (RR = 2.16; 95% CI, 1.74-2.69) independent of age, season, number of comorbidities, and cognitive function; among institutionalized seniors, the risk of hip fracture was 26% lower among women compared with men (RR = 0.77; 95% CI: 0.63-0.95) adjusting for the same confounders. In the sensitivity analysis of 2,349 hip fracture patients (mean age 85.0 years, 76% women), this pattern remained largely unchanged. There is no seasonal swing in hip fracture incidence. We confirm for seniors living in the community that women have a higher risk of hip fracture than men. However, among institutionalized seniors, men are at higher risk for hip fracture.

Effect of the push-up exercise at different palmar width on muscle activities.

PubMed

Kim, You-Sin; Kim, Do-Yeon; Ha, Min-Seong

2016-01-01

[Purpose] The purpose of the present study was to determine the effects of changes in palmar width on the muscle activities of the shoulder and truncus muscles during push-up exercise. [Subjects] Twelve healthy adult males participated in this study as subjects. [Methods] Push-up exercises were performed with three different palmar width in narrow (50%), neutral (100%), and wide positions (150%). We measured the muscle activities of the deltoideus p. acromialis, pectoralis minor, pectoralis major, serratus anterior, biceps brachii, triceps brachii, latissimus dorsi, and infraspinatus. [Results] Pectoralis minor, triceps brachii, and infraspinatus muscle activities were greater during push-ups performed with the 50% palmar width compared with the other palmar widths. Pectoralis major muscle activity was greater during push-ups performed with the 50% and 100% palmar widths compared with the 150% palmar width. Serratus anterior muscle activity was greater during push-ups performed with the 150% palmar width compared with the other palmar widths. [Conclusion] These results are expected to serve as reference materials for push-up exercise applications in training programs for truncus muscle strengthening or rehabilitation programs for scapula patients.