20 CFR 404.1044 - Vacation pay.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Vacation pay. 404.1044 Section 404.1044 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Wages § 404.1044 Vacation pay. We consider...

20 CFR 404.1044 - Vacation pay.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Vacation pay. 404.1044 Section 404.1044 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Wages § 404.1044 Vacation pay. We consider...

28 CFR 545.27 - Inmate vacations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... because of the inmate's poor performance or adverse behavior. [49 FR 38915, Oct. 1, 1984. Redesignated and... COMPENSATION Inmate Work and Performance Pay Program § 545.27 Inmate vacations. (a) An inmate who has worked... shall approve the request if the inmate's work performance qualifies for vacation credit. (b) Staff...

28 CFR 545.27 - Inmate vacations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Inmate vacations. 545.27 Section 545.27... COMPENSATION Inmate Work and Performance Pay Program § 545.27 Inmate vacations. (a) An inmate who has worked full-time for 12 consecutive months on an institution work assignment is eligible to take a five-day...

Tackling Production Techniques: Vacations via Kodak's Visualmaker.

ERIC Educational Resources Information Center

Martin, Ron

1986-01-01

Describes a library media production activity in which each student uses a Kodak Ektagraphic Visualmaker to produce a color slide illustrating his/her winter vacation. The project is designed to be low-budget and to involve uncomplicated equipment. Included are explanations of performance objectives, materials, procedures, and evaluation. (EM)

Annual Vacations and Vacation Laws: Recent Developments in the United States and Abroad. A Report Prepared for the Select Subcommittee on Labor.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Education and Labor.

The paid annual vacation is now the rule rather than the exception in conditions of employment in the United States. Collective bargaining and unilateral decisions by employers have increased the length of paid annual vacations and reduced qualifying periods of employment for millions of workers. In recent years the 4-week annual vacation has…

Vacation health care

MedlinePlus

... page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the sharing features on this page, ... and help you avoid problems. Talk to your health care provider or visit a travel clinic 4 to ...

Working Vacations: Jobs in Tourism and Leisure

ERIC Educational Resources Information Center

Torpey, Elka Maria

2011-01-01

Vacation jobs often mix work and play. For some, the job is their ticket to career happiness. The article's first section describes four jobs specific to entertainment and leisure: (1) cruise ship musician; (2) destination marketing manager; (3) resort activities director; and (4) river rafting guide. The second section helps a person decide if a…

10 Things to Consider before Your Next Family Vacation

ERIC Educational Resources Information Center

Exceptional Parent, 2011

2011-01-01

Vacations allow the mind and body to recharge from stress and fatigue; and it's nice to escape everyday busyness. Children need vacation time too: school can be hard work! Vacation is a great time to enjoy good food, fun, and bonding, whether it takes one to the beach, an amusement park, camping, or cruising rivers, lakes, and oceans. This article…

29 CFR 4.173 - Meeting requirements for vacation fringe benefits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... vacation benefits: (i) The total length of time spent by an employee in any capacity in the continuous... vacation eligibility before the employee's anniversary date of employment, and no segment of time smaller... at the time the vacation right vests, i.e., on the employee's anniversary date of employment, must...

29 CFR 4.173 - Meeting requirements for vacation fringe benefits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... vacation benefits: (i) The total length of time spent by an employee in any capacity in the continuous... vacation eligibility before the employee's anniversary date of employment, and no segment of time smaller... at the time the vacation right vests, i.e., on the employee's anniversary date of employment, must...

Vacation Study Abroad.

ERIC Educational Resources Information Center

Howard, Edrice Marguerite, Ed.

This directory of vacation study-abroad programs provides brief descriptions of the programs offered by institutions around the world. An introductory section describes the organization of the listings (which provide program sponsor and name, location, dates, subjects, credit, eligibility, instruction, highlights, costs, housing, deadline, and…

9 CFR 202.7 - Modification or vacation of final order.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Modification or vacation of final... Modification or vacation of final order. (a) Informal petition. Any interested person may file an informal petition to modify or vacate a final order at any time. Any such petition must be filed with the...

9 CFR 202.7 - Modification or vacation of final order.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Modification or vacation of final... Modification or vacation of final order. (a) Informal petition. Any interested person may file an informal petition to modify or vacate a final order at any time. Any such petition must be filed with the...

29 CFR 778.219 - Pay for foregoing holidays and vacations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... entitled, under his employment contract, to a week's paid vacation in the amount of his usual straight-time... total straight-time earnings for the week, and $240 in addition as his vacation pay. Under the statute... vacation pay will be measured by straight-time earnings for any agreed number of hours or days, or by total...

29 CFR 778.219 - Pay for foregoing holidays and vacations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... entitled, under his employment contract, to a week's paid vacation in the amount of his usual straight-time... total straight-time earnings for the week, and $240 in addition as his vacation pay. Under the statute... vacation pay will be measured by straight-time earnings for any agreed number of hours or days, or by total...

20 CFR 322.5 - Payments under vacation agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Payments under vacation agreements. 322.5 Section 322.5 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.5 Payments under vacation agreements. (a) General. In ascertaining the...

20 CFR 322.5 - Payments under vacation agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Payments under vacation agreements. 322.5 Section 322.5 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.5 Payments under vacation agreements. (a) General. In ascertaining the...

20 CFR 322.5 - Payments under vacation agreements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Payments under vacation agreements. 322.5 Section 322.5 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.5 Payments under vacation agreements. (a) General. In ascertaining the...

20 CFR 322.5 - Payments under vacation agreements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Payments under vacation agreements. 322.5 Section 322.5 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.5 Payments under vacation agreements. (a) General. In ascertaining the...

20 CFR 322.5 - Payments under vacation agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Payments under vacation agreements. 322.5 Section 322.5 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.5 Payments under vacation agreements. (a) General. In ascertaining the...

20 CFR 410.653 - Vacation of dismissal of request for hearing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Vacation of dismissal of request for hearing... Determinations, Administrative Review, Finality of Decisions, and Representation of Parties § 410.653 Vacation of... and for good cause shown, vacate any dismissal of a request for hearing at any time within 60 days...

20 CFR 410.653 - Vacation of dismissal of request for hearing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Vacation of dismissal of request for hearing... Determinations, Administrative Review, Finality of Decisions, and Representation of Parties § 410.653 Vacation of... and for good cause shown, vacate any dismissal of a request for hearing at any time within 60 days...

26 CFR 301.9100-16T - Election to accrue vacation pay.

Code of Federal Regulations, 2011 CFR

2011-04-01

... vacation pay is earned. (b) Time for making election. (1) In the case of a taxpayer who established or... 26 Internal Revenue 18 2011-04-01 2011-04-01 false Election to accrue vacation pay. 301.9100-16T... § 301.9100-16T Election to accrue vacation pay. (a) In general. Section 463 provides that taxpayers...

Special Vacation Advice for Families with Special Needs Children

ERIC Educational Resources Information Center

Barkin, Scott L.

2010-01-01

The excitement of going on a family vacation can be matched only by the stress parents experience as they prepare for the excursion. Parents of children with disabilities have special considerations to keep in mind, including the mode of transportation, the accessibility of accommodations, whether the activities will be appropriate for all members…

Multiserver Queueing Model subject to Single Exponential Vacation

NASA Astrophysics Data System (ADS)

Vijayashree, K. V.; Janani, B.

2018-04-01

A multi-server queueing model subject to single exponential vacation is considered. The arrivals are allowed to join the queue according to a Poisson distribution and services takes place according to an exponential distribution. Whenever the system becomes empty, all the servers goes for a vacation and returns back after a fixed interval of time. The servers then starts providing service if there are waiting customers otherwise they will wait to complete the busy period. The vacation times are also assumed to be exponentially distributed. In this paper, the stationary and transient probabilities for the number of customers during ideal and functional state of the server are obtained explicitly. Also, numerical illustrations are added to visualize the effect of various parameters.

Effect of January vacations and prior night call status on resident ABSITE performance.

PubMed

Sugar, Jane G; Chu, Quyen D; Cole, Philip A; Li, Benjamin D L; Kim, Roger H

2013-01-01

To determine if vacations in January or on-call status have an effect on American Board of Surgery In-Training Examination (ABSITE) scores. Retrospective review of the performance of general surgery residents on ABSITE. Data collected included ABSITE scores, United States Medical Licensing Examination Step 2 scores, January vacation schedules, and call schedules. ABSITE performance was examined for correlation with vacation or call schedules. Student t test was used for statistical analysis, with a p value of less than 0.05 considered significant. General surgery residency program at the Louisiana State University Health Sciences Center-Shreveport, a university hospital-based program with 5 categorical residents per year. Postgraduate year (PGY) 1 through 5 general surgery categorical residents from 2006 to 2012. A total of 170 ABSITE scores from 55 residents were reviewed. The mean score when vacation was taken was 48.6 as compared with 36.3 when no vacation was taken (p = 0.02). Residents who took a January vacation at least once in their residency had a mean score of 42.8 as compared with 37.7 of those who did not (p = 0.43). The mean United States Medical Licensing Examination Step 2 score of residents who took a January vacation at least once in their residency was 218 as compared with 217 for their peers (p = 0.78). Among residents who took January vacations, the mean score in the years they took vacation was 49.4 as compared with 35.4 in the years they did not (p = 0.02). Prior night call status had no effect on the examination scores (44.2 vs 38.6, p = 0.30). Mean ABSITE scores were higher for residents who took a January vacation before the examination, despite no apparent difference in baseline test-taking ability. Among residents who took January vacations, mean scores were higher in the years they took vacation than in other years. On-call status did not have an effect on ABSITE performance. Vacation schedules in January can have a significant effect on

The Social Psychology of Potential Problems in Family Vacation Travel

ERIC Educational Resources Information Center

Rosenblatt, Paul C.; Russell, Martha G.

1975-01-01

Social psychological thinking and the data of an exploratory study are used to illuminate potential problems in family vacation travel. Vacation travel is seen as providing both the opportunity for revitalization and creative change and the opportunity for serious interpersonal difficulties. (Author)

ADHD Medication Vacations and Parent-Child Interactions by Gender

ERIC Educational Resources Information Center

Barnard-Brak, Lucy; Schmidt, Marcelo; Sulak, Tracey

2013-01-01

Objective: The purpose of the current study was to examine medication vacations among children with ADHD according to parent-child dyads (e.g., mother-son, father-daughter, mother-daughter, and father-son). Method: In a survey study of 259 parents of children with ADHD, the use of medication vacations according to parent-child sex dyads was…

Art Curriculum That Works. Art for Your Summer Vacation

ERIC Educational Resources Information Center

Healy, John W.

2005-01-01

Kids can pack their shovel and pail, slather on the sunscreen and get ready to create their best artwork yet this summer. Art can be the one activity that you can take to the beach, the lake and special faraway places this summer. Being an artist on your vacation is an added dimension to how you see and experience the world you visit during this…

A Pre-Vacation Chemistry Experiment

ERIC Educational Resources Information Center

Gabel, Dorothy; McSweeny, Jean

1973-01-01

Describes a chemistry experiment appropriate for the day before Christmas vacation. Students prepare candy canes by following a recipe written in chemical terms. This illustrates that food is composed of chemicals and that the processes involved in cooking are chemical and physical changes. (JR)

A Virtual, Shoestring Vacation

ERIC Educational Resources Information Center

Texley, Juliana

2009-01-01

If there is a discrepancy between the scope of your imagination and the depth of your bank account, this may be the ideal summer to stretch your horizons by diving into a good book. You can take a virtual vacation to almost any place or time by reading. You will not need to fill your gas tank or empty your pocketbook. Reading has a small carbon…

Multi stage unreliable retrial Queueing system with Bernoulli vacation

NASA Astrophysics Data System (ADS)

Radha, J.; Indhira, K.; Chandrasekaran, V. M.

2017-11-01

In this work we considered the Bernoulli vacation in group arrival retrial queues with unreliable server. Here, a server providing service in k stages. Any arriving group of units finds the server free, one from the group entering the first stage of service and the rest are joining into the orbit. After completion of the i th, (i=1,2,…k) stage of service, the customer may go to (i+1)th stage with probability θi , or leave the system with probability qi = 1 - θi , (i = 1,2,…k - 1) and qi = 1, (i = k). The server may enjoy vacation (orbit is empty or not) with probability v after finishing the service or continuing the service with probability 1-v. After finishing the vacation, the server search for the customer in the orbit with probability θ or remains idle for new arrival with probability 1-θ. We analyzed the system using the method of supplementary variable.

26 CFR 301.9100-16T - Election to accrue vacation pay.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accounts maintained by the taxpayer within a single trade or business if the liability is contingent when vacation pay is earned. (b) Time for making election. (1) In the case of a taxpayer who established or maintained a vacation pay account pursuant to I.T. 3956 and who continued to maintain such account pursuant...

Vacation effects on behaviour, cognition and emotions of compulsive and non-compulsive workers: do obsessive workers go 'cold turkey'?

PubMed

de Bloom, Jessica; Radstaak, Mirjam; Geurts, Sabine

2014-08-01

Compulsive workers often face psychological and physical health disturbances because of working long hours and an obsessive preoccupation with work during off-job time. Prolonged respite episodes may either relief these employees from their daily stressors to recover or trigger withdrawal symptoms. Our research question was as follows: How do (1) work hours, (2) rumination and (3) affective well-being unfold for compulsive workers compared with non-compulsive workers across long vacations? In a longitudinal field study, work hours, rumination and affective well-being were assessed in 54 employees 2 weeks before, during and in the first, second and fourth week after a long summer vacation. Working compulsively was assessed 3 weeks before vacation. Work hours decreased during and increased after vacation. Levels of rumination dropped during vacation and remained below baseline until 2 weeks after vacation. Initial differences in rumination between obsessive and non-obsessive workers disappeared during and directly after vacation. Affective well-being rose during vacation and returned to baseline directly after vacation. Increases in affective well-being during vacation as well as decreases after vacation were greater in obsessive workers than in non-obsessive workers. Vacations seem to temporarily offset characteristic differences between obsessive and non-obsessive workers, decrease rumination and improve affective well-being. Copyright © 2014 John Wiley & Sons, Ltd.

Vacations improve mental health among rural women: the Wisconsin Rural Women's Health Study.

PubMed

Chikani, Vatsal; Reding, Douglas; Gunderson, Paul; McCarty, Catherine A

2005-08-01

To compare psychological stress, quality of marital life, and disruptive homelife due to work among rural women of central Wisconsin who take vacations frequently and those who do not. Women were recruited from 1996 to 2001 for a prospective cohort study from the Marshfield Epidemiologic Study area, a geographic area in central Wisconsin. Stratified sampling was used to select a random sample of 1500 farm and non-farm resident women. The odds of depression and tension were higher among women who took vacations only once in 2 years (Depression: OR=1.92, 95% CI=1.2,3.0; Tension: OR=1.7, 95%CI=1.2, 2.3) or once in 6 years (Depression: OR=1.97, 95% CI=1.2, 3.2; Tension: OR=1.9, 95% CI=1.3,2.8) compared to women who took vacations twice or more per year. The odds of marital satisfaction decreased as the frequency of vacations decreased. Women who take vacations frequently are less likely to become tense, depressed, or tired, and are more satisfied with their marriage. These personal psychological benefits that lead to increased quality of life may also lead to improved work performance.

Stalked by E-mail on Vacation

ERIC Educational Resources Information Center

Bugeja, Michael

2006-01-01

In this essay, the author describes the difficulties email has introduced to the academic world, from monopolizing faculty's down time to adding a new dimension to interpersonal problems. He discusses the "withdrawal" symptoms he felt when he decided to go without email during a family vacation, and his realization, upon examining the emails sent…

What Is Summer Vacation Costing Us?

ERIC Educational Resources Information Center

Henkel, Tara

2010-01-01

This paper explores the standard traditional summer vacation model; this includes the accompanying food insecurity, loss of nutrition and the lost knowledge that must be re-taught at the beginning of each new academic year. It compares the number of academic days attended in various Industrialized Nations compared to the United States. Also,…

Analysis of bulk arrival queueing system with batch size dependent service and working vacation

NASA Astrophysics Data System (ADS)

Niranjan, S. P.; Indhira, K.; Chandrasekaran, V. M.

2018-04-01

This paper concentrates on single server bulk arrival queue system with batch size dependent service and working vacation. The server provides service in two service modes depending upon the queue length. The server provides single service if the queue length is at least `a'. On the other hand the server provides fixed batch service if the queue length is at least `k' (k > a). Batch service is provided with some fixed batch size `k'. After completion of service if the queue length is less than `a' then the server leaves for working vacation. During working vacation customers are served with lower service rate than the regular service rate. Service during working vacation also contains two service modes. For the proposed model probability generating function of the queue length at an arbitrary time will be obtained by using supplementary variable technique. Some performance measures will also be presented with suitable numerical illustrations.

Demonstration PreFab Solar Heated Vacation Home

ERIC Educational Resources Information Center

Ariola, Frank; Walencik, Vincent J.

1978-01-01

To update a traditional construction shop program, students at Passaic Valley High School, New Jersey, developed a mock-up model of a solar-heated A-frame vacation house using prefab construction. The article describes the project and illustrates it with photographs of the model and a drawing of the solar collector. (MF)

Performance characteristics of a batch service queueing system with functioning server failure and multiple vacations

NASA Astrophysics Data System (ADS)

Niranjan, S. P.; Chandrasekaran, V. M.; Indhira, K.

2018-04-01

This paper examines bulk arrival and batch service queueing system with functioning server failure and multiple vacations. Customers are arriving into the system in bulk according to Poisson process with rate λ. Arriving customers are served in batches with minimum of ‘a’ and maximum of ‘b’ number of customers according to general bulk service rule. In the service completion epoch if the queue length is less than ‘a’ then the server leaves for vacation (secondary job) of random length. After a vacation completion, if the queue length is still less than ‘a’ then the server leaves for another vacation. The server keeps on going vacation until the queue length reaches the value ‘a’. The server is not stable at all the times. Sometimes it may fails during functioning of customers. Though the server fails service process will not be interrupted.It will be continued for the current batch of customers with lower service rate than the regular service rate. The server will be repaired after the service completion with lower service rate. The probability generating function of the queue size at an arbitrary time epoch will be obtained for the modelled queueing system by using supplementary variable technique. Moreover various performance characteristics will also be derived with suitable numerical illustrations.

The Effects of Nine-Week Summer Vacation: Losses in Mathematics and Gains in Reading

ERIC Educational Resources Information Center

Paechter, Manuela; Luttenberger, Silke; Macher, Daniel; Berding, Florian; Papousek, Ilona; Weiss, Elisabeth M.; Fink, Andreas

2015-01-01

Summer vacations interrupt the rhythm of learning and may result in a loss of knowledge and skills. This study investigates summer learning losses in an Austrian sample with nine-week summer vacations. The results show losses as well as gains for students in lower secondary education (182 students between 10 and 12 years old). Students experienced…

32 CFR 644.446 - Vacation and protection of premises.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and protection of premises. The DE will take action to insure that the premises are vacated by the... service or the DE, as appropriate, for proper protection of the property pending the transfer of custody...

32 CFR 644.446 - Vacation and protection of premises.

Code of Federal Regulations, 2011 CFR

2011-07-01

... and protection of premises. The DE will take action to insure that the premises are vacated by the... service or the DE, as appropriate, for proper protection of the property pending the transfer of custody...

Relationship of chronotype to sleep pattern in a cohort of college students during work days and vacation days.

PubMed

Yadav, Arjita; Singh, Sudhi

2014-05-01

To study whether the chronotype is linked with the sleep characteristics among college going students assessed during college days and vacation days, adult female students at undergraduate level were asked to answer the Hindi/English version of the Munich Chronotype Questionnaire (MCTQ), fill a sleep log, and drinking and feeding logs for three weeks covering college and vacation days. Based on chronotype categorization as morning type, intermediate type and evening type, sleep onset and offset times, sleep duration and mid-sleep times for each group were compared, separately for college and vacation days. Results indicate that the sleep duration of the morning types was significantly longer than the evening types, both, during college and vacation days. Similarly, the sleep onset and sleep offset times were significantly earlier in the morning types than the evening type students. During the vacation days, the individuals exhibited longer sleep duration with delayed mid-sleep times. Further there was no significant difference among the chronotypes regarding their feeding and drinking frequency per cent during the college and the vacation days. It is suggested that the students should be made aware of their chronotype, so that they can utilize their time optimally, and develop a schedule more suitable to their natural needs.

Vacations to sunny destinations, sunburn, and intention to tan: a cross-sectional study in Denmark, 2007-2009.

PubMed

Køster, Brian; Thorgaard, Camilla; Philip, Anja; Clemmensen, Inge Haunstrup

2011-02-01

Denmark has experienced an increase in melanoma incidence since the 1960s. Exposure to ultraviolet radiation is the main preventable cause of this cancer. We examined current travel to, and sun-related behaviour of Danes at, sunny destinations in relation to their risk for sunburn. A population-based sample of 11,158 respondents aged 15-59 years completed three questionnaires in 2007-2009 that included items on exposure to ultraviolet radiation. Using logistic regression analysis we examined the relations between sunny vacations, sun-related behaviour, demographic factors and risk for sunburn. During 2007-2009, 44.8-45.8% of the respondents travelled to a sunny destination at least once a year; 24% became sunburnt, and 69% tanned intentionally. The odds ratio for sunburn in general for people who went on a sunny vacation as compared with those who did not was 1.6 (1.5-1.7). Sunscreen use (1.9; 1.4-2.6) and intentional tanning (3.4; 2.8-4.1) were positively associated with sunburn on vacation. Taking a vacation in a sunny place is a risk factor for sunburn, especially for young people. The recommendation for sunscreen use should be re-evaluated, as intention to tan is the most important factor in sunburn on vacation and should be targeted more strategically.

Streaming potential modeling in fractured rock: Insights into the identification of hydraulically active fractures

NASA Astrophysics Data System (ADS)

Roubinet, D.; Linde, N.; Jougnot, D.; Irving, J.

2016-05-01

Numerous field experiments suggest that the self-potential (SP) geophysical method may allow for the detection of hydraulically active fractures and provide information about fracture properties. However, a lack of suitable numerical tools for modeling streaming potentials in fractured media prevents quantitative interpretation and limits our understanding of how the SP method can be used in this regard. To address this issue, we present a highly efficient two-dimensional discrete-dual-porosity approach for solving the fluid flow and associated self-potential problems in fractured rock. Our approach is specifically designed for complex fracture networks that cannot be investigated using standard numerical methods. We then simulate SP signals associated with pumping conditions for a number of examples to show that (i) accounting for matrix fluid flow is essential for accurate SP modeling and (ii) the sensitivity of SP to hydraulically active fractures is intimately linked with fracture-matrix fluid interactions. This implies that fractures associated with strong SP amplitudes are likely to be hydraulically conductive, attracting fluid flow from the surrounding matrix.

Is Vacation Apprenticeship of Undergraduate Life Science Students a Model for Human Capacity Development in the Life Sciences?

ERIC Educational Resources Information Center

Downs, Colleen Thelma

2010-01-01

A life sciences undergraduate apprenticeship initiative was run during the vacations at a South African university. In particular, the initiative aimed to increase the number of students from disadvantaged backgrounds. Annually 12-18 undergraduate biology students were apprenticed to various institutions during the January and July vacations from…

Physical Activity and Hip Fracture Disability: A Review

PubMed Central

Marks, Ray

2011-01-01

Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability. Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed. Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability. Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged. PMID:21584248

The Effect of Summer Vacation on Bilingual Preschoolers' Language Development

ERIC Educational Resources Information Center

Hammer, Carol Scheffner; Lawrence, Frank R.; Miccio, Adele W.

2008-01-01

The purpose of the investigation was to examine the developmental trajectories of bilingual preschoolers' comprehension of Spanish and English and to determine whether a lengthy summer vacation impacted children's development during the preschool years. Participants included 83 bilingual children who were followed over a 2-year period during which…

A study on M/G/1 retrial G - queue with two phases of service, immediate feedback and working vacations

NASA Astrophysics Data System (ADS)

Varalakshmi, M.; Chandrasekaran, V. M.; Saravanarajan, M. C.

2017-11-01

In this paper, we discuss about the steady state behaviour of M/G/1 retrial queueing system with two phases of services and immediate feedbacks under working vacation policy where the regular busy server is affected due to the arrival of negative customers. Upon arrival if the customer finds the server busy, breakdown or on working vacation it enters an orbit; otherwise the customer enters into the service area immediately. After service completion, the customer is allowed to make finite number of immediate feedback. The feedback service also consists of two phases. At the service completion epoch of a positive customer, if the orbit is empty the server goes for a working vacation. The server works at a lower service rate during working vacation (WV) period. Using the supplementary variable technique, we found out the steady state probability generating function for the system and in orbit. System performance measures and reliability measures are discussed. Finally, some numerical examples are presented to validate the analyticalresults.

Student and Staff Perceptions of a Vacation Research Assistantship Scheme

ERIC Educational Resources Information Center

Penn, Felicity; Stephens, Danielle; Morgan, Jessica; Upton, Penney; Upton, Dominic

2013-01-01

There is a push for universities to equip graduates with desirable employability skills and "hands-on" experience. This article explores the perceptions of students and staff experiences of a research assistantship scheme. Nine students from the University of Worcester were given the opportunity to work as a student vacation researcher…

42 CFR 61.8 - Benefits: Stipends; dependency allowances; travel allowances; vacation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Benefits: Stipends; dependency allowances; travel...; dependency allowances; travel allowances; vacation. Individuals awarded regular fellowships shall be entitled...) Stipend. (b) Dependency allowances. (c) When authorized in advance, separate allowances for travel. Such...

42 CFR 61.8 - Benefits: Stipends; dependency allowances; travel allowances; vacation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Benefits: Stipends; dependency allowances; travel...; dependency allowances; travel allowances; vacation. Individuals awarded regular fellowships shall be entitled...) Stipend. (b) Dependency allowances. (c) When authorized in advance, separate allowances for travel. Such...

42 CFR 61.8 - Benefits: Stipends; dependency allowances; travel allowances; vacation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Benefits: Stipends; dependency allowances; travel...; dependency allowances; travel allowances; vacation. Individuals awarded regular fellowships shall be entitled...) Stipend. (b) Dependency allowances. (c) When authorized in advance, separate allowances for travel. Such...

42 CFR 61.8 - Benefits: Stipends; dependency allowances; travel allowances; vacation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Benefits: Stipends; dependency allowances; travel...; dependency allowances; travel allowances; vacation. Individuals awarded regular fellowships shall be entitled...) Stipend. (b) Dependency allowances. (c) When authorized in advance, separate allowances for travel. Such...

42 CFR 61.8 - Benefits: Stipends; dependency allowances; travel allowances; vacation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Benefits: Stipends; dependency allowances; travel...; dependency allowances; travel allowances; vacation. Individuals awarded regular fellowships shall be entitled...) Stipend. (b) Dependency allowances. (c) When authorized in advance, separate allowances for travel. Such...

State dependent arrival in bulk retrial queueing system with immediate Bernoulli feedback, multiple vacations and threshold

NASA Astrophysics Data System (ADS)

Niranjan, S. P.; Chandrasekaran, V. M.; Indhira, K.

2017-11-01

The objective of this paper is to analyse state dependent arrival in bulk retrial queueing system with immediate Bernoulli feedback, multiple vacations, threshold and constant retrial policy. Primary customers are arriving into the system in bulk with different arrival rates λ a and λ b . If arriving customers find the server is busy then the entire batch will join to orbit. Customer from orbit request service one by one with constant retrial rate γ. On the other hand if an arrival of customers finds the server is idle then customers will be served in batches according to general bulk service rule. After service completion, customers may request service again with probability δ as feedback or leave from the system with probability 1 - δ. In the service completion epoch, if the orbit size is zero then the server leaves for multiple vacations. The server continues the vacation until the orbit size reaches the value ‘N’ (N > b). At the vacation completion, if the orbit size is ‘N’ then the server becomes ready to provide service for customers from the main pool or from the orbit. For the designed queueing model, probability generating function of the queue size at an arbitrary time will be obtained by using supplementary variable technique. Various performance measures will be derived with suitable numerical illustrations.

Anthropometry, physical activity and hip fractures in the elderly.

PubMed

Benetou, Vassiliki; Orfanos, Philippos; Benetos, Ioannis S; Pala, Valeria; Evangelista, Alberto; Frasca, Graziella; Giurdanella, Maria Concetta; Peeters, Petra H M; van der Schouw, Ivonne T; Rohrmann, Sabine; Linseisen, Jakob; Boeing, Heiner; Weikert, Cornelia; Pettersson, Ulrika; Van Guelpen, Bethany; Bueno de Mesquita, H Bas; Altzibar, Jone; Boffetta, Paolo; Trichopoulou, Antonia

2011-02-01

Hip fractures constitute a major and growing public health problem amongst the elderly worldwide. We examined the association of anthropometry and physical activity with hip fracture incidence in a cohort of elderly Europeans, participants in the European Prospective Investigation into Cancer and nutrition (EPIC) study. The study population consisted of 27 982 volunteers (10 553 men and 17 429 women) aged 60 years and above from five European countries. Information on anthropometry, physical activity, medical history and other characteristics was collected at baseline. During a median follow-up of 8 years, 261 incident hip fractures (203 women and 58 men) were recorded. Data were analysed through Cox proportional hazard regression with adjustment for potential confounders. A higher body mass index (BMI) was associated with lower hip fracture risk (hazard ratio (HR)per increasing sex-specific-quintile: 0.85, 95% confidence interval (95% CI): 0.77–0.94). Body height was associated with increased hip fracture risk (HR per 5 cm: 1.13, 95% CI: 1.01–1.25). Waist-to-hip ratio was not related to hip fracture risk. Increasing levels of leisure-time physical activity were related to lower risk (HR per increasing tertile: 0.84, 95% CI: 0.70–0.99, p for trend: 0.039). In a prospective cohort study of elderly Europeans, we found evidence that high body stature increased and high BMI decreased the incidence of hip fractures. After adjustment for BMI,waist to-hip ratio was not associated with hip fracture risk. Leisure-time physical activity appears to play a beneficial role in the prevention of hip fractures. 2010 Elsevier Ltd. All rights reserved.

An unreliable group arrival queue with k stages of service, retrial under variant vacation policy

NASA Astrophysics Data System (ADS)

Radha, J.; Indhira, K.; Chandrasekaran, V. M.

2017-11-01

In this research work we considered repairable retrial queue with group arrival and the server utilize the variant vacations. A server gives service in k stages. Any arriving group of units finds the server free, one from the group entering the first stage of service and the rest are joining into the orbit. After completion of the i th stage of service, the customer may have the option to choose (i+1)th stage of service with probability θi , with probability pi may join into orbit as feedback customer or may leave the system with probability {q}i=≤ft\\{\\begin{array}{l}1-{p}i-{θ }i,i=1,2,\\cdots k-1\\ 1-{p}i,i=k\\end{array}\\right\\}. If the orbit is empty at the service completion of each stage service, the server takes modified vacation until at least one customer appears in the orbit on the server returns from a vacation. Busy server may get to breakdown and the service channel will fail for a short interval of time. By using the supplementary variable method, steady state probability generating function for system size, some system performance measures are discussed.

Fracture properties of concrete specimens made from alkali activated binders

NASA Astrophysics Data System (ADS)

Šimonová, Hana; Kucharczyková, Barbara; Topolář, Libor; Bílek, Vlastimil, Jr.; Keršner, Zbyněk

2017-09-01

The aim of this paper is to quantify crack initiation and other fracture properties - effective fracture toughness and specific fracture energy - of two types of concrete with an alkali activated binder. The beam specimens with a stress concentrator were tested in a three-point bending test after 28, 90, and 365 days of maturing. Records of fracture tests in the form of load versus deflection (P-d) diagrams were evaluated using effective crack model and work-of-fracture method and load versus mouth crack opening displacement (P-CMOD) diagrams were evaluated using the Double-K fracture model. The initiation of cracks during the fracture tests for all ages was also monitored by the acoustic emission method. The higher value of monitored mechanical fracture parameters of concrete with alkali activated blast furnace slag were achieved with substitution blast furnace slag by low calcium fly ash in comparison with substitution by cement kiln dust.

A comprehensive bibliography on vacation homes and recreational lands in the United States

Treesearch

Richard L. Ragatz; H. Ken Cordell

1980-01-01

This bibliography contains 619 references on vacation homes and recreational lands. It is divided into five major parts: I-evolution of the markets. II-analyzing the markets. III-the consumer, IV-impacts from recreational properties, and V-miscellaneous.

The NASA SCI Files: The Case of the Galactic Vacation. [Videotape].

ERIC Educational Resources Information Center

National Aeronautics and Space Administration, Hampton, VA. Langley Research Center.

The tree house detectives go galactic with their latest project by traveling to Mars and also seeing how the Moon affects the Earth. They visit the largest radio telescope in the world and help look for intelligent life in the universe. The tree house detectives prepare for an out-of-this-world vacation as they explore the future of space travel.…

Arthroplasty for Unreconstructable Acute Fractures and Failed Fracture Fixation About the Hip and Knee in the Active Elderly: A New Paradigm.

PubMed

Kyle, Richard F; Duwelius, Paul J; Haidukewych, George J; Schmidt, Andrew H

2017-02-15

The techniques, materials, and designs for total joint arthroplasty underwent major improvements in the past 30 years. During this time, trauma surgeons classified the severity of fractures as well as identified certain articular fractures that do not have good outcomes and have a high rate of failure after internal fixation. Advanced improvements in arthroplasty have increased its reliability and longevity. Total joint arthroplasty is becoming a standard of care for some acute articular fractures, particularly displaced femoral neck fractures in the active elderly. Total joint arthroplasty also has become the standard of care after failed internal fixation in patients who have very complicated fractures about the knee, hip, and shoulder. As the population ages, fractures worldwide continue to rapidly increase. Elderly patients have a high risk for fractures that result from falls because of their poor bone quality. The current active elderly population participates in higher risk activities than previous elderly populations, which places them at risk for more injuries. This has become both a worldwide healthcare problem and an economic problem. Surgeons need to manage fractures in the active elderly with the latest advancements in technology and patient selection to ensure rapid recovery and the reduction of complications.

The Effects of Preliteracy Knowledge, Schooling, and Summer Vacation on Literacy Acquisition

ERIC Educational Resources Information Center

Tiruchittampalam, Shanthi; Nicholson, Tom; Levin, Joel R.; Ferron, John M.

2018-01-01

What causes the literacy gap and can schools compensate for it? The authors investigated 3 drivers of the gap: preliteracy knowledge, schooling, and the summer vacation. Longitudinal literacy data over 5 time points were collected on 126 five-year-olds attending higher or lower socioeconomic status (SES) schools during their first 15 months of…

On buffer overflow duration in a finite-capacity queueing system with multiple vacation policy

NASA Astrophysics Data System (ADS)

Kempa, Wojciech M.

2017-12-01

A finite-buffer queueing system with Poisson arrivals and generally distributed processing times, operating under multiple vacation policy, is considered. Each time when the system becomes empty, the service station takes successive independent and identically distributed vacation periods, until, at the completion epoch of one of them, at least one job waiting for service is detected in the buffer. Applying analytical approach based on the idea of embedded Markov chain, integral equations and linear algebra, the compact-form representation for the cumulative distribution function (CDF for short) of the first buffer overflow duration is found. Hence, the formula for the CDF of next such periods is obtained. Moreover, probability distributions of the number of job losses in successive buffer overflow periods are found. The considered queueing system can be efficienly applied in modelling energy saving mechanisms in wireless network communication.

Fault activation by hydraulic fracturing in western Canada.

PubMed

Bao, Xuewei; Eaton, David W

2016-12-16

Hydraulic fracturing has been inferred to trigger the majority of injection-induced earthquakes in western Canada, in contrast to the Midwestern United States, where massive saltwater disposal is the dominant triggering mechanism. A template-based earthquake catalog from a seismically active Canadian shale play, combined with comprehensive injection data during a 4-month interval, shows that earthquakes are tightly clustered in space and time near hydraulic fracturing sites. The largest event [moment magnitude (M W ) 3.9] occurred several weeks after injection along a fault that appears to extend from the injection zone into crystalline basement. Patterns of seismicity indicate that stress changes during operations can activate fault slip to an offset distance of >1 km, whereas pressurization by hydraulic fracturing into a fault yields episodic seismicity that can persist for months. Copyright © 2016, American Association for the Advancement of Science.

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

PubMed

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

2005-02-01

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

Physical activity in middle-aged women and hip fracture risk: the UFO study.

PubMed

Englund, U; Nordström, P; Nilsson, J; Bucht, G; Björnstig, U; Hallmans, G; Svensson, O; Pettersson, U

2011-02-01

In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women. In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture. The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years. Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05-0.53 for walking and OR 0.19; 95% CI; 0.08-0.46, OR 0.17, 95% CI; 0.05-0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women. An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

Active commuting reduces the risk of wrist fractures in middle-aged women-the UFO study.

PubMed

Englund, U; Nordström, P; Nilsson, J; Hallmans, G; Svensson, O; Bergström, U; Pettersson-Kymmer, U

2013-02-01

Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus. Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture. The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years. Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk. This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

Affective and cognitive effects of information use over the course of a vacation

Treesearch

Christine A. Vogt; Susan I. Stewart

1998-01-01

From pre-trip planning through post-trip remembering, vacations unfold over long periods of time. Through the course of a trip the same travel information may be used repeatedly but with different levels of success and satisfaction. These experiential fluctuations over time were examined in a study of trip planners, who collected information from a chamber of commerce...

Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures.

PubMed

Giangregorio, L M; McGill, S; Wark, J D; Laprade, J; Heinonen, A; Ashe, M C; MacIntyre, N J; Cheung, A M; Shipp, K; Keller, H; Jain, R; Papaioannou, A

2015-03-01

An international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided. The objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. The Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed. Response rates were 52% (39/75) and 69% (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing generic restrictions (e.g., lifting <10

Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures

PubMed Central

McGill, S.; Wark, J. D.; Laprade, J.; Heinonen, A.; Ashe, M. C.; MacIntyre, N. J.; Cheung, A. M.; Shipp, K.; Keller, H.; Jain, R.; Papaioannou, A.

2016-01-01

Summary An international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided. Introduction The objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Methods The Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed. Results Response rates were 52 % (39/75) and 69 % (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing

Supracondylar humerus fractures in children: the effect of weather conditions on their risk.

PubMed

Sinikumpu, Juha-Jaakko; Pokka, Tytti; Hyvönen, Hanna; Ruuhela, Reija; Serlo, Willy

2017-02-01

Supracondylar humerus fractures are the most common fractures of the elbow in children. Many environmental factors such as weather conditions may affect the risk of these fractures. The purpose of the study was to analyze the effect of weather conditions (temperature, rainfall, wind) on fracture risk in children <16 years of age during the extended summer time period with the absence of snow cover. All children <16 years of age with an outdoor supracondylar humerus fracture between May 1 and September 30 in a defined geographical area during the decade of 2000-2009 were included. Daily meteorological recordings for altogether 1526 study days were reviewed from the national weather service and the association of weather conditions and fractures were analyzed. A majority (79.7%, N = 181) of the fractures occurred on dry days versus rainy days (20.3%) (P = 0.011), and risk of a fracture was 3.5-fold higher on dry days as compared with rainy days (crude OR 3.5, 3.41-3.59, P < 0.001). The weather was warm, instead of cool or hot, when the majority of the fractures (N = 147, 64.8%) occurred (P = 0.008): Warm temperatures (15-24.9 °C) increased the fracture risk 2.6-fold (crude OR 2.64, 2.59-2.70, P < 0.001), compared with cool (<15 °C) days. The fracture incidence did not change according to the wind speed (P = 0.171). The findings were similar through the school term and summer vacation. Dry and warm weather conditions increase the risk of outdoor supracondylar humerus fractures in children during the time period with the absence of snow cover.

Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals.

PubMed

Stattin, Karl; Hållmarker, Ulf; Ärnlöv, Johan; James, Stefan; Michaëlsson, Karl; Byberg, Liisa

2018-06-22

It is not known how physical exercise affects the risk of different types of fractures, especially in highly active individuals. To investigate this association, we studied a cohort of 118,204 men and 71,757 women who from 1991 to 2009 participated in Vasaloppet, a long-distance cross-country skiing race in Sweden, and 505,194 nonparticipants frequency-matched on sex, age, and county of residence from the Swedish population. Participants ranged from recreational exercisers to world-class skiers. Race participation, distance of race run, number of races participated in, and finishing time were used as proxies for physical exercise. Incident fractures from 1991 to 2010 were obtained from national Swedish registers. Over a median follow-up of 8.9 years, 53,175 fractures of any type, 2929 hip, 3107 proximal humerus, 11,875 lower leg, 11,733 forearm, and 2391 vertebral fractures occurred. In a Cox proportional hazard regression analysis using time-updated exposure and covariate information, participation in the race was associated with an increased risk of any type of fracture (hazard ratio [HR], 1.02; 95% CI, 1.00 to 1.05); forearm fractures had an HR, 1.11 with a 95% CI, 1.06 to 1.15. There was a lower risk of hip (HR, 0.75; 95% CI, 0.67 to 0.83), proximal humerus (HR, 0.90; 95% CI, 0.82 to 0.98), and lower leg fractures (HR, 0.93; 95% CI, 0.89 to 0.97), whereas the HR of vertebral fracture was 0.97 with a 95% CI, 0.88 to 1.07. Among participants, the risk of fracture was similar irrespective of race distance and number of races run. Participants close to the median finishing time had a lower risk of fracture compared with faster and slower participants. In summary, high levels of physical exercise were associated with a slightly higher risk of fractures of any type, including forearm fractures, but a lower risk of hip, proximal humerus, and lower leg fractures. © 2018 American Society for Bone and Mineral Research. © 2018 American Society for Bone and Mineral

Dependence for basic and instrumental activities of daily living after hip fractures.

PubMed

González-Zabaleta, Jorge; Pita-Fernandez, Salvador; Seoane-Pillado, Teresa; López-Calviño, Beatriz; Gonzalez-Zabaleta, Jose Luis

2015-01-01

The objective of the study is to determine basic activities of daily living (Barthel Index) and instrumental activities of daily living (Lawton-Brody Index) before and after hip fracture. Follow-up study of patients (n=100) with hip fracture, operated at Complejo Hospitalario Universitario de A Coruña (Spain). Period January/2009-December/2011. Demographic characteristic of the patients, Charlson Index, Glomerular filtration rate, Barthel index, Lawton index, type of proximal femur fracture and surgical treatment delay were recorded. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Before fracture were independent for activities of daily living (ADL) a 38.0%, at 90 days were 15.4%. The Barthel index score decreased from 75.2±28.2 to 56.5±31.8) (p<0.0001). If we consider the age, gender, comorbidity (Charlson index), renal function, fracture type and surgical delay objectify the only independent variable to predict dependency effect is age. If we also consider the Barthel score objectify the variable that significantly modifies that score at 90 days is the baseline value of the index. The prevalence of independence for instrumental activities of daily living (IADL) at the baseline moment is 11% and at 90 days is decreased to 2.2%. There is a decrease in the independence effect in all activities. The variable predictor of independence for all activities after taking into consideration age, sex, comorbidity, fracture type, surgical delay and renal function is the baseline score of the Barthel and Lawton index. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes.

PubMed

Wang, Pinger; Ying, Jun; Luo, Cheng; Jin, Xing; Zhang, Shanxing; Xu, Taotao; Zhang, Lei; Mi, Meng; Chen, Di; Tong, Peijian; Jin, Hongting

2017-01-01

Osthole is a bioactive coumarin derivative and has been reported to be able to enhance bone formation and improve fracture healing. However, the molecular mechanism of Osthole in bone fracture healing has not been fully defined. In this study we determined if Osthole enhances bone fracture healing through activation of BMP2 signaling in mice. We performed unilateral open transverse tibial fracture procedure in 10-week-old C57BL/6 mice which were treated with or without Osthole. Our previous studies demonstrated that chondrocyte BMP signaling is required for bone fracture healing, in this study we also performed tibial fracture procedure in Cre-negative and Col2-Cre;Bmp2 flox/flox conditional knockout (KO) mice ( Bmp2 Col2Cre ) to determine if Osthole enhances fracture healing in a BMP2-dependent manner. Fracture callus tissues were collected and analyzed by X-ray, micro-CT (μCT), histology, histomorphometry, immunohistochemistry (IHC), biomechanical testing and quantitative gene expression analysis. In addition, mouse chondrogenic ATDC5 cells were cultured with or without Osthole and the expression levels of chondrogenic marker genes were examined. The results demonstrated that Osthole promotes bone fracture healing in wild-type (WT) or Cre - control mice. In contrast, Osthole failed to promote bone fracture healing in Bmp2 Col2Cre conditional KO mice. In the mice receiving Osthole treatment, expression of cartilage marker genes was significantly increased. We conclude that Osthole could promote bone strength and enhance fracture healing by activation of BMP2 signaling. Osthole may be used as an alternative approach in the orthopaedic clinic for the treatment of fracture healing.

Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes

PubMed Central

Wang, Pinger; Ying, Jun; Luo, Cheng; Jin, Xing; Zhang, Shanxing; Xu, Taotao; Zhang, Lei; Mi, Meng; Chen, Di; Tong, Peijian; Jin, Hongting

2017-01-01

Osthole is a bioactive coumarin derivative and has been reported to be able to enhance bone formation and improve fracture healing. However, the molecular mechanism of Osthole in bone fracture healing has not been fully defined. In this study we determined if Osthole enhances bone fracture healing through activation of BMP2 signaling in mice. We performed unilateral open transverse tibial fracture procedure in 10-week-old C57BL/6 mice which were treated with or without Osthole. Our previous studies demonstrated that chondrocyte BMP signaling is required for bone fracture healing, in this study we also performed tibial fracture procedure in Cre-negative and Col2-Cre;Bmp2flox/flox conditional knockout (KO) mice (Bmp2Col2Cre) to determine if Osthole enhances fracture healing in a BMP2-dependent manner. Fracture callus tissues were collected and analyzed by X-ray, micro-CT (μCT), histology, histomorphometry, immunohistochemistry (IHC), biomechanical testing and quantitative gene expression analysis. In addition, mouse chondrogenic ATDC5 cells were cultured with or without Osthole and the expression levels of chondrogenic marker genes were examined. The results demonstrated that Osthole promotes bone fracture healing in wild-type (WT) or Cre- control mice. In contrast, Osthole failed to promote bone fracture healing in Bmp2Col2Creconditional KO mice. In the mice receiving Osthole treatment, expression of cartilage marker genes was significantly increased. We conclude that Osthole could promote bone strength and enhance fracture healing by activation of BMP2 signaling. Osthole may be used as an alternative approach in the orthopaedic clinic for the treatment of fracture healing. PMID:28924381

Dynamic Fixation of Humeral Shaft Fractures Using Active Locking Plates: A Prospective Observational Study.

PubMed

Madey, Steven M; Tsai, Stanley; Fitzpatrick, Daniel C; Earley, Kathleen; Lutsch, Michael; Bottlang, Michael

2017-01-01

Rigid locked plating constructs can suppress fracture healing by inhibiting interfragmentary motion required to stimulate natural bone healing by callus formation. Dynamic fixation with active locking plates reduces construct stiffness, enables controlled interfragmentary motion, and has been shown to induce faster and stronger bone healing in vivo compared to rigid locking plates. This prospective observational study represents the first clinical use of active locking plates. It documents our early clinical experience with active plates for stabilization of humeral shaft fractures to assess their durability and understand potential complications. Eleven consecutive patients with humeral shaft fractures (AO/OTA types 12 A-C) were prospectively enrolled at a level I and a level II trauma center. Fractures were stabilized by using active locking plates without supplemental bone graft or bone morphogenic proteins. The screw holes of active locking plates are elastically suspended in elastomer envelopes inside the plate, enabling up to 1.5 mm of controlled interfragmentary motion. Progression of fracture healing and integrity of implant fixation was assessed radiographically at 3, 6, 12, and 24 weeks post surgery. Patient-reported functional outcome measures were obtained at 6, 12, and 24 weeks post surgery. The primary endpoint of this study was plate durability in absence of plate bending or breakage, or failure of the elastically suspended locking hole mechanism. Secondary endpoints included fracture healing, complications requiring revision surgery, and functional outcome scores. The eleven patients had six simple AO/ OTA type 12A fractures, three wedge type 12B fractures, and two comminuted type 12C fracture, including one open fracture. All active locking plates endured the 6-month loading period without any signs of fatigue or failure. Ten of eleven fractures healed at 10.9 ± 5.2 weeks, as evident by bridging callus and pain-free function. One fracture required

Assisted Vacations for Men with Dementia and Their Caregiving Spouses: Evaluation of Health-Related Effects

ERIC Educational Resources Information Center

Wilz, Gabriele; Fink-Heitz, Margit

2008-01-01

Purpose: In this study, we conducted the first evaluation of assisted vacations for persons with dementia and their caregivers in the field of caregiving research. Design and Methods: We used a quasi-experimental, two-group, repeated measures design with two measuring times (preintervention, 3-month follow-up) to examine whether assisted vacations…

The Role of Active Fractures on Borehole Breakout Development

NASA Astrophysics Data System (ADS)

Sahara, D.; Kohl, T.; Schoenball, M.; Müller, B.

2013-12-01

The properties of georeservoirs are strongly related to the stress field and their interpretation is a major target in geotechnical management. Borehole breakouts are direct indicators of the stress field as they develop due to the concentration of the highest compressional stress toward the minimum horizontal stress direction. However, the interaction with fractures might create local perturbations. Such weakened zones are often observed by localized anomalies of the borehole breakout orientation. We examined high-quality acoustic borehole televiewer (UBI) logs run in the entire granite sections at the deep well GPK4 at Soultz-sous-Forêts, France. The borehole is moderately inclined (15° - 35°) in its middle section. Detailed analysis of 1221 borehole elongation pairs in the vicinity of 1871 natural fractures observed in GPK4 well is used to infer the role of fractures on the borehole breakouts shape and orientation. Patterns of borehole breakout orientation in the vicinity of active fractures suggest that the wavelength of the borehole breakout orientation anomalies in this granite rock depend on the scale of the fracture while the rotation amplitude and direction is strongly influenced by the fracture orientation. In the upper and middle part of the well even a linear trend between fracture and breakout orientations could be established. In addition to the rotation, breakouts typically are found to be asymmetrically formed in zones of high fracture density. We find that major faults tend to create a systematic rotation of borehole breakout orientation with long spatial wavelength while abrupt changes are often observed around small fractures. The finding suggest that the borehole breakout heterogeneities are not merely governed by the principal stress heterogeneities, but that the effect of mechanical heterogeneities like elastic moduli changes, rock strength anisotropy and fracturing must be taken into account. Thus, one has to be careful to infer the

Trends and characteristics of maxillofacial fractures sustained during sports activities in Japan.

PubMed

Yamamoto, Kazuhiko; Matsusue, Yumiko; Horita, Satoshi; Murakami, Kazuhiro; Sugiura, Tsutomu; Kirita, Tadaaki

2018-03-11

Sports activity increases the risk of maxillofacial fractures. The aim of this study was to analyze trends and characteristics of maxillofacial fractures sustained during sports activity to develop more effective treatments and possibly to prevent injury. Data of 248 patients with maxillofacial fractures sustained during sports activity were retrospectively analyzed based on their clinical records and radiographs. The patients were 226 males (91.1%) and 22 females (8.9%). Their ages ranged from 6 to 70 years and the majority were in their second decade. The fractures were sustained in various sports which included baseball in 85 patients (34.3%), rugby in 40 (16.1%), soccer in 30 (12.1%), softball in 22 (8.9%), golf in 10 (4.0%), hockey in 8 (3.2%), combat sports in 28 (11.3%), and others in 29 (11.7%). The cause of injuries was collision with another player in 97 patients (39.1%), hit by a ball in 89 (35.9%), intended attack in 20 (8.1%), hit by equipment of another player in 15 (6.0%), a fall in 14 (5.6%), and collision with ground equipment in 13 (5.2%). The site of fractures was the mandible in 145 patients (58.5%), midface in 100 (40.3%), and both in 3 (1.2%). Among 210 fracture sites in the mandible, 77 (36.6%) were in the angle, 68 (32.4%) in the symphysis, and 65 (30.9%) in others. Among 103 fractures in the midface, 58 (56.3%) were in the zygoma, 26 (25.2%) in alveolar bone, and 19 (18.4%) in others. Treatment was observation in 67 patients (27.0%), maxillomandibular fixation in 64 (25.8%), open reduction and internal fixation in 63 (25.4%), intramaxillary splinting in 40 (16.1%), transcutaneous reduction in 10 (4.0%), and other procedures in 4 (1.6%). Maxillofacial fractures sustained during sports activity showed characteristic features dependent on the type of sport and cause of injury. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Two-dimensional distribution of microbial activity and flow patterns within naturally fractured chalk.

PubMed

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

2005-10-01

The two-dimensional distribution of flow patterns and their dynamic change due to microbial activity were investigated in naturally fractured chalk cores. Long-term biodegradation experiments were conducted in two cores ( approximately 20 cm diameter, 31 and 44 cm long), intersected by a natural fracture. 2,4,6-tribromophenol (TBP) was used as a model contaminant and as the sole carbon source for aerobic microbial activity. The transmissivity of the fractures was continuously reduced due to biomass accumulation in the fracture concurrent with TBP biodegradation. From multi-tracer experiments conducted prior to and following the microbial activity, it was found that biomass accumulation causes redistribution of the preferential flow channels. Zones of slow flow near the fracture inlet were clogged, thus further diverting the flow through zones of fast flow, which were also partially clogged. Quantitative evaluation of biodegradation and bacterial counts supported the results of the multi-tracer tests, indicating that most of the bacterial activity occurs close to the inlet. The changing flow patterns, which control the nutrient supply, resulted in variations in the concentrations of the chemical constituents (TBP, bromide and oxygen), used as indicators of biodegradation.

Effects of Flexitime on Sick Leave, Vacation Leave, Anxiety, Performance, and Satisfaction in a Library Setting.

ERIC Educational Resources Information Center

Saunders, Carol Stoak; Saunders, Russell

1985-01-01

Results of study using pretest and posttest control group design in public university library setting to study impact of flexitime indicate that: satisfaction with promotions decreased with significant effect, sick leaves decreased, average length of vacation leaves increased, and results were mixed on performance and approached significance for…

Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers.

PubMed

Loibl, Markus; Bäumlein, Martin; Massen, Felix; Gueorguiev, Boyko; Glaab, Richard; Perren, Thomas; Rillmann, Paavo; Ryf, Christian; Naal, Florian D

2013-06-01

Tibial plateau fractures occur frequently while participating in winter sports, but there is no information on whether skiers can resume sports and recreational activities after internal fixation of these fractures. Skiers can resume low-impact sports activity after internal fixation of tibial plateau fractures. Case series; Level of evidence, 4. A total of 103 patients were surveyed by postal questionnaires to determine their sports activities at a mean of 7.8 ± 1.8 years after internal fixation of intra-articular tibial plateau fractures. The survey also included the Lysholm score, the Tegner activity scale, and a visual analog scale (VAS) for pain. At the time of the survey, 88% of the patients were engaged in sports activities (rate of return to sports, 88%), and 53% continued to participate in downhill skiing. The median number of different activities declined from 5 (range, 1-17) preoperatively to 4 (range, 0-11) postoperatively (P < .01). Sports frequency and duration per week did not change: 3 (range, 1-7) preoperatively versus 3 (range, 0-7) postoperatively (P = .275) and 4 hours (range, 1-16 hours) preoperatively versus 3.5 hours (range, 0-15 hours) postoperatively (P = .217), respectively. Median values of all outcome scores declined: Lysholm score, 100 (range, 85-100) preoperatively versus 94.5 (range, 37-100) postoperatively (P < .01); VAS, 0 (range, 0-7) preoperatively versus 1 (range, 0-8) postoperatively (P < .01). Median Tegner activity scale scores declined in all age groups except for patients aged 51 to 60 years. The ability to participate in sports at the time of follow-up compared with the ability before the accident was rated as "similar" by 57 patients (62.0%) and as "worse" by 35 patients (38.0%). The more severe fracture types, B3 and C3 according to the AO classification system, were associated with poorer outcomes related to return to sports and functional scores. A large percentage of skiers with surgically treated intra

Usual Physical Activity and Hip Fracture in Older Men: An Application of Semiparametric Methods to Observational Data

PubMed Central

Mackey, Dawn C.; Hubbard, Alan E.; Cawthon, Peggy M.; Cauley, Jane A.; Cummings, Steven R.; Tager, Ira B.

2011-01-01

Few studies have examined the relation between usual physical activity level and rate of hip fracture in older men or applied semiparametric methods from the causal inference literature that estimate associations without assuming a particular parametric model. Using the Physical Activity Scale for the Elderly, the authors measured usual physical activity level at baseline (2000–2002) in 5,682 US men ≥65 years of age who were enrolled in the Osteoporotic Fractures in Men Study. Physical activity levels were classified as low (bottom quartile of Physical Activity Scale for the Elderly score), moderate (middle quartiles), or high (top quartile). Hip fractures were confirmed by central review. Marginal associations between physical activity and hip fracture were estimated with 3 estimation methods: inverse probability-of-treatment weighting, G-computation, and doubly robust targeted maximum likelihood estimation. During 6.5 years of follow-up, 95 men (1.7%) experienced a hip fracture. The unadjusted risk of hip fracture was lower in men with a high physical activity level versus those with a low physical activity level (relative risk = 0.51, 95% confidence interval: 0.28, 0.92). In semiparametric analyses that controlled confounding, hip fracture risk was not lower with moderate (e.g., targeted maximum likelihood estimation relative risk = 0.92, 95% confidence interval: 0.62, 1.44) or high (e.g., targeted maximum likelihood estimation relative risk = 0.88, 95% confidence interval: 0.53, 2.03) physical activity relative to low. This study does not support a protective effect of usual physical activity on hip fracture in older men. PMID:21303805

Active unicameral bone cysts in the upper limb are at greater risk of fracture.

PubMed

Tey, Inn Kuang; Mahadev, Arjandas; Lim, Kevin Boon Leong; Lee, Eng Hin; Nathan, Saminathan Suresh

2009-08-01

To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture. 14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate. There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture. Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.

Physical Activity Levels During Acute Inpatient Admission After Hip Fracture are Very Low.

PubMed

Davenport, Sarah J; Arnold, Meaghan; Hua, Carol; Schenck, Amie; Batten, Sarah; Taylor, Nicholas F

2015-09-01

Hip fractures are very common in older adults and result in serious health consequences. Early mobilization post-surgical intervention for hip fractures is very important. The purpose of this study was to determine physical activity levels during an acute inpatient admission of patients after surgery for hip fracture. The observational study was completed on an orthopaedic ward in an acute general hospital. Twenty patients (18 women, mean age ± standard deviation, 79.1 ± 9.3 years) post-surgical intervention for a hip fracture were included. Physical activity levels were measured using an accelerometer to record the percentage of time spent in lying/sitting, standing and walking, number of steps taken and average energy expenditure. Physical activity levels were extremely low, with participants spending an average of 99% of the day either lying or sitting and a little more than 1% of the day either standing or walking (16 min). Participants took an average of 35.7 ± 80.4 steps per day. Patients received more physiotherapy intervention on weekdays compared with weekends. There was no significant difference in activity levels between weekdays to weekends. No measures of physical activity were associated with length of stay. A mild to moderate association (r = 0.26-0.41) was observed between the measures of physical activity and the amount of physiotherapy received during the weekdays. Physical activity levels during an acute inpatient admission surgery for hip fracture are very low. Patients may have difficulty completing basic activities of daily living post-discharge into the community. Physical activity should be optimized as early in the rehabilitation process as able. Copyright © 2014 John Wiley & Sons, Ltd.

Activities and impairments in the early stage of rehabilitation after Colles' fracture.

PubMed

Dekkers, Merete; Søballe, Kjeld

2004-06-03

The purpose of this study was to investigate problems in performing activities after Colles' fracture, and to correlate activity limitations with impairments in the early stage of rehabilitation. Assessments were performed 1 and 5 weeks after removing plaster casts. A client-specific instrument, The Canadian Occupational Performance Measure, and a disease-specific dichotomous scale of 10 activities of daily living were used. Range of motion, grip strength, pain and dexterity were also assessed according to standardized methods. Thirty-three women, aged 51-87 years, with Colles' fracture treated with closed reduction and a plaster cast participated. Highly significant statistical and clinical improvements were found in the capacity, number and performance of activities. Problems were mainly classified as self-care activities at 1 week, and as productivity activities at 5 weeks, while problems in leisure activities were practically the same. However, one-third of the patients were not able to perform all basic activities of daily living at 5 weeks. Improvements in pain frequency, range of motion, grip strength and dexterity did not correlate very well with improvements in performance or the patients' satisfaction with the performance of their activities. The importance of assessing both impairments and activities in patients with Colles' fracture must be stressed.

Streaming Potential Modeling to Understand the Identification of Hydraulically Active Fractures and Fracture-Matrix Fluid Interactions Using the Self-Potential Method

NASA Astrophysics Data System (ADS)

Jougnot, D.; Roubinet, D.; Linde, N.; Irving, J.

2016-12-01

Quantifying fluid flow in fractured media is a critical challenge in a wide variety of research fields and applications. To this end, geophysics offers a variety of tools that can provide important information on subsurface physical properties in a noninvasive manner. Most geophysical techniques infer fluid flow by data or model differencing in time or space (i.e., they are not directly sensitive to flow occurring at the time of the measurements). An exception is the self-potential (SP) method. When water flows in the subsurface, an excess of charge in the pore water that counterbalances electric charges at the mineral-pore water interface gives rise to a streaming current and an associated streaming potential. The latter can be measured with the SP technique, meaning that the method is directly sensitive to fluid flow. Whereas numerous field experiments suggest that the SP method may allow for the detection of hydraulically active fractures, suitable tools for numerically modeling streaming potentials in fractured media do not exist. Here, we present a highly efficient two-dimensional discrete-dual-porosity approach for solving the fluid-flow and associated self-potential problems in fractured domains. Our approach is specifically designed for complex fracture networks that cannot be investigated using standard numerical methods due to computational limitations. We then simulate SP signals associated with pumping conditions for a number of examples to show that (i) accounting for matrix fluid flow is essential for accurate SP modeling and (ii) the sensitivity of SP to hydraulically active fractures is intimately linked with fracture-matrix fluid interactions. This implies that fractures associated with strong SP amplitudes are likely to be hydraulically conductive, attracting fluid flow from the surrounding matrix.

The Contributions of Intrinsic and Extrinsic Reading Motivation to the Development of Reading Competence over Summer Vacation

ERIC Educational Resources Information Center

Schaffner, Ellen; Schiefele, Ulrich

2016-01-01

This study addressed the role of reading motivation as a potential determinant of losses or gains in reading competence over six weeks of summer vacation (SV). Based on a sample of 223 third-grade elementary students, structural equation analyses showed that intrinsic reading motivation before SV contributed positively to both word and sentence…

20 CFR 405.382 - Vacating a dismissal of a request for a hearing before an administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... hearing before an administrative law judge. 405.382 Section 405.382 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Administrative Law Judge Hearing § 405.382 Vacating a dismissal of a request for a hearing before an administrative law judge. If...

31 CFR 351.48 - May I purchase definitive Series EE savings bonds through employee thrift, savings, vacation, and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false May I purchase definitive Series EE savings bonds through employee thrift, savings, vacation, and similar plans? 351.48 Section 351.48 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT...

31 CFR 359.36 - May I purchase definitive Series I savings bonds through employee thrift, savings, vacation, and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false May I purchase definitive Series I savings bonds through employee thrift, savings, vacation, and similar plans? 359.36 Section 359.36 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT...

Contaminant behavior in fractured sedimentary rocks: Seeing the fractures that matter

NASA Astrophysics Data System (ADS)

Parker, B. L.

2017-12-01

High resolution spatial sampling of continuous cores from sites contaminated with chlorinated solvents over many decades was used as a strategy to quantify mass stored in low permeability blocks of rock between hydraulically active fractures. Given that core and geophysical logging methods cannot distinguish between hydraulically active fractures and those that do not transmit water, these samples were informed by careful logging of visible fracture features in the core with sample spacing determined by modelled diffusion transport distances given rock matrix properties and expected ages of contamination. These high resolution contaminant concentration profiles from long term contaminated sites in sedimentary rock showed evidence of many more hydraulically active fractures than indicated by the most sophisticated open-hole logging methods. Fracture density is an important attribute affecting fracture connectivity and influencing contaminant plume evolution in fractured porous sedimentary rock. These contaminant profile findings were motivation to find new borehole methods to directly measure hydraulically active fracture occurrence and flux to corroborate the long term "DNAPL tracer experiment" results. Improved sensitivity is obtained when boreholes are sealed using flexible fabric liners (FLUTeTM technology) and various sensor options are deployed in the static water columns used to inflate these liners or in contact with the borehole wall behind the liners. Several methods rely on high resolution temperature measurements of ambient or induced temperature variability such as temperature vector probes (TVP), fiber optic cables for distributed temperature sensing (DTS), both using active heat; packer testing, point dilution testing and groundwater flux measurements between multiple straddle packers to account for leakage. In all cases, numerous hydraulically active fractures are identified over 100 to 300 meters depth, with a large range in transmissivities and

41 CFR 301-10.117 - May I keep compensation an airline gives me for voluntarily vacating my seat on my scheduled...

Code of Federal Regulations, 2013 CFR

2013-07-01

... asks for volunteers? 301-10.117 Section 301-10.117 Public Contracts and Property Management Federal... airline asks for volunteers? Yes: (a) If voluntarily vacating your seat will not interfere with performing...

41 CFR 301-10.117 - May I keep compensation an airline gives me for voluntarily vacating my seat on my scheduled...

Code of Federal Regulations, 2014 CFR

2014-07-01

... asks for volunteers? 301-10.117 Section 301-10.117 Public Contracts and Property Management Federal... airline asks for volunteers? Yes: (a) If voluntarily vacating your seat will not interfere with performing...

41 CFR 301-10.117 - May I keep compensation an airline gives me for voluntarily vacating my seat on my scheduled...

Code of Federal Regulations, 2010 CFR

2010-07-01

... asks for volunteers? 301-10.117 Section 301-10.117 Public Contracts and Property Management Federal... airline asks for volunteers? Yes: (a) If voluntarily vacating your seat will not interfere with performing...

41 CFR 301-10.117 - May I keep compensation an airline gives me for voluntarily vacating my seat on my scheduled...

Code of Federal Regulations, 2011 CFR

2011-07-01

... asks for volunteers? 301-10.117 Section 301-10.117 Public Contracts and Property Management Federal... airline asks for volunteers? Yes: (a) If voluntarily vacating your seat will not interfere with performing...

41 CFR 301-10.117 - May I keep compensation an airline gives me for voluntarily vacating my seat on my scheduled...

Code of Federal Regulations, 2012 CFR

2012-07-01

... asks for volunteers? 301-10.117 Section 301-10.117 Public Contracts and Property Management Federal... airline asks for volunteers? Yes: (a) If voluntarily vacating your seat will not interfere with performing...

Anti-DKK1 antibody promotes bone fracture healing through activation of β-catenin signaling

PubMed Central

Jin, Hongting; Wang, Baoli; Li, Jia; Xie, Wanqing; Mao, Qiang; Li, Shan; Dong, Fuqiang; Sun, Yan; Ke, Hua-Zhu; Babij, Philip; Tong, Peijian; Chen, Di

2015-01-01

In this study we investigated if Wnt/β-catenin signaling in mesenchymal progenitor cells plays a role in bone fracture repair and if DKK1-Ab promotes fracture healing through activation of β-catenin signaling. Unilateral open transverse tibial fractures were created in CD1 mice and in β-cateninPrx1ER conditional knockout (KO) and Cre-negative control mice (C57BL/6 background). Bone fracture callus tissues were collected and analyzed by radiography, micro-CT (μCT), histology, biomechanical testing and gene expression analysis. The results demonstrated that treatment with DKK1-Ab promoted bone callus formation and increased mechanical strength during the fracture healing processinCD1 mice. DKK1-Ab enhanced fracture repair by activation of endochondral ossification. The normal rate of bone repair was delayed when the β-catenin gene was conditionally deleted in mesenchymal progenitor cells during the early stages of fracture healing. DKK1-Ab appeared to act through β-catenin signaling to enhance bone repair since the beneficial effect of DKK1-Ab was abrogated in β-cateninPrx1ER conditional KO mice. Further understanding of the signaling mechanism of DKK1-Ab in bone formation and bone regeneration may facilitate the clinical translation of this anabolic agent into therapeutic intervention. PMID:25263522

Clavicle fractures.

PubMed

Ropars, M; Thomazeau, H; Huten, D

2017-02-01

Management of clavicle fracture has progressed over the last decade, notably with wider use of surgery in midshaft fracture, and new techniques for lateral fracture. Midshaft clavicle fracture treatment needs to be personalized and adapted to the patient's activity level. Whichever the segment involved, treatment for non-displaced fracture is functional; elbow-to-body sling immobilization seems the best tolerated. Apart from regular surgical indications (shoulder impaction, floating shoulder, open fracture or fracture with neurovascular complications), surgery is recommended in case of bone shortening exceeding 1.5cm in young active patients. The technique needs to take account of clavicle anatomy: notably periosteal vascularization in midshaft fracture and acromioclavicular ligament integrity and location in case of lateral fracture. Plate osteosynthesis should take account of bone diameter and 3D curvature; intramedullary fixation should take account of intramedullary canal morphology. Although iatrogenic vascular complications are rare, vessel relations and variants need to be known, especially in the medial end of the clavicle and midshaft. Lateral segment fractures are a particular entity. Large-scale randomized studies are needed to assess indications and results for the various possible internal fixation techniques: isolated or associated to ligament reconstruction, rigid or flexible, and open or arthroscopic. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Analysis on preemptive priority retrial queue with two types of customers, balking, optional re-service, single vacation and service interruption

NASA Astrophysics Data System (ADS)

Yuvarani, S.; Saravanarajan, M. C.

2017-11-01

This paper concerned with performance analysis of single server preemptive priority retrial queue with a single vacation where two types of customers are considered and they are called priority customers and ordinary customers. The ordinary customers arrive in batch into the system. The priority customers do not form any queue. After the completion of regular service, the customers may demand re-service for the previous service without joining the orbit or may leave the system. As soon as the system is empty, the server goes for vacation and the regular busy server can be subjected to breakdown. By using the supplementary variable technique, we obtain the steady-state probability generating functions for the system/orbit size. Some important system performance measures and the stochastic decomposition are discussed. Finally, numerical examples are presented to visualize the effect of parameters on system performance measures.

The surface geometry of inherited joint and fracture trace patterns resulting from active and passive deformation

NASA Technical Reports Server (NTRS)

Podwysocki, M. H.; Gold, D. P.

1974-01-01

Hypothetical models are considered for detecting subsurface structure from the fracture or joint pattern, which may be influenced by the structure and propagated to the surface. Various patterns of an initially orthogonal fracture grid are modeled according to active and passive deformation mechanisms. In the active periclinal structure with a vertical axis, fracture frequency increased both over the dome and basin, and remained constant with decreasing depth to the structure. For passive periclinal features such as a reef or sand body, fracture frequency is determined by the arc of curvature and showed a reduction over the reefmound and increased over the basin.

Forming a Learning Culture to Promote Fracture Prevention Activities

ERIC Educational Resources Information Center

Hjalmarson, Helene V.; Strandmark, Margaretha

2012-01-01

Purpose: The purpose of this paper is to explore interprofessional experiences of incorporating fracture prevention activities in clinical practice inspired by an empowerment approach. Design/methodology/approach: Data collection consisted primarily of focus groups interviews, systematized and analyzed by the grounded theory method. The study took…

Dynamic Stabilization of Simple Fractures With Active Plates Delivers Stronger Healing Than Conventional Compression Plating

PubMed Central

Tsai, Stanley; Bliven, Emily K.; von Rechenberg, Brigitte; Kindt, Philipp; Augat, Peter; Henschel, Julia; Fitzpatrick, Daniel C.; Madey, Steven M.

2017-01-01

Objectives: Active plates dynamize a fracture by elastic suspension of screw holes within the plate. We hypothesized that dynamic stabilization with active plates delivers stronger healing relative to standard compression plating. Methods: Twelve sheep were randomized to receive either a standard compression plate (CP) or an active plate (ACTIVE) for stabilization of an anatomically reduced tibial osteotomy. In the CP group, absolute stabilization was pursued by interfragmentary compression with 6 cortical screws. In the ACTIVE group, dynamic stabilization after bony apposition was achieved with 6 elastically suspended locking screws. Fracture healing was analyzed weekly on radiographs. After sacrifice 9 weeks postsurgery, the torsional strength of healed tibiae and contralateral tibiae was measured. Finally, computed tomography was used to assess fracture patterns and healing modes. Results: Healing in both groups included periosteal callus formation. ACTIVE specimens had almost 6 times more callus area by week 9 (P < 0.001) than CP specimens. ACTIVE specimens recovered on average 64% of their native strength by week 9, and were over twice as strong as CP specimens, which recovered 24% of their native strength (P = 0.008). Microcomputed tomography demonstrated that compression plating induced a combination of primary bone healing and gap healing. Active plating consistently stimulated biological bone healing by periosteal callus formation. Conclusions: Compared with compression plating, dynamic stabilization of simple fractures with active plates delivers significantly stronger healing. PMID:27861456

[Osteoarthritis, disability, travel and recreational activities: comments from physicians and travel specialists].

PubMed

Solignac, Marie

2004-05-22

IMPACT OF DISABILITY: A survey of general practitioners, rheumatology specialists, and tourism specialists conducted by NEGMA-LERADS Laboratories demonstrated that subjects with osteoarthritis avoid vacation trips more readily than recreational activities. VACATION TRIPS ARE STILL POSSIBLE: Certain tourism organisms have nevertheless developed specialized services for disabled persons. Special emphasis is placed on adequate preparation before the vacation trip. PROBLEMS WITH WALKING: Many persons disabled by osteoarthritis do not require a wheel chair, yet have difficulty walking long distances. It is important to recognize the specific disabilities related to osteoarthritis and their effects on grip force and/or ambulation.

A Pronounced Inflammatory Activity Characterizes the Early Fracture Healing Phase in Immunologically Restricted Patients

PubMed Central

Hoff, Paula; Gaber, Timo; Strehl, Cindy; Jakstadt, Manuela; Hoff, Holger; Schmidt-Bleek, Katharina; Lang, Annemarie; Röhner, Eric; Huscher, Dörte; Matziolis, Georg; Burmester, Gerd-Rüdiger; Schmidmaier, Gerhard; Perka, Carsten; Duda, Georg N.; Buttgereit, Frank

2017-01-01

Immunologically restricted patients such as those with autoimmune diseases or malignancies often suffer from delayed or insufficient fracture healing. In human fracture hematomas and the surrounding bone marrow obtained from immunologically restricted patients, we analyzed the initial inflammatory phase on cellular and humoral level via flow cytometry and multiplex suspension array. Compared with controls, we demonstrated higher numbers of immune cells like monocytes/macrophages, natural killer T (NKT) cells, and activated T helper cells within the fracture hematomas and/or the surrounding bone marrow. Also, several pro-inflammatory cytokines such as Interleukin (IL)-6 and Tumor necrosis factor α (TNFα), chemokines (e.g., Eotaxin and RANTES), pro-angiogenic factors (e.g., IL-8 and Macrophage migration inhibitory factor: MIF), and regulatory cytokines (e.g., IL-10) were found at higher levels within the fracture hematomas and/or the surrounding bone marrow of immunologically restricted patients when compared to controls. We conclude here that the inflammatory activity on cellular and humoral levels at fracture sites of immunologically restricted patients considerably exceeds that of control patients. The initial inflammatory phase profoundly differs between these patient groups and is probably one of the reasons for prolonged or insufficient fracture healing often occurring within immunologically restricted patients. PMID:28282868

Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women.

PubMed

Armstrong, Miranda E G; Spencer, Elizabeth A; Cairns, Benjamin J; Banks, Emily; Pirie, Kirstin; Green, Jane; Wright, F Lucy; Reeves, Gillian K; Beral, Valerie

2011-06-01

Hip fracture risk is known to increase with physical inactivity and decrease with obesity, but there is little information on their combined effects. We report on the separate and combined effects of body mass index (BMI) and physical activity on hospital admissions for hip fracture among postmenopausal women in a large prospective UK study. Baseline information on body size, physical activity, and other relevant factors was collected in 1996-2001, and participants were followed for incident hip fractures by record linkage to National Health Service (NHS) hospital admission data. Cox regression was used to calculate adjusted relative risks of hip fracture. Among 925,345 postmenopausal women followed for an average of 6.2 years, 2582 were admitted to hospital with an incident hip fracture. Hip fracture risk increased with decreasing BMI: Compared with obese women (BMI of 30+ kg/m(2) ), relative risks were 1.71 [95% confidence interval (CI) 1.47-1.97)] for BMI of 25.0 to 29.9 kg/m(2) and 2.55 (95% CI 2.22-2.94) for BMI of 20.0 to 24.9 kg/m(2). The increase in fracture risk per unit decrease in BMI was significantly greater among lean women than among overweight women (p < .001). For women in every category of BMI, physical inactivity was associated with an increased risk of hip fracture. There was no significant interaction between the relative effects of BMI and physical activity. For women who reported that they took any exercise versus no exercise, the adjusted relative risk of hip fracture was 0.68 (95% CI 0.62-0.75), with similar results for strenuous exercise. In this large cohort of postmenopausal women, BMI and physical activity had independent effects on hip fracture risk. Copyright © 2011 American Society for Bone and Mineral Research.

Fault tolerant system with imperfect coverage, reboot and server vacation

NASA Astrophysics Data System (ADS)

Jain, Madhu; Meena, Rakesh Kumar

2017-06-01

This study is concerned with the performance modeling of a fault tolerant system consisting of operating units supported by a combination of warm and cold spares. The on-line as well as warm standby units are subject to failures and are send for the repair to a repair facility having single repairman which is prone to failure. If the failed unit is not detected, the system enters into an unsafe state from which it is cleared by the reboot and recovery action. The server is allowed to go for vacation if there is no failed unit present in the system. Markov model is developed to obtain the transient probabilities associated with the system states. Runge-Kutta method is used to evaluate the system state probabilities and queueing measures. To explore the sensitivity and cost associated with the system, numerical simulation is conducted.

Fracture-induced mechanophore activation and solvent healing in poly(methyl methacrylate)

NASA Astrophysics Data System (ADS)

Celestine, Asha-Dee N.

Damage detection is a highly desirable functionality in engineering materials. The potential of using mechanophores, stress-sensitive molecules, as material stress sensors has been established through tensile, compressive and shear tests. Spiropyran (SP) has been the chosen mechanophore and this molecule undergoes a ring opening reaction (activation) upon the application of mechanical stress. This activation is accompanied by a change in color and fluorescence as the colorless SP is converted to the highly colored merocyanine (MC) form. One requirement for SP activation in bulk polymers is large scale plastic deformation. In order to induce this plastic deformation during fracture testing of SP-linked brittle polymers such as poly(methyl methacrylate) (PMMA), rubber nanoparticles can be incorporated into the matrix material. These nanoparticles facilitate the increased shear yielding necessary for SP activation during mechanical testing. Cross-linked SP-PMMA, containing 7.3 wt% rubber nanoparticles is synthesized via a free radical polymerization. Specimens of this material are fabricated for Single Edge Notch Tension (SENT) testing. The rubber toughened SP-PMMA specimens are first prestretched to approximately 35% axial strain to align the spiropyran molecules in the direction of applied force and thus increase the likelihood of fracture-induced activation. After prestretching the specimens are pre-notched and irradiated with 532 nm wavelength light to revert the colored merocyanine to the colorless spiropyran form. Specimens are then fracture tested to failure using the SENT test. The evolution of mechanophore activation is monitored via in situ fluorescence imaging and inspection of the specimens after testing. Activation of the SP is observed ahead of the crack tip and along the propagated crack. Also, the degree of activation is found to increase with crack growth and the size of the activation zone is linearly correlated to the size of the plastic zone ahead

Quantifying Discrete Fracture Network Connectivity in Hydraulic Fracturing Stimulation

NASA Astrophysics Data System (ADS)

Urbancic, T.; Ardakani, E. P.; Baig, A.

2017-12-01

Hydraulic fracture stimulations generally result in microseismicity that is associated with the activation or extension of pre-existing microfractures and discontinuities. Microseismic events acquired under 3D downhole sensor coverage provide accurate event locations outlining hydraulic fracture growth. Combined with source characteristics, these events provide a high quality input for seismic moment tensor inversion and eventually constructing the representative discrete fracture network (DFN). In this study, we investigate the strain and stress state, identified fracture orientation, and DFN connectivity and performance for example stages in a multistage perf and plug completion in a North American shale play. We use topology, the familiar concept in many areas of structural geology, to further describe the relationships between the activated fractures and their effectiveness in enhancing permeability. We explore how local perturbations of stress state lead to the activation of different fractures sets and how that effects the DFN interaction and complexity. In particular, we observe that a more heterogeneous stress state shows a higher percentage of sub-horizontal fractures or bedding plane slips. Based on topology, the fractures are evenly distributed from the injection point, with decreasing numbers of connections by distance. The dimensionless measure of connection per branch and connection per line are used for quantifying the DFN connectivity. In order to connect the concept of connectivity back to productive volume and stimulation efficiency, the connectivity is compared with the character of deformation in the reservoir as deduced from the collective behavior of microseismicity using robustly determined source parameters.

Ambient Seismic Imaging of Hydraulically Active Fractures at km Depths

NASA Astrophysics Data System (ADS)

Malin, P. E.; Sicking, C.

2017-12-01

Streaming Depth Images of ambient seismic signals using numerous, densely-distributed, receivers have revealed their connection to hydraulically active fractures at 0.5 to 5 km depths. Key for this type of imaging is very high-fold stacking over both multiple receives and periods of a few hours. Also important is suppression of waveforms from fixed, repeating sources such as pumps, generators, and traffic. A typical surface-based ambient SDI survey would use a 3D seismic receiver grid. It would have 1,000 to 4,000 uniformly distributed receivers at a density of 50/km2over the target. If acquired by borehole receivers buried 100 m deep, the density can be dropped by an order of magnitude. We show examples of the acquisition and signal processing scenarios used to produce the ambient images. (Sicking et al., SEG Interpretation, Nov 2017.) While the fracture-fluid source connection of SDI has been verified by drilling and various types of hydraulic tests, the precise nature of the signal's origin is not clear. At the current level of observation, the signals do not have identifiable phases, but can be focused using P wave velocities. Suggested sources are resonances of pressures fluctuations in the fractures, or small, continuous, slips on fractures surfaces. In either case, it appears that the driving mechanism is tectonic strain in an inherently unstable crust. Solid earth tides may enhance these strains. We illustrate the value of the ambient SDI method in its industrial application by showing case histories from energy industry and carbon-capture-sequestration projects. These include ambient images taken before, during, and after hydraulic treatments in un-conventional reservoirs. The results show not only locations of active fractures, but also their time responses to stimulation and production. Time-lapse ambient imaging can forecast and track events such as well interferences and production changes that can result from nearby treatments.

Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

PubMed Central

Young, Ki Won; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

2015-01-01

Background We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Methods Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. Results The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Conclusions Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were

Paratrooper's ankle fracture: posterior malleolar fracture.

PubMed

Young, Ki Won; Kim, Jin-su; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

2015-03-01

We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to

Leisure time physical activity and risk of non-vertebral fracture in men and women aged 55 years and older: the Tromsø Study.

PubMed

Morseth, Bente; Ahmed, Luai A; Bjørnerem, Åshild; Emaus, Nina; Jacobsen, Bjarne K; Joakimsen, Ragnar; Størmer, Jan; Wilsgaard, Tom; Jørgensen, Lone

2012-06-01

Our aim was to examine associations between leisure time physical activity and risk of non-vertebral fractures in men and women aged ≥55 years, with focus on the anatomical fracture location. Self-reported physical activity was registered in 3,450 men and 4,072 women aged 55-97 years at baseline in the Tromsø Study, Norway, in 1994-1995. Non-vertebral fractures were registered through December 31, 2009. During 75,546 person-years at risk, 1,693 non-vertebral fractures were identified. Risk of any non-vertebral fracture decreased with increasing physical activity level in men (P (trend) = 0.006) and non-significantly in women (P (trend) = 0.15), after adjustment for age, body mass index, height, smoking, and previous fracture. The reduced fracture risk was due to a reduced risk in the weight-bearing skeleton, particular at the hip, whereas risk of fracture in the non-weight-bearing skeleton was not related to physical activity. At weight-bearing sites, an inverse relationship between physical activity and fracture risk was present in both sexes (P (trend) ≤ 0.013). Compared with sedentary subjects, the most active men and women had respectively 37% (HR = 0.63, 95% CI: 0.45, 0.88) and 23% (HR = 0.77, 95% CI: 0.62, 0.95) reduced fracture risk in the weight-bearing skeleton. Physical activity is associated with reduced fracture risk at weight-bearing sites, with no associations at non-weight-bearing sites, in both sexes. Habitual physical activity is an important amendable approach to prevent hip fracture.

Motor function and activities of daily living capacity of patients with fractures sustained during the Wenchuan earthquake.

PubMed

Zhang, Jin-Long; He, Hong-Chen; Lin, Hai-Dan; Luo, Qing-Lu; Xia, Lu; Li, Sha-Sha; He, Cheng-Qi

2011-05-01

On the afternoon of May 12, 2008, a 8.0-magnitude earthquake hit Sichuan Province, a mountainous region in Western China, killing about 70 000 people and leaving over 18 000 missing. What about the survivors motor functions and activities of daily living (ADL) capacity, especially for fractures? We need the data to guide the rehabilitation for the seismic wounded and it's important to collect the data for the future. We study the survivors to understand the motor functions and ADL capacity of patients with fractures sustained in the Wenchuan earthquake, to provide a basis for rehabilitation and treatment. We used the Manual Muscle Testing method to evaluate muscle strength, the joint angle scale to measure joint range of motion (ROM), and the Barthel index to evaluate the activities of daily living status. SPSS 13.0 software was used to analyze the data and the results were tested using one-way analysis of variance (ANOVA). The number of seismic wounded amounted to 487; 81.1% of patients had fractures. Most of the injured had fractures in multiple regions (53.9% of all fracture patients), followed by fractures of the upper limb (34.0% of patients); cranial fractures were rare (2.3%). Totally 82.0% had restricted range of motion, 23.5% had decreased muscle force, and 72.2% of the patients had restricted activities of daily living capacities. With time the activities of daily living capacity of female increased (P < 0.05), compared with the male fracture patients who did not show any relative improvement (P > 0.05). The difference between the patients' ages and ADL capacities did not reach statistical significance (P > 0.05), nor was there a significant difference between their ages and the numbers of days in hospital (P > 0.05). Fractures were the main issue in the seismic wounded, many of them had reductions in the ROM, muscle force and ADL capacities. The physicians involved in rehabilitation should pay greater attention to muscle force exercises, joint

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.

Risk Behaviors Among HIV-Positive Gay and Bisexual Men at Party-Oriented Vacations

PubMed Central

Fisher, Michael P.; Ramchand, Rajeev; Bana, Sarah; Iguchi, Martin Y.

2013-01-01

Objective: This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened. Method: A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI). Results: HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or “poppers”) (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status. Conclusions: HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men. PMID:23200162

The Dramaturgy Approach to Education in Nature: Reflections of a Decade of International Vacation School Lipnice Courses, Czech Republic, 1997-2007

ERIC Educational Resources Information Center

Martin, Andrew J.

2011-01-01

This paper provides an auto-ethnography or narrative of self related to the development of international experiential education programmes in nature developed by Vacation School Lipnice (VSL) in the Czech Republic. The paper provides the cultural background that influences the course design and provides examples, through participant observation,…

Television, computer, and video viewing; physical activity; and upper limb fracture risk in children: a population-based case control study.

PubMed

Ma, Deqiong; Jones, Graeme

2003-11-01

The effect of physical activity on upper limb fractures was examined in this population-based case control study with 321 age- and gender-matched pairs. Sports participation increased fracture risk in boys and decreased risk in girls. Television viewing had a deleterious dose response association with wrist and forearm fractures while light physical activity was protective. The aim of this population-based case control study was to examine the association between television, computer, and video viewing; types and levels of physical activity; and upper limb fractures in children 9-16 years of age. A total of 321 fracture cases and 321 randomly selected individually matched controls were studied. Television, computer, and video viewing and types and levels of physical activity were determined by interview-administered questionnaire. Bone strength was assessed by DXA and metacarpal morphometry. In general, sports participation increased total upper limb fracture risk in boys and decreased risk in girls. Gender-specific risk estimates were significantly different for total, contact, noncontact, and high-risk sports participation as well as four individual sports (soccer, cricket, surfing, and swimming). In multivariate analysis, time spent television, computer, and video viewing in both sexes was positively associated with wrist and forearm fracture risk (OR 1.6/category, 95% CI: 1.1-2.2), whereas days involved in light physical activity participation decreased fracture risk (OR 0.8/category, 95% CI: 0.7-1.0). Sports participation increased hand (OR 1.5/sport, 95% CI: 1.1-2.0) and upper arm (OR 29.8/sport, 95% CI: 1.7-535) fracture risk in boys only and decreased wrist and forearm fracture risk in girls only (OR 0.5/sport, 95% CI: 0.3-0.9). Adjustment for bone density and metacarpal morphometry did not alter these associations. There is gender discordance with regard to sports participation and fracture risk in children, which may reflect different approaches to sport

The Effects of Age, Adiposity, and Physical Activity on the Risk of Seven Site‐Specific Fractures in Postmenopausal Women

PubMed Central

Lacombe, Jason; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K; Beral, Valerie

2016-01-01

ABSTRACT Risk factors for fracture of the neck of the femur are relatively well established, but those for fracture at other sites are little studied. In this large population study we explore the role of age, body mass index (BMI), and physical activity on the risk of fracture at seven sites in postmenopausal women. As part of the Million Women Study, 1,154,821 postmenopausal UK women with a mean age of 56.0 (SD 4.8) years provided health and lifestyle data at recruitment in 1996 to 2001. All participants were linked to National Health Service (NHS) hospital records for day‐case or overnight admissions with a mean follow‐up of 11 years per woman. Adjusted absolute and relative risks for seven site‐specific incident fractures were calculated using Cox regression models. During follow‐up, 4931 women had a fracture of the humerus; 2926 of the forearm; 15,883 of the wrist; 9887 of the neck of the femur; 1166 of the femur (not neck); 3199 a lower leg fracture; and 10,092 an ankle fracture. Age‐specific incidence rates increased gradually with age for fractures of forearm, lower leg, ankle, and femur (not neck), and steeply with age for fractures of neck of femur, wrist, and humerus. When compared to women with desirable BMI (20.0 to 24.9 kg/m2), higher BMI was associated with a reduced risk of fracture of the neck of femur, forearm, and wrist, but an increased risk of humerus, femur (not neck), lower leg, and ankle fractures (p < 0.001 for all). Strenuous activity was significantly associated with a decreased risk of fracture of the humerus and femur (both neck and remainder of femur) (p < 0.001), but was not significantly associated with lower leg, ankle, wrist, and forearm fractures. Postmenopausal women are at a high lifetime risk of fracture. BMI and physical activity are modifiable risk factors for fracture, but their associations with fracture risk differ substantially across fracture sites. © 2016 The Authors. Journal of Bone and Mineral

Facilitation of bone resorption activities in synovial lavage fluid patients with mandibular condyle fractures.

PubMed

Takano, H; Takahashi, T; Nakata, A; Nogami, S; Yusa, K; Kuwajima, S; Yamazaki, M; Fukuda, M

2016-05-01

The aim of this study was to investigate the bone resorption effect of the mediators delivered in joint cavity of patients with mandibular condyle fractures by detecting osteoclast markers using cellular biochemistry methods, and by analysing bone resorption activities via inducing osteoclast differentiation of the infiltrated cells from arthrocentesis. Sixteen joints in 10 patients with mandibular condyle fractures were evaluated. The control group consisted of synovial fluid (SF) samples from seven joints of four volunteers who had no clinical signs or symptoms involving the temporomandibular joint (TMJ) or disc displacement. We collected SF cells from all patients during therapeutic arthrocentesis. The infiltrating cells from TMJ SF were cultured, differentiated into tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and examined bone resorption activities. We also investigated factors related to osteoclast induction of SF, using ELISA procedures. Osteoclast-like cells were induced from the SF cells obtained from all patients with condylar fractures. These multinucleated giant cells were positive for TRAP and actin, and had the ability to absorb dentin slices. The levels of macrophage colony-stimulating factor (M-CSF), prostaglandin E2 (PGE2), soluble form of receptor activator of nuclear factor kappa-B ligand (sRANKL) and osteoprotegerin (OPG), in SF samples from the patients, were significantly higher than in the controls. These findings indicate that bone resorption activities in SF from patients with mandibular condyle fractures were upregulated and may participate in the pathogenesis and wound healing. © 2016 The Authors. Journal of Oral Rehabilitation Published by John Wiley & Sons Ltd.

An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia.

PubMed

Malkoc, Melih; Korkmaz, Ozgur; Ormeci, Tugrul; Oltulu, Ismail; Isyar, Mehmet; Mahirogulları, Mahir

2014-01-01

Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for last one month and after imaging studies posterior longitudinal tibial stress fracture was detected on his left tibia. After six months the patient was admitted to our clinic with the same type of complaints in his right leg. All imaging modalities and blood counts were performed and as a result longitudinal posterior tibial stress fractures were detected on his right tibia. Treatment of tibial stress fracture includes rest and modified activity, followed by a graded return to activity commensurate with bony healing. We have applied the same treatment protocol and our results were acceptable but our follow up time short for this reason our study is restricted for separate stress fractures of the posterior tibia. Although the main localization of tibial stress fractures were unilateral, anterior and transverse pattern, rarely, like in our case, the unusual bilateral posterior localization and longitudinal pattern can be seen. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Fatigue Fractures

PubMed Central

Morris, James M.

1968-01-01

Fatigue (or stress) fracture of bone in military recruits has been recognized for many years. Most often it is a metatarsal bone that is involved but the tarsal bones, calcaneus, tibia, fibula, femur, and pelvis are occasionally affected. Reports of such fractures in the ribs, ulna and vertebral bodies may be found in the literature. In recent years, there has been increasing awareness of the occurrence of fatigue fractures in the civilian population. Weekend sportsmen, athletes in an early phase of training, and persons engaged in unaccustomed, repetitive, vigorous activity are potential victims of such a fracture. The signs and symptoms, roentgenographic findings, treatment and etiology of fatigue fractures are dealt with in this presentation. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:5652745

Active shape modeling of the hip in the prediction of incident hip fracture.

PubMed

Baker-LePain, Julie C; Luker, Kali R; Lynch, John A; Parimi, Neeta; Nevitt, Michael C; Lane, Nancy E

2011-03-01

The objective of this study was to evaluate right proximal femur shape as a risk factor for incident hip fracture using active shape modeling (ASM). A nested case-control study of white women 65 years of age and older enrolled in the Study of Osteoporotic Fractures (SOF) was performed. Subjects (n = 168) were randomly selected from study participants who experienced hip fracture during the follow-up period (mean 8.3 years). Controls (n = 231) had no fracture during follow-up. Subjects with baseline radiographic hip osteoarthritis were excluded. ASM of digitized right hip radiographs generated 10 independent modes of variation in proximal femur shape that together accounted for 95% of the variance in proximal femur shape. The association of ASM modes with incident hip fracture was analyzed by logistic regression. Together, the 10 ASM modes demonstrated good discrimination of incident hip fracture. In models controlling for age and body mass index (BMI), the area under receiver operating characteristic (AUROC) curve for hip shape was 0.813, 95% confidence interval (CI) 0.771-0.854 compared with models containing femoral neck bone mineral density (AUROC = 0.675, 95% CI 0.620-0.730), intertrochanteric bone mineral density (AUROC = 0.645, 95% CI 0.589-0.701), femoral neck length (AUROC = 0.631, 95% CI 0.573-0.690), or femoral neck width (AUROC = 0.633, 95% CI 0.574-0.691). The accuracy of fracture discrimination was improved by combining ASM modes with femoral neck bone mineral density (AUROC = 0.835, 95% CI 0.795-0.875) or with intertrochanteric bone mineral density (AUROC = 0.834, 95% CI 0.794-0.875). Hips with positive standard deviations of ASM mode 4 had the highest risk of incident hip fracture (odds ratio = 2.48, 95% CI 1.68-3.31, p < .001). We conclude that variations in the relative size of the femoral head and neck are important determinants of incident hip fracture. The addition of hip shape to fracture-prediction tools may improve the risk

Parametrization in models of subcritical glass fracture: Activation offset and concerted activation

NASA Astrophysics Data System (ADS)

Rodrigues, Bruno Poletto; Hühn, Carolin; Erlebach, Andreas; Mey, Dorothea; Sierka, Marek; Wondraczek, Lothar

2017-08-01

There are two established but fundamentally different empirical approaches to parametrize the rate of subcritical fracture in brittle materials. While both are relying on a thermally activated reaction of bond rupture, the difference lies in the way as to how the externally applied stresses affect the local energy landscape. In the consideration of inorganic glasses, the strain energy is typically taken as an off-set on the activation barrier. As an alternative interpretation, the system’s volumetric strain-energy is added to its thermal energy. Such an interpretation is consistent with the democratic fiber bundle model. Here, we test this approach of concerted activation against macroscopic data of bond cleavage activation energy, and also against ab initio quantum chemical simulation of the energy barrier for cracking in silica. The fact that both models are able to reproduce experimental observation to a remarkable degree highlights the importance of a holistic consideration towards non-empirical understanding.

Is Vacation Apprenticeship of Undergraduate Life Science Students a Model for Human Capacity Development in the Life Sciences?

NASA Astrophysics Data System (ADS)

Thelma Downs, Colleen

2010-03-01

A life sciences undergraduate apprenticeship initiative was run during the vacations at a South African university. In particular, the initiative aimed to increase the number of students from disadvantaged backgrounds. Annually 12-18 undergraduate biology students were apprenticed to various institutions during the January and July vacations from 2005 to 2007. This was to develop their skills and interests in the biological sciences, particularly in biocontrol and entomology. Results suggest that this "grassroots" approach increased the number of Black and female students in the life sciences. In particular, it developed their knowledge of the discipline of science and of how it progresses. For most students it enthused and motivated them in the pursuit of their studies and in considering postgraduate research. Students benefited socially from the interactions with researchers and staff, and learnt the protocols of research institutions. Economically most students benefited as they had financial loans for their studies, and the additional monies assisted them in meeting some of the payments. It is proposed that this undergraduate apprenticeship be used as a model for human capacity development at an undergraduate level that can be adopted in the other sciences and universities. This provides an alternative to the current South African National Research Foundation model, a top-down approach, that is aimed at recruiting Black and female students at the postgraduate level.

Pain and fracture-related limitations persist 6 months after a fragility fracture.

PubMed

Sale, Joanna E M; Frankel, Lucy; Thielke, Stephen; Funnell, Larry

2017-08-01

Our objective was to examine the experience of pain after a fracture beyond the conventional healing duration of 6 months. We conducted a phenomenological study in participants who were deemed high risk for future fracture and recruited through an urban fracture clinic in Toronto, Canada. In-depth interviews were conducted with questions addressing the experience of pain, the status of recovery from the fracture, ways in which the fracture affected one's daily activities, and interactions with health care providers. Two researchers coded the transcripts within the phenomenological perspective to develop a structure of the pain experience, promoting rigour through the use of multiple analysts, searching for negative cases, and supporting claims with direct quotations from participants. We interviewed 21 participants who had sustained fractures of the wrist (n = 4), hip (n = 6), vertebrae (n = 2), and multiple or other locations (n = 9). All patients were ambulatory, had a range of socioeconomic status, and lived in the community. Eleven of the 21 participants reported persistent pain at the site of the fracture. Of the 10 participants who reported no pain, four indicated they had ongoing difficulties with range of motion and specific activities and two others described persistent pain from a previous fracture or reliance on a scooter for mobility. Our study demonstrated that over two-thirds of older adults reported fracture-related pain and/or limitations at, or beyond, 6 months post-fracture. We suggest that health care providers ask questions about post-fracture pain and/or limitations when assessing fracture status beyond 6 months.

Converting unused vacation days to retiree medical benefits: a proposed partial solution to an emerging national crisis.

PubMed

Saxon, Donald R

2003-06-01

Costs for retiree medical benefits are spiraling upward. One way to help fund this area of compensation, with little or no additional financial burden to either employers or employees, could be using an employee benefit plan whereby each year's unused vacation days and sick days are transferred into an employee's tax-free account in a voluntary employee benefit association (VEBA) trust. On retirement, the account is used to purchase a (pre-Medicare) retiree medical plan, prescription drug benefit, a Medicare supplemental policy and/or simply make Medicare premium payments.

The role of physical activity in bone health: a new hypothesis to reduce risk of vertebral fracture.

PubMed

Sinaki, Mehrsheed

2007-08-01

Locomotion has always been a major criterion for human survival. Thus, it is no surprise that science supports the dependence of bone health on weight-bearing physical activities. The effect of physical activity on bone is site-specific. Determining how to perform osteogenic exercises, especially in individuals who have osteopenia or osteoporosis, without exceeding the biomechanical competence of bone always poses a dilemma and must occur under medical advice. This article presents the hypothesis that back exercises performed in a prone position, rather than a vertical position, may have a greater effect on decreasing the risk for vertebral fractures without resulting in compression fracture. The risk for vertebral fractures can be reduced through improvement in the horizontal trabecular connection of vertebral bodies.

A Study of High School Attendance Representing Mexican Culture from the Perspective of Students, Parents, and Teachers: A Policy Recommendation for Student Vacations

ERIC Educational Resources Information Center

Jenkins, Tomorrow S.

2009-01-01

Kennett High School faces an attendance problem with a portion of its Mexican student population. These students vacation for a period of time beyond the winter break established by the district's school calendar. A practice was implemented when staff members noticed that students "disappeared" mostly in December and January. This project took a…

Incidence and epidemiology of tibial shaft fractures.

PubMed

Larsen, Peter; Elsoe, Rasmus; Hansen, Sandra Hope; Graven-Nielsen, Thomas; Laessoe, Uffe; Rasmussen, Sten

2015-04-01

The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. Retrospective reviews of clinical and radiological records. A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010. The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity.

PubMed

Morin, Vincent; Pailhé, Régis; Sharma, Akash; Rouchy, René-Christopher; Cognault, Jérémy; Rubens-Duval, Brice; Saragaglia, Dominique

2016-06-01

Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers. We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up. Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement. In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by

Adults With Idiopathic Scoliosis Diagnosed at Youth Experience Similar Physical Activity and Fracture Rate as Controls.

PubMed

Diarbakerli, Elias; Grauers, Anna; Danielsson, Aina; Gerdhem, Paul

2017-04-01

Cross-sectional. To describe physical activity level and fracture rates in adults with idiopathic scoliosis, diagnosed before maturity, and to compare with a control group. A previous study found a lower level of sporting activities in adults treated for idiopathic scoliosis compared with controls. Other studies have shown a lower bone mass in adults with idiopathic scoliosis compared with controls. One thousand two hundred seventy-eight adults (aged 18-71 yr) with idiopathic scoliosis and 214 controls (aged 18-70 yr) were included and answered the International Physical Activity Questionnaire - Short Form (IPAQ-SF) and questions about previous fractures. The three scoliosis treatment groups (untreated n = 360, brace n = 460, and surgically treated n = 458) were compared. Furthermore, a comparison based on onset (juvenile n = 169 or adolescent n = 976) was performed. Achieved weekly moderate activity level and metabolic equivalent task (MET) minutes/week were assessed for patients and controls. Statistical comparisons were made with analysis of covariance with adjustments for age, body mass index, and sex. The proportion achieving weekly moderate activity level was 962 out of 1278 for individuals with idiopathic scoliosis (75%) and 157 out of 214 (73%) for controls (P = 0.40). The scoliosis patients reported 2016 MET-minutes/week (median value) and the controls 2456 (P = 0.06). Fracture rates did not differ (P = 0.72). Fewer surgically treated individuals achieved moderate activity level (P = 0.046) compared with the untreated and the previously braced individuals. No difference was seen regarding MET-minutes/week (P = 0.86). No differences were seen between individuals with a juvenile onset compared with individuals with an adolescent onset (all P ≥ 0.05). Adults with idiopathic scoliosis have similar physical activity level and do not sustain more fractures compared with controls. Adults with surgically treated

Different effects of age, adiposity and physical activity on the risk of ankle, wrist and hip fractures in postmenopausal women

PubMed Central

Armstrong, Miranda E.G.; Cairns, Benjamin J.; Banks, Emily; Green, Jane; Reeves, Gillian K.; Beral, Valerie

2012-01-01

While increasing age, decreasing body mass index (BMI), and physical inactivity are known to increase hip fracture risk, whether these factors have similar effects on other common fractures is not well established. We used prospectively-collected data from a large cohort to examine the role of these factors on the risk of incident ankle, wrist and hip fractures in postmenopausal women. 1,155,304 postmenopausal participants in the Million Women Study with a mean age of 56.0 (SD 4.8) years, provided information about lifestyle, anthropometric, and reproductive factors at recruitment in 1996–2001. All participants were linked to National Health Service cause-specific hospital records for day-case or overnight admissions. During follow-up for an average of 8.3 years per woman, 6807 women had an incident ankle fracture, 9733 an incident wrist fracture, and 5267 an incident hip fracture. Adjusted absolute and relative risks (RRs) for incident ankle, wrist, and hip fractures were calculated using Cox regression models. Age-specific rates for wrist and hip fractures increased sharply with age, whereas rates for ankle fracture did not. Cumulative absolute risks from ages 50 to 84 years per 100 women were 2.5 (95%CI 2.2–2.8) for ankle fracture, 5.0 (95%CI 4.4–5.5) for wrist fracture, and 6.2 (95%CI 5.5–7.0) for hip fracture. Compared with lean women (BMI < 20 kg/m2), obese women (BMI ≥ 30 kg/m2) had a three-fold increased risk of ankle fracture (RR = 3.07; 95%CI 2.53–3.74), but a substantially reduced risk of wrist fracture and especially of hip fracture (RR = 0.57; 0.51–0.64 and 0.23; 0.21–0.27, respectively). Physical activity was associated with a reduced risk of hip fracture but was not associated with ankle or wrist fracture risk. Ankle, wrist and hip fractures are extremely common in postmenopausal women, but the associations with age, adiposity, and physical activity differ substantially between the three fracture sites. PMID:22465850

Stress fractures: diagnosis, treatment, and prevention.

PubMed

Patel, Deepak S; Roth, Matt; Kapil, Neha

2011-01-01

Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.

Direct Imaging of Natural Fractures and Stress Compartments Stimulated by Hydraulic Fracturing

NASA Astrophysics Data System (ADS)

Lacazette, A.; Vermilye, J. M.

2014-12-01

This contribution will present results from passive seismic studies of hydraulic fracture treatments in North American and Asian basins. One of the key data types is a comparatively new surface-based seismic imaging product - "Tomographic Fracture Images®" (TFI®). The procedure is an extension of Seismic Emission Tomography (SET), which is well-established and widely used. Conventional microseismic results - microearthquake hypocenter locations, magnitudes, and focal mechanism solutions - are also obtained from the data via a branch of the processing workflow. TFI is accomplished by summing the individual time steps in a multidimensional SET hypervolume over extended periods of time, such as an entire frac stage. The dimensions of a SET hypervolume are the X, Y, and Z coordinates of the voxels, the time step (typically on the order of 100 milliseconds), and the seismic activity value. The resulting summed volume is skeletonized to produce images of the main fracture surfaces, which are known to occupy the maximum activity surfaces of the high activity clouds from theory, field studies, and experiments. The orientation vs. area of the resulting TFIs can be analyzed in detail and compared with independent data sets such as volumetric structural attributes from reflection seismic data and borehole fracture data. We find that the primary effect of hydraulic fracturing is to stimulate preexisting natural fracture networks and faults. The combination of TFIs with hypocenter distributions and microearthquake focal mechanisms provides detailed information on subsurface stress compartmentalization. Faults are directly imaged which allows discrimination of fault planes from auxiliary planes of focal mechanism solutions. Examples that will be shown include simultaneous movement on a thrust fault and tear fault and examples of radically different stress compartments (e.g. extensional vs. wrench faulting) stimulated during a single hydraulic fracture treatment. The figure

Decreased activity of daily living produced by the combination of Alzheimer's disease and lower limb fracture in elderly requiring nursing care.

PubMed

Inagawa, Toshimitsu; Hamagishi, Toshio; Takaso, Yuji; Hitomi, Yoshiaki; Kambayashi, Yasuhiro; Hibino, Yuri; Shibata, Aki; Ngoc, Nguyen T M; Okochi, Jiro; Hatta, Kotaro; Takamuku, Kiyoshi; Konoshita, Tadashi; Nakamura, Hiroyuki

2013-01-01

Alzheimer's disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture. We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants. We recognized that activities of cognitive function (p < 0.001), eating (dysphagia) (p < 0.001), eating (feeding) (p < 0.001), and toilet use (p < 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p < 0.05), transfer and locomotion (p < 0.001), and bathing (p < 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p < 0.001), dysphagia (p < 0.01), feeding (p < 0.001), and toilet use (p < 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery. These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.

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

PubMed

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

2010-08-01

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

Effects of Vacation Rental Websites on the Concentration of Tourists-Potential Environmental Impacts. An Application to the Balearic Islands in Spain.

PubMed

Martín, José María Martín; Martín, José Antonio Rodriguez; Mejía, Karla Aída Zermeño; Fernández, José Antonio Salinas

2018-02-15

The concentration of tourists at certain times of the year can damage sensitive environments. The use of peer-to-peer vacation rental websites has increased greatly during the last decade. This system could either reduce seasonality in touristic destinations where the tourist activity takes place throughout the year at a lower price or on the contrary, it could increase the number of visitors at certain times of the year even more. This paper intends to analyze the effect that these platforms have on tourism seasonality in order to calculate if they help reduce or increase the pressure on the destinations. To do so, the Gini Index has been applied to one of the main touristic spots in Europe, the Balearic Islands in Spain. The conclusion is that this type of accommodation has aggravated the problem, generating a greater concentration of tourists and a higher pressure on the resources of the islands.

Management of hip fractures pre- and post-Major Trauma Centre activation.

PubMed

Wong, Ken; Rich, James; Yip, Grace; Loizou, Constantinos; Hull, Peter

2015-10-01

In April 2012, the activation of the regional trauma networks in England was carried out to improve the organisation of trauma care. NHS Trusts that could meet the highest standard of care to complex trauma were designated Major Trauma Centres (MTCs). MTCs receive patients fulfilling certain triage criteria, as well as secondary transfers from nearby trauma units. While complex trauma care is streamlined with this new organisation, the impact this would have on the rest of the trauma workload within MTCs as well as non-MTC hospitals is uncertain. We investigate whether the management of hip fracture cases had suffered as a result of a trauma unit becoming a MTC. Summary data was collated from the National Hip Fracture Database website for the periods of April 2011-April 2012 (the 'pre-MTC' activation period) and April 2012-April 2013 (the 'post-MTC' activation period). As our primary outcome, we compared the time to surgery within 36h between MTCs and non-MTCs for the periods detailed above. Other outcome measures were: reasons for delay to surgery, length of acute stay, proportion of cases meeting Best Practice Tariff criteria. A total of 54,897 and 55,998 fNOF patients were included for all hospitals in England in the pre- and post-MTC periods respectively. For MTCs, a weighted mean average of 66.6% patients had surgery within 36h in the pre-MTC period versus 71.4% of patients in the post MTC period (p<0.0001). For non-MTCs, a weighted mean average of 70.0% of patients had surgery within 36h in the pre-MTC period versus 73.8% of patients in the post-MTC period (p<0.0001). Non-MTCs in both pre- and post-MTC activation periods were therefore better in percentage of patients receiving surgery within 36h. The data presented suggests that the creation of MTCs has not had a deleterious effect on the management of hip fracture patients. This paper aims to stimulate the important discussion of maintaining a consistently improving standard throughout the spectrum of

A systematic review of evidence for older adults' sedentary behavior and physical activity after hip fracture.

PubMed

Zusman, Enav Z; Dawes, Martin G; Edwards, Nicola; Ashe, Maureen C

2018-05-01

To synthesize evidence on older adults' sedentary behavior and physical activity during rehabilitation and recovery for hip fracture (1) across the care continuum and (2) from clinical interventions. We conducted a systematic review of peer-reviewed publications using CINAHL, Embase, Ovid MEDLINE, PsycINFO, and SportDiscus (last search: 17 October 2017). We included studies that measured sedentary behavior and physical activity of older adults with hip fracture using activity monitors (e.g. accelerometers). We identified literature at Level 1 (title and abstract) and Level 2 (full text), and conducted forward and backward searches. We assessed observational studies' adherence to reporting guidelines and intervention studies' risk of bias. We included 14 studies (882 participants). Four studies reported sedentary behavior data, while all studies reported information on physical activity. Settings included hospital, rehabilitation centers, and the community. Nine studies were observational; five were experimental design. Older adults had excessive sedentary time (>10 hours/day) and low physical activity. Participants' average upright time differed across settings. During hospital stay, it ranged 16-52 minutes/day, while in the community, it ranged 51-261 minutes/day. Data from five interventions reported on physical activity change: two studies increased between 14 and 27 minutes/day. Another study reported participants accumulated 6994 steps/day at the end of the intervention, but for two other interventions, activity was below 5000 steps/day. Based on available evidence, older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery.

Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial.

PubMed

Katzman, W B; Vittinghoff, E; Kado, D M; Lane, N E; Ensrud, K E; Shipp, K

2016-03-01

Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. We used data from the Fracture Intervention Trial among 3038 women 55-81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. Mean baseline kyphosis was 48° (SD = 12) (range 7-83). At baseline, 962 (32%) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95% CI 2.8-4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22% increase (95% CI 8-38%, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8% per 10° kyphosis (95% CI -4 to 22%, p = 0.18). While greater kyphosis increased the rate of incident vertebral fractures, our analysis does not

Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial

PubMed Central

Vittinghoff, E.; Kado, D. M.; Lane, N. E.; Ensrud, K. E.; Shipp, K.

2016-01-01

Summary Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. Introduction Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. Methods We used data from the Fracture Intervention Trial among 3038 women 55–81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. Results Mean baseline kyphosis was 48° (SD = 12) (range 7–83). At baseline, 962 (32 %) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95 % CI 2.8–4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22 % increase (95 % CI 8–38 %, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8 % per 10° kyphosis (95 % CI −4 to 22 %, p = 0.18). Conclusions While greater kyphosis increased the rate of

"How I Spent My Summer Vacation": Time-Use Data from the Spring 2001 BCTF Worklife of Teachers Workload Issues and Stress Survey. BCTF Research Report.

ERIC Educational Resources Information Center

Schaefer, Anne C.

The British Columbia Teachers' Federation surveyed 1,500 teachers regarding workload issues and stress. This report examines teachers' use of time during summer. Teachers described how many of the 9 summer vacation weeks they spent taking holidays, teaching summer school, working in employment other than teaching summer school, taking educational…

[Iliac spine fractures in children].

PubMed

Sułko, Jerzy; Olipra, Wojciech

2010-01-01

Iliac spine fractures in children are a form of avulsion fractures at mechanically weak spot caused by the presence of the growth plate. Presentation of observations concerning treatment and results of iliac spine fractures in children. 49 children (1 girl and 48 boys). Age, at the time of injury, average 15.1 years (10.6-18 years). We analyzed medical and radiological documentation of patients. 17 patients sustained anterior superior iliac spine fractures (ASIS), 32 fracture of the inferior iliac spine (AIIS). Most of injuries happened during sport activities--27 patients suffered fracture while playing football. 37 patients asked for medical advice immediately after the injury. Rest of patients, who came late--sustained AIIS fracture. We hospitalized 26 patients (53%), all of them suffered significant pain. The average length of stay in hospital was 8 days. All patients were treated conservatively. All of the fractures healed without complications. Larger study than ours group, concerning 84 patients with iliac spine fractures, was presented only by Italian authors who analyzed injures of professional athletes. In literature reviewed conservative treatment strongly predominates. Only a small group of patients were treated surgically (including athletes treated by Croatian surgeons). The treatment of iliac spines in children should be conservative, consisting of a couple days of bed rest and then for 2-3 weeks walking on crutches with only toe touching until the pain resolves. We recommend return to full activities after 2 months.

Factors that influence exercise activity among women post hip fracture participating in the Exercise Plus Program.

PubMed

Resnick, Barbara; Orwig, Denise; D'Adamo, Christopher; Yu-Yahiro, Janet; Hawkes, William; Shardell, Michelle; Golden, Justine; Zimmerman, Sheryl; Magaziner, Jay

2007-01-01

Using a social ecological model, this paper describes selected intra- and interpersonal factors that influence exercise behavior in women post hip fracture who participated in the Exercise Plus Program. Model testing of factors that influence exercise behavior at 2, 6 and 12 months post hip fracture was done. The full model hypothesized that demographic variables; cognitive, affective, physical and functional status; pain; fear of falling; social support for exercise, and exposure to the Exercise Plus Program would influence self-efficacy, outcome expectations, and stage of change both directly and indirectly influencing total time spent exercising. Two hundred and nine female hip fracture patients (age 81.0 +/- 6.9), the majority of whom were Caucasian (97%), participated in this study. The three predictive models tested across the 12 month recovery trajectory suggest that somewhat different factors may influence exercise over the recovery period and the models explained 8 to 21% of the variance in time spent exercising. To optimize exercise activity post hip fracture, older adults should be helped to realistically assess their self-efficacy and outcome expectations related to exercise, health care providers and friends/peers should be encouraged to reinforce the positive benefits of exercise post hip fracture, and fear of falling should be addressed throughout the entire hip fracture recovery trajectory.

Tarsal navicular stress fractures: radiographic evaluation

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

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

1983-09-01

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

Coupled Fracture and Flow in Shale in Hydraulic Fracturing

NASA Astrophysics Data System (ADS)

Carey, J. W.; Mori, H.; Viswanathan, H.

2014-12-01

Production of hydrocarbon from shale requires creation and maintenance of fracture permeability in an otherwise impermeable shale matrix. In this study, we use a combination of triaxial coreflood experiments and x-ray tomography characterization to investigate the fracture-permeability behavior of Utica shale at in situ reservoir conditions (25-50 oC and 35-120 bars). Initially impermeable shale core was placed between flat anvils (compression) or between split anvils (pure shear) and loaded until failure in the triaxial device. Permeability was monitored continuously during this process. Significant deformation (>1%) was required to generate a transmissive fracture system. Permeability generally peaked at the point of a distinct failure event and then dropped by a factor of 2-6 when the system returned to hydrostatic failure. Permeability was very small in compression experiments (< 1 mD), possibly because of limited fracture connectivity through the anvils. In pure share experiments, shale with bedding planes perpendicular to shear loading developed complex fracture networks with narrow apertures and peak permeability of 30 mD. Shale with bedding planes parallel to shear loading developed simple fractures with large apertures and a peak permeability as high as 1 D. Fracture systems held at static conditions for periods of several hours showed little change in effective permeability at hydrostatic conditions as high as 140 bars. However, permeability of fractured systems was a function of hydrostatic pressure, declining in a pseudo-linear, exponential fashion as pressure increased. We also observed that permeability decreased with increasing fluid flow rate indicating that flow did not follow Darcy's Law, possibly due to non-laminar flow conditions, and conformed to Forscheimer's law. The coupled deformation and flow behavior of Utica shale, particularly the large deformation required to initiate flow, indicates the probable importance of activation of existing

Sacral Fractures and Associated Injuries

PubMed Central

Kurd, Mark F.; Schroeder, Gregory D.; Kepler, Christopher K.; Krieg, James C.; Holstein, Jörg H.; Bellabarba, Carlo; Firoozabadi, Reza; Oner, F. Cumhur; Kandziora, Frank; Dvorak, Marcel F.; Kleweno, Conor P.; Vialle, Luiz R.; Rajasekaran, S.; Schnake, Klause J.; Vaccaro, Alexander R.

2017-01-01

Study Design: Literature review. Objective: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome. Methods: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures. Results: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration. Conclusions: Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management. PMID:28989838

On Subsurface Fracture Opening and Closure

NASA Astrophysics Data System (ADS)

Wang, Y.

2016-12-01

Mechanistic understanding of fracture opening and closure in geologic media is of significant importance to nature resource extraction and waste management, such as geothermal energy extraction, oil/gas production, radioactive waste disposal, and carbon sequestration and storage). A dynamic model for subsurface fracture opening and closure has been formulated. The model explicitly accounts for the stress concentration around individual aperture channels and the stress-activated mineral dissolution and precipitation. A preliminary model analysis has demonstrated the importance of the stress-activated dissolution mechanism in the evolution of fracture aperture in a stressed geologic medium. The model provides a reasonable explanation for some key features of fracture opening and closure observed in laboratory experiments, including a spontaneous switch from a net permeability reduction to a net permeability increase with no changes in a limestone fracture experiment.

Hydraulic Fracturing for Oil and Gas: Impacts from the ...

EPA Pesticide Factsheets

This final report provides a review and synthesis of available scientific information concerning the relationship between hydraulic fracturing activities and drinking water resources in the United States. The report is organized around activities in the hydraulic fracturing water cycle and their potential to impact drinking water resources.  The stages include: (1) acquiring water to be used for hydraulic fracturing (Water Acquisition), (2) mixing the water with chemical additives to prepare hydraulic fracturing fluids (Chemical Mixing), (3) injecting the hydraulic fracturing fluids into the production well to create fractures in the targeted production zone (Well Injection), (4) collecting the wastewater that returns through the well after injection (Produced Water Handling), and (5) managing the wastewater via disposal or reuse methods (Wastewater Disposal and Reuse). EPA found scientific evidence that hydraulic fracturing activities can impact drinking water resources under some circumstances. The report identifies certain conditions under which impacts from hydraulic fracturing activities can be more frequent or severe: Water withdrawals for hydraulic fracturing in times or areas of low water availability, particularly in areas with limited or declining groundwater resources; Spills during the handling of hydraulic fracturing fluids and chemicals or produced water that result in large volumes or high concentrations of chem

Clinical usefulness of fracture site in situ block on lumbar spine transverse process fracture.

PubMed

Park, Jun-Mo; Kwak, Kyung-Hwa

2014-11-01

Lumbar spine transverse process fractures (LSTPFs) are uncommon and frequently overlooked on plain film radiographs. Even when recognized, they are often regarded as trivial and minimally painful injuries compared with combined serious major abdominal, pelvic, and spinal injuries. Conservative treatments are usually offered to patients with LSTPFs. This report presents 4 cases of LSTPFs where symptoms did not improve after more than 1 week of conservative management. Local anesthetics and steroids were injected directly into the fracture site under computed tomography guidance, referred to as a fracture site in situ block, in an attempt to accelerate the return to daily lives and professional activities. Three of the 4 patients returned to their daily lives almost immediately after completing the procedure. Although the procedure was appropriately performed at L4, 1 patient still complained of pain. This patient's all films were meticulously re-examined, and it was determined that a transverse process fracture was present at not only L4 but also L1. This report introduces a method of active treatment to help patients with LSTPFs quickly return to their daily lives and professional activities. The positive results in these cases suggest that fracture site in situ block might be a useful option for treating patients with LSTPFs. © 2014 World Institute of Pain.

Electromyography assessment in zygomaticomaxillary complex fractures.

PubMed

Waheed El-Anwar, Mohammad; Elsheikh, Ezzeddin; Sweed, Ahmed Hassan; Ezzeldin, Nillie

2015-12-01

The aim of this study was to assess the activity of the masseter and temporalis muscles using surface electromyography (EMG) in patients with zygomaticomaxillary complex (ZMC) fractures. This prospective study was carried out on 25 patients who had ZMC fractures. Fifteen patients were managed by open reduction and rigid fixation (ORIF) using titanium miniplates. This study, using surface electromyography, analyzed the activity of the masseter and temporalis muscles of 25 patients with ZMC fractures; 15 of them were surgically treated under general anesthesia (GA). Evaluations were made before surgery and 6 weeks after surgery by recording the mean of muscle contraction of 20 motor unit action potential (MUAP) against resistance, and statistical analyses were performed. A significant EMG difference between the normal and ZMC fracture sides was found (P < 0.0001) for both masseter and temporalis muscles and was significantly improved after ORIF. However, postoperative EMV values of the repaired side was significantly less than measured postoperatively in the normal side (P < 0.0001) for both muscles. ZMC fractures significantly diminish muscular activity of the masseter and temporalis and even though significant recovery of muscle activity was revealed after 6 weeks, it is still less than normal activity, highlighting the importance of postoperative rehabilitation.

Ligand field splittings in core level transitions for transition metal (TM) oxides: Tanabe-Sugano diagrams and (TM) dangling bonds in vacated O-atom defects

NASA Astrophysics Data System (ADS)

Lucovsky, Gerry; Wu, Kun; Pappas, Brian; Whitten, Jerry

2013-04-01

Defect states in the forbidden band-gap below the conduction band edge are active as electron traps in nano-grain high-) transition metal (TM) oxides with thickness >0.3 nm, e.g., ZrO2 and HfO2. These oxides have received considerable attention as gate-dielectrics in complementary metal oxide semiconductor (CMOS) devices, and more recently are emerging as candidates for charge storage and memory devices. To provide a theoretical basis for device functionality, ab-initio many-electron theory is combined with X-ray absorption spectroscopy (XAS) to study O K edge and TM core level transitions. These studies identify ligand field splittings (ΔLF) for defect state features,. When compared with those obtained from O-atom and TM-atom core spectroscopic transitions, this provides direct information about defect state sun-nm bonding arrangements. comparisons are made for (i) elemental TiO2 and Ti2O3 with different formal ionic charges, Ti4+ and Ti3+ and for (ii) Magneli Phase alloys, TinO2n-1, n is an integer 9>=n>3, and (TiO2)x(HfO2)1-x alloys. The alloys display multi-valent behavior from (i) different ionic-charge states, (ii} local bond-strain, and (iii) metallic hopping transport. The intrinsic bonding defects in TM oxides are identified as pairs of singly occupied dangling bonds. For 6-fold coordinated Ti-oxides defect excited states in 2nd derivative O K pre-edge spectra are essentially the same as single Ti-atom d2 transitions in Tanabe-Sugano (T-S) diagrams. O-vacated site defects in 8-fold coordinated ZrO2 and HfO2 are described by d8 T-S diagrams. T-S defect state ordering and splittings are functions of the coordination and symmetry of vacated site bordering TM atoms. ΔLF values from the analysis of T-S diagrams indicate medium range order (MRO) extending to 3rd and 4th nearest-neighbor (NN) TM-atoms. Values are different for 6-fold Ti, and 8-fold ZrO2 and HfO2, and scale inversely with differences in respective formal ionic radii. O-vacated site bonding

Effects of Vacation Rental Websites on the Concentration of Tourists—Potential Environmental Impacts. An Application to the Balearic Islands in Spain

PubMed Central

Rodriguez Martín, José Antonio; Zermeño Mejía, Karla Aída; Salinas Fernández, José Antonio

2018-01-01

The concentration of tourists at certain times of the year can damage sensitive environments. The use of peer-to-peer vacation rental websites has increased greatly during the last decade. This system could either reduce seasonality in touristic destinations where the tourist activity takes place throughout the year at a lower price or on the contrary, it could increase the number of visitors at certain times of the year even more. This paper intends to analyze the effect that these platforms have on tourism seasonality in order to calculate if they help reduce or increase the pressure on the destinations. To do so, the Gini Index has been applied to one of the main touristic spots in Europe, the Balearic Islands in Spain. The conclusion is that this type of accommodation has aggravated the problem, generating a greater concentration of tourists and a higher pressure on the resources of the islands. PMID:29462863

The Loss of Activating Transcription Factor 4 (ATF4) Reduces Bone Toughness and Fracture Toughness

PubMed Central

Makowski, Alexander J.; Uppuganti, Sasidhar; Waader, Sandra A.; Whitehead, Jack M.; Rowland, Barbara J.; Granke, Mathilde; Mahadevan-Jansen, Anita; Yang, Xiangli; Nyman, Jeffry S.

2014-01-01

Even though age-related changes to bone tissue affecting fracture risk are well characterized, only a few matrix-related factors have been identified as important to maintaining fracture resistance. As a gene critical to osteoblast differentiation, activating transcription factor 4 (ATF4) is possibly one of the seimportant factors. To test the hypothesis that the loss of ATF4 affects the fracture resistance of bone beyond bone mass and structure, we harvested bones from Atf4+/+ and Atf4−/− littermates at 8 and 20 weeks of age (n≥9 per group) for bone assessment across several length scales. From whole bone mechanical tests in bending, femurs from Atf4−/− mice were found to be brittle with reduced toughness and fracture toughness compared to femurs from Atf4+/+ mice. However, there were no differences in material strength and in tissue hardness, as determined by nanoindentation, between the genotypes, irrespective age. Tissue mineral density of the cortex at the point of loading as determined by micro-computed tomography was also not significantly different. However, by analyzing local composition by Raman Spectroscopy (RS), bone tissue of Atf4−/− mice was found to have higher mineral to collagen ratio compared to wild-type tissue, primarily at 20 weeks of age. From RS analysis of intact femurs at 2 orthogonal orientations relative to the polarization axis of the laser, we also found that the organizational-sensitive peak ratio, ν1 Phosphate per Amide I, changed to a greater extent upon bone rotation for Atf4-deficient tissue, implying bone matrix organization may contribute to the brittleness phenotype. Target genes of ATF4 activity are not only important to osteoblast differentiation but also maintaining bone toughness and fracture toughness. PMID:24509412

The loss of activating transcription factor 4 (ATF4) reduces bone toughness and fracture toughness.

PubMed

Makowski, Alexander J; Uppuganti, Sasidhar; Wadeer, Sandra A; Whitehead, Jack M; Rowland, Barbara J; Granke, Mathilde; Mahadevan-Jansen, Anita; Yang, Xiangli; Nyman, Jeffry S

2014-05-01

Even though age-related changes to bone tissue affecting fracture risk are well characterized, only a few matrix-related factors have been identified as important to maintaining fracture resistance. As a gene critical to osteoblast differentiation, activating transcription factor 4 (ATF4) is possibly one of these important factors. To test the hypothesis that the loss of ATF4 affects the fracture resistance of bone beyond bone mass and structure, we harvested bones from Atf4+/+ and Atf4-/- littermates at 8 and 20 weeks of age (n≥9 per group) for bone assessment across several length scales. From whole bone mechanical tests in bending, femurs from Atf4-/- mice were found to be brittle with reduced toughness and fracture toughness compared to femurs from Atf4+/+ mice. However, there were no differences in material strength and in tissue hardness, as determined by nanoindentation, between the genotypes, irrespective of age. Tissue mineral density of the cortex at the point of loading as determined by micro-computed tomography was also not significantly different. However, by analyzing local composition by Raman Spectroscopy (RS), bone tissue of Atf4-/- mice was found to have higher mineral to collagen ratio compared to wild-type tissue, primarily at 20 weeks of age. From RS analysis of intact femurs at 2 orthogonal orientations relative to the polarization axis of the laser, we also found that the organizational-sensitive peak ratio, ν1Phosphate per Amide I, changed to a greater extent upon bone rotation for Atf4-deficient tissue, implying bone matrix organization may contribute to the brittleness phenotype. Target genes of ATF4 activity are not only important to osteoblast differentiation but also in maintaining bone toughness and fracture toughness. Published by Elsevier Inc.

Vacation model for Markov machine repair problem with two heterogeneous unreliable servers and threshold recovery

NASA Astrophysics Data System (ADS)

Jain, Madhu; Meena, Rakesh Kumar

2018-03-01

Markov model of multi-component machining system comprising two unreliable heterogeneous servers and mixed type of standby support has been studied. The repair job of broken down machines is done on the basis of bi-level threshold policy for the activation of the servers. The server returns back to render repair job when the pre-specified workload of failed machines is build up. The first (second) repairman turns on only when the work load of N1 (N2) failed machines is accumulated in the system. The both servers may go for vacation in case when all the machines are in good condition and there are no pending repair jobs for the repairmen. Runge-Kutta method is implemented to solve the set of governing equations used to formulate the Markov model. Various system metrics including the mean queue length, machine availability, throughput, etc., are derived to determine the performance of the machining system. To provide the computational tractability of the present investigation, a numerical illustration is provided. A cost function is also constructed to determine the optimal repair rate of the server by minimizing the expected cost incurred on the system. The hybrid soft computing method is considered to develop the adaptive neuro-fuzzy inference system (ANFIS). The validation of the numerical results obtained by Runge-Kutta approach is also facilitated by computational results generated by ANFIS.

Recovery of physical activity levels in adolescents after lower limb fractures: a longitudinal, accelerometry-based activity monitor study.

PubMed

Ceroni, Dimitri; Martin, Xavier; Lamah, Léopold; Delhumeau, Cécile; Farpour-Lambert, Nathalie; De Coulon, Geraldo; Ferrière, Victor Dubois

2012-07-25

In adolescents, loss of bone mineral mass usually occurs during phases of reduced physical activity (PA), such as when an injured extremity spends several weeks in a cast. We recorded the PA of adolescents with lower limb fractures during the cast immobilization, at 6 and at 18 months after the fracture, and we compared these values with those of healthy controls. Fifty adolescents with a first episode of limb fracture and a control group of 50 healthy cases were recruited for the study through an advertisement placed at the University Children's Hospital of Geneva, Switzerland. PA was assessed during cast immobilization and at 6- and 18-month follow-up by accelerometer measurement (Actigraph(®) 7164, MTI, Fort Walton Beach, FL, USA). Patients and their healthy peers were matched for gender and age. Time spent in PA at each level of intensity was determined for each participant and expressed in minutes and as a percentage of total valid time. From the 50 initial teenagers with fractures, 44 sustained functional evaluations at 6 months follow-up, whereas only 38 patients were studied at 18 months. The total PA count (total number of counts/min) was lower in patients with lower limb fractures (-62.4%) compared with healthy controls (p<0.0001) during cast immobilization. Similarly, time spent in moderate-to-vigorous PA was lower by 76.6% (p<0.0001), and vigorous PA was reduced by 84.4% (p<0.0001) in patients with cast immobilization for lower limb injuries compared to healthy controls values. At 6 and 18 months after the fracture, the mean PA level of injured adolescents was comparable to those of healthy teenagers (-2.3%, and -1.8%, respectively).Importantly, we observed that time spent in vigorous PA, which reflects high-intensity forces beneficial to skeletal health, returned to similar values between both groups from the six month follow-up in adolescents who sustained a fracture. However, a definitive reduction in time spent in moderate PA was observed among

Expected Values for Pedometer-Determined Physical Activity in Youth

ERIC Educational Resources Information Center

Tudor-Locke, Catrine; McClain, James J.; Hart, Teresa L.; Sisson, Susan B.; Washington, Tracy L.

2009-01-01

This review assembles pedometry literature focused on youth, with particular attention to expected values for habitual, school day, physical education class, recess, lunch break, out-of-school, weekend, and vacation activity. From 31 studies published since 1999, we constructed a youth habitual activity step-curve that indicates: (a) from ages 6…

Physical Activity in the Acute Ward Following Hip Fracture Surgery is Associated with Less Fear of Falling.

PubMed

Kronborg, Lise; Bandholm, Thomas; Palm, Henrik; Kehlet, Henrik; Kristensen, Morten Tange

2016-10-01

Early mobilization following hip fracture surgery reduces medical complications and mortality, but may increase the risk of falling. The aim was to objectively measure the physical activity (time spent upright) the first week after hip fracture surgery and relate it to functional performance and fear of falling at discharge. The 24-hr upright time was measured for a median of six days using a thigh-worn accelerometer in 37 patients (mean 80 years ± 8.4) and increased from median 13 (IQR 6-31) min to 46 (11-107) min at day 7. More upright time at discharge was associated with less fear of falling (r = -.48, p = .01, n = 27), which also was associated with fast gait speed (r = -.50, p = .02, n = 23) and a faster Timed Up and Go test time (r = .54, p < .01, n = 22), indicating a need for further studies on motivation and limitations for more physical activity following hip fracture surgery.

Unexpected timely fracture union in matrix metalloproteinase 9 deficient mice.

PubMed

Yuasa, Masato; Saito, Masanori; Molina, Cesar; Moore-Lotridge, Stephanie N; Benvenuti, Michael A; Mignemi, Nicholas A; Okawa, Atsushi; Yoshii, Toshitaka; Schwartz, Herbert S; Nyman, Jeffry S; Schoenecker, Jonathan G

2018-01-01

Immediately following a fracture, a fibrin laden hematoma is formed to prevent bleeding and infection. Subsequently, the organized removal of fibrin, via the protease plasmin, is essential to permit fracture repair through angiogenesis and ossification. Yet, when plasmin activity is lost, the depletion of fibrin alone is insufficient to fully restore fracture repair, suggesting the existence of additional plasmin targets important for fracture repair. Previously, activated matrix metalloproteinase 9 (MMP-9) was demonstrated to function in fracture repair by promoting angiogenesis. Given that MMP-9 is a defined plasmin target, it was hypothesized that pro-MMP-9, following plasmin activation, promotes fracture repair. This hypothesis was tested in a fixed murine femur fracture model with serial assessment of fracture healing. Contrary to previous findings, a complete loss of MMP-9 failed to affect fracture healing and union through 28 days post injury. Therefore, these results demonstrated that MMP-9 is dispensable for timely fracture union and cartilage transition to bone in fixed femur fractures. Pro-MMP-9 is therefore not a significant target of plasmin in fracture repair and future studies assessing additional plasmin targets associated with angiogenesis are warranted.

Fracture of the fabella.

PubMed

Woo, C C

1988-10-01

A very rare case of traumatic avulsion fracture of the fabella in a middle-age lady, presented as intermittent posterolateral localized knee pain accentuated by compression against the lateral femoral condyle and by active and passive knee extension, is illustrated. The accumulated chronic microtrauma of the osteoarthritic fabello femoral joint in this lady especially during the whip-kick of daily breaststroke swimming for over 30 yr, may precipitate a fabella stress fracture. Radiographs reveal bilateral fabellae with a left bipartite fabella as a stress fracture traversing it without displacement; this later became a completely displaced bipartite avulsion fracture after accidental knee hyperextension. Conservative treatment consisted of anti-inflammatory/analgesic cream, cryotherapy, TENS, strapping and avoiding knee hyperextension.

Pediatric fractures during skateboarding, roller skating, and scooter riding.

PubMed

Zalavras, Charalampos; Nikolopoulou, Georgia; Essin, Daniel; Manjra, Nahid; Zionts, Lewis E

2005-04-01

Skateboarding, roller skating, and scooter riding are popular recreational and sporting activities for children and adolescents but can be associated with skeletal injury. The purpose of this study is to describe the frequency and characteristics of fractures resulting from these activities. Fractures from skateboarding, roller skating, and scooter riding compose a considerable proportion of pediatric musculoskeletal injuries. Case series; Level of evidence, 4. Demographic data and injury characteristics were analyzed for all patients who presented to the pediatric fracture clinic of the level I trauma center from January 2001 to May 2002 after sustaining fractures due to skateboarding, roller skating, and scooter riding. Among a total of 2371 fractures, the authors identified 325 fractures (13.7%) that occurred during one of these activities. There were 187 patients (mean age, 13 years; 95% male) who sustained 191 skateboard-related fractures, 64 patients (mean age, 10.8 years; 54% male) who sustained 65 fractures while roller skating, and 66 patients (mean age, 9.7 years; 64% male) who sustained 69 fractures while riding a scooter. The forearm was fractured most often, composing 48.2% of skate-boarding fractures, 63.1% of roller-skating fractures, and 50.7% of fractures due to scooter riding. Of the forearm fractures, 94% were located in the distal third. In the skateboarding group, 10 of 191 (5.2%) fractures were open injuries of the forearm, compared to 6 of 2046 (0.3%) fractures caused by other mechanisms of injury (significant odds ratio, 18.8). Skateboarding, roller-skating, and scooter-riding accidents result in a large proportion of pediatric fractures. An open fracture, especially of the forearm, was more likely to be caused by skateboarding than by other mechanisms of injury. Use of wrist and forearm protective equipment should be considered in all children who ride a skateboard.

Active and passive seismic imaging of a hydraulic fracture in diatomite

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

Vinegar, H.J.; Wills, P.B.; De Martini, D.C.

1992-01-01

This paper reports on a comprehensive set of experiments including remote- and treatment-well microseismic monitoring, interwell shear-wave shadowing, and surface tiltmeter arrays, that was used to monitor the growth of a hydraulic fracture in the Belridge diatomite. To obtain accurate measurements, and extensive subsurface network of geophones was cemented spanning the diatomite formation in three closely spaced observation wells around the well to be fracture treated. Data analysis indicates that the minifracture and main hydraulic fracture stimulations resulted in a nearly vertical fracture zone (striking N26{degrees}E) vertically segregated into two separate elements, the uppermost of which grew 60 ft abovemore » the perforated interval. The interwell seismic effects are consistent with a side process zone of reduced shear velocity, which remote-well microseismic data independently suggest may be as wide as 40 ft. The experiments indicate complicated processes occurring during hydraulic fracturing that have significant implications for stimulation, waterflooding, in fill drilling, and EOR. These processes are neither well understood nor included in current hydraulic fracture models.« less

Fracture-permeability behavior of shale

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

Carey, J. William; Lei, Zhou; Rougier, Esteban

The fracture-permeability behavior of Utica shale, an important play for shale gas and oil, was investigated using a triaxial coreflood device and X-ray tomography in combination with finite-discrete element modeling (FDEM). Fractures generated in both compression and in a direct-shear configuration allowed permeability to be measured across the faces of cylindrical core. Shale with bedding planes perpendicular to direct-shear loading developed complex fracture networks and peak permeability of 30 mD that fell to 5 mD under hydrostatic conditions. Shale with bedding planes parallel to shear loading developed simple fractures with peak permeability as high as 900 mD. In addition tomore » the large anisotropy in fracture permeability, the amount of deformation required to initiate fractures was greater for perpendicular layering (about 1% versus 0.4%), and in both cases activation of existing fractures are more likely sources of permeability in shale gas plays or damaged caprock in CO₂ sequestration because of the significant deformation required to form new fracture networks. FDEM numerical simulations were able to replicate the main features of the fracturing processes while showing the importance of fluid penetration into fractures as well as layering in determining fracture patterns.« less

Fracture-permeability behavior of shale

DOE PAGES

Carey, J. William; Lei, Zhou; Rougier, Esteban; ...

2015-05-08

The fracture-permeability behavior of Utica shale, an important play for shale gas and oil, was investigated using a triaxial coreflood device and X-ray tomography in combination with finite-discrete element modeling (FDEM). Fractures generated in both compression and in a direct-shear configuration allowed permeability to be measured across the faces of cylindrical core. Shale with bedding planes perpendicular to direct-shear loading developed complex fracture networks and peak permeability of 30 mD that fell to 5 mD under hydrostatic conditions. Shale with bedding planes parallel to shear loading developed simple fractures with peak permeability as high as 900 mD. In addition tomore » the large anisotropy in fracture permeability, the amount of deformation required to initiate fractures was greater for perpendicular layering (about 1% versus 0.4%), and in both cases activation of existing fractures are more likely sources of permeability in shale gas plays or damaged caprock in CO₂ sequestration because of the significant deformation required to form new fracture networks. FDEM numerical simulations were able to replicate the main features of the fracturing processes while showing the importance of fluid penetration into fractures as well as layering in determining fracture patterns.« less

Transverse Stress Fracture of the Proximal Patella

PubMed Central

Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

2016-01-01

Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

Hydraulic fracturing in granite under geothermal conditions

USGS Publications Warehouse

Solberg, P.; Lockner, D.; Byerlee, J.D.

1980-01-01

The experimental hydraulic fracturing of granite under geothermal conditions produces tensile fracture at rapid fluid injection rates and shear fracture at slow injection rates and elevated differential stress levels. A sudden burst of acoustic emission activity accompanies tensile fracture formation whereas the acoustic emission rate increases exponentially prior to shear fracture. Temperature does not significantly affect the failure mechanism, and the experimental results have not demonstrated the occurrence of thermal fracturing. A critical result of these experiments is that fluid injection at intermediate rates and elevated differential stress levels increases permeability by more than an order of magnitude without producing macroscopic fractures, and low-level acoustic emission activity occurs simultaneously near the borehole and propagates outward into the specimen with time. Permeability measurements conducted at atmospheric pressure both before and after these experiments show that increased permeability is produced by permanent structural changes in the rock. Although results of this study have not demonstrated the occurrence of thermal fracturing, they suggest that fluid injection at certain rates in situ may markedly increase local permeability. This could prove critical to increasing the efficiency of heat exchange for geothermal energy extraction from hot dry rock. ?? 1980.

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.

[Bone fracture and the healing mechanisms. The role of BMP signaling in fracture healing].

PubMed

Imai, Yuuki; Takaoka, Kunio

2009-05-01

When bone tissue, which plays a central role in locomotive organs, is broken by trauma and decreased in its own function of support, it is lead to be remarkable decline in the activity of daily life (ADL). Recently, in a clinical situation, various treatments have been tried for prophylaxis of fractures, and these treatments have been rewarded with good results. However, fractures would be occurred in a certain amount and there would be serious problems in ADL if the treatment fails to repair fractures. Furthermore, fractures could spontaneously heal in several weeks, it can be achieved in early rehabilitation and improvement of ADL, if we can accelerate fracture healing. Bone morphogenetic proteins, which were advocated by Dr. Urist, would be expected to be a key to establish much better society especially for the old.

Novel Semiquantitative Bone Marrow Oedema Score and Fracture Score for the Magnetic Resonance Imaging Assessment of the Active Charcot Foot in Diabetes

PubMed Central

Meacock, L.; Donaldson, Ana; Isaac, A.; Briody, A.; Ramnarine, R.; Edmonds, M. E.; Elias, D. A.

2017-01-01

There are no accepted methods to grade bone marrow oedema (BMO) and fracture on magnetic resonance imaging (MRI) scans in Charcot osteoarthropathy. The aim was to devise semiquantitative BMO and fracture scores on foot and ankle MRI scans in diabetic patients with active osteoarthropathy and to assess the agreement in using these scores. Three radiologists assessed 45 scans (Siemens Avanto 1.5T, dedicated foot and ankle coil) and scored independently twenty-two bones (proximal phalanges, medial and lateral sesamoids, metatarsals, tarsals, distal tibial plafond, and medial and lateral malleoli) for BMO (0—no oedema, 1—oedema < 50% of bone volume, and 2—oedema > 50% of bone volume) and fracture (0—no fracture, 1—fracture, and 2—collapse/fragmentation). Interobserver agreement and intraobserver agreement were measured using multilevel modelling and intraclass correlation (ICC). The interobserver agreement for the total BMO and fracture scores was very good (ICC = 0.83, 95% confidence intervals (CI) 0.76, 0.91) and good (ICC = 0.62; 95% CI 0.48, 0.76), respectively. The intraobserver agreement for the total BMO and fracture scores was good (ICC = 0.78, 95% CI 0.6, 0.95) and fair to moderate (ICC = 0.44; 95% CI 0.14, 0.74), respectively. The proposed BMO and fracture scores are reliable and can be used to grade the extent of bone damage in the active Charcot foot. PMID:29230422

Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study

PubMed Central

Ibrahim, Nurul Izzah; Ahmad, Mohd Sharkawi; Zulfarina, Mohamed S; Zaris, Sharifah Nurul Aqilah Sayed Mohd; Mohamed, Isa Naina; Mohamed, Norazlina; Mokhtar, Sabarul Afian; Shuid, Ahmad Nazrun

2018-01-01

Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient’s ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that ‘age’ and ‘ability to walk before fracture’ were the determinant factors of dependent for ‘bathing’, ‘dressing’ and ‘toileting’. The ‘ability to walk before fracture’ was the determinant factor of dependent for ‘transferring’. ‘Age’ and ‘gender’ were the determinant factors of dependent for ‘continence’, while ‘age’ was the determinant factor of dependent for ‘feeding’. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study. PMID:29772744

Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study.

PubMed

Barrett-Connor, Elizabeth; Nielson, Carrie M; Orwoll, Eric; Bauer, Douglas C; Cauley, Jane A

2010-03-15

To study the causes and consequences of radiologically confirmed rib fractures (seldom considered in the context of osteoporosis) in community dwelling older men. Prospective cohort study (Osteoporotic Fractures in Men (MrOS) Study). 5995 men aged 65 or over recruited in 2000-2 from six US sites; 99% answered mailed questionnaires about falls and fractures every four months for a mean 6.2 (SD 1.3) year follow-up. New fractures validated by radiology reports; multivariate Cox proportional hazard ratios were used to evaluate factors independently associated with time to incident rib fracture; associations between baseline rib fracture and incident hip and wrist fracture were also evaluated. The incidence of rib fracture was 3.5/1000 person years, and 24% (126/522) of all incident non-spine fractures were rib fractures. Nearly half of new rib fractures (48%; n=61) followed falling from standing height or lower. Independent risk factors for an incident rib fracture were age 80 or above, low bone density, difficulty with instrumental activities of daily living, and a baseline history of rib/chest fracture. Men with a history of rib/chest fracture had at least a twofold increased risk of an incident rib fracture (adjusted hazard ratio 2.71, 95% confidence interval 1.86 to 3.95), hip fracture (2.05, 1.33 to 3.15), and wrist fracture (2.06, 1.14 to 3.70). Only 14/82 of men reported being treated with bone specific drugs after their incident rib fracture. Rib fracture, the most common incident clinical fracture in men, was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture. A history of rib fracture predicted a more than twofold increased risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture.

Vacated niches, competitive release and the community ecology of pathogen eradication

PubMed Central

Lloyd-Smith, James O.

2013-01-01

A recurring theme in the epidemiological literature on disease eradication is that each pathogen occupies an ecological niche, and eradication of one pathogen leaves a vacant niche that favours the emergence of new pathogens to replace it. However, eminent figures have rejected this view unequivocally, stating that there is no basis to fear pathogen replacement and even that pathogen niches do not exist. After exploring the roots of this controversy, I propose resolutions to disputed issues by drawing on broader ecological theory, and advance a new consensus based on robust mechanistic principles. I argue that pathogen eradication (and cessation of vaccination) leads to a ‘vacated niche’, which could be re-invaded by the original pathogen if introduced. Consequences for other pathogens will vary, with the crucial mechanisms being competitive release, whereby the decline of one species allows its competitors to perform better, and evolutionary adaptation. Hence, eradication can cause a quantitative rise in the incidence of another infection, but whether this leads to emergence as an endemic pathogen depends on additional factors. I focus on the case study of human monkeypox and its rise following smallpox eradication, but also survey how these ideas apply to other pathogens and discuss implications for eradication policy. PMID:23798698

Return to sports after ankle fractures: a systematic review.

PubMed

Del Buono, Angelo; Smith, Rebecca; Coco, Manuela; Woolley, Laurence; Denaro, Vincenzo; Maffulli, Nicola

2013-01-01

This review aims to provide information on the time athletes will take to resume sports activity following ankle fractures. We systematically searched Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports Discus and Google scholar databases using the combined keywords 'ankle fractures', 'ankle injuries', 'athletes', 'sports', 'return to sport', 'recovery', 'operative fixation', 'pinning', 'return to activity' to identify articles published in English, Spanish, French, Portuguese and Italian. Seven retrospective studies fulfilled our inclusion criteria. Of the 793 patients, 469 (59%) were males and 324 (41%) were females, and of the 356 ankle fractures we obtained information on, 338 were acute and 18 stress fractures. The general principles were to undertake open reduction and internal fixation of acute fractures, and manage stress fractures conservatively unless a thin fracture line was visible on radiographs. The best timing to return to sports after an acute ankle fracture is still undefined, given the heterogeneity of the outcome measures and results. The time to return to sports after an acute stress injury ranged from 3 to 51 weeks. When facing athletes with ankle fractures, associated injuries have to be assessed and addressed to improve current treatment lines and satisfy future expectancies. The best timing to return to sports after an ankle fracture has not been established yet. The ideas of the return to activity parameter and surgeon databases including sports-related information could induce research to progress.

Discrete Fracture Network Characterization of Fractured Shale Reservoirs with Implications to Hydraulic Fracturing Optimization

NASA Astrophysics Data System (ADS)

Jin, G.

2016-12-01

Shales are important petroleum source rocks and reservoir seals. Recent developments in hydraulic fracturing technology have facilitated high gas production rates from shale and have had a strong impact on the U.S. gas supply and markets. Modeling of effective permeability for fractured shale reservoirs has been challenging because the presence of a fracture network significantly alters the reservoir hydrologic properties. Due to the frequent occurrence of fracture networks, it is of vital importance to characterize fracture networks and to investigate how these networks can be used to optimize the hydraulic fracturing. We have conducted basic research on 3-D fracture permeability characterization and compartmentization analyses for fractured shale formations, which takes the advantages of the discrete fracture networks (DFN). The DFN modeling is a stochastic modeling approach using the probabilistic density functions of fractures. Three common scenarios of DFN models have been studied for fracture permeability mapping using our previously proposed techniques. In DFN models with moderately to highly concentrated fractures, there exists a representative element volume (REV) for fracture permeability characterization, which indicates that the fractured reservoirs can be treated as anisotropic homogeneous media. Hydraulic fracturing will be most effective if the orientation of the hydraulic fracture is perpendicular to the mean direction of the fractures. A DFN model with randomized fracture orientations, on the other hand, lacks an REV for fracture characterization. Therefore, a fracture permeability tensor has to be computed from each element. Modeling of fracture interconnectivity indicates that there exists no preferred direction for hydraulic fracturing to be most effective oweing to the interconnected pathways of the fracture network. 3-D fracture permeability mapping has been applied to the Devonian Chattanooga Shale in Alabama and the results suggest that an

Ontology of fractures

NASA Astrophysics Data System (ADS)

Zhong, Jian; Aydina, Atilla; McGuinness, Deborah L.

2009-03-01

Fractures are fundamental structures in the Earth's crust and they can impact many societal and industrial activities including oil and gas exploration and production, aquifer management, CO 2 sequestration, waste isolation, the stabilization of engineering structures, and assessing natural hazards (earthquakes, volcanoes, and landslides). Therefore, an ontology which organizes the concepts of fractures could help facilitate a sound education within, and communication among, the highly diverse professional and academic community interested in the problems cited above. We developed a process-based ontology that makes explicit specifications about fractures, their properties, and the deformation mechanisms which lead to their formation and evolution. Our ontology emphasizes the relationships among concepts such as the factors that influence the mechanism(s) responsible for the formation and evolution of specific fracture types. Our ontology is a valuable resource with a potential to applications in a number of fields utilizing recent advances in Information Technology, specifically for digital data and information in computers, grids, and Web services.

Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures.

PubMed

Nachtrab, O; Cassar-Pullicino, V N; Lalam, R; Tins, B; Tyrrell, P N M; Singh, J

2012-12-01

MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

PubMed

Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

2016-12-01

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

A Survey of Practice Patterns for Rehabilitation Post Elbow Fracture

PubMed Central

MacDermid, Joy C; Vincent, Joshua I; Kieffer, Leah; Kieffer, Ashley; Demaiter, Jennifer; MacIntosh, Stephanie

2012-01-01

Background and Purpose: Elbow fractures amount to 4.3% of all the fractures. The elbow is prone to stiffness after injury and fractures can often lead to significant functional impairment. Rehabilitation is commonly used to restore range of motion (ROM) and function. Practice patterns in elbow fracture rehabilitation have not been defined. The purpose of this study was to describe current elbow fracture rehabilitation practices; and compare those to the existing evidence base. Methods: Hand therapists (n=315) from the USA (92%) and Canada (8%) completed a web-based survey on their practice patterns and beliefs related to the acute (0-6 weeks) and functional (6-12 weeks) phases of elbow fracture rehabilitation. Results: More than 99% of respondents agreed that fracture severity, co-morbidities, time since fracture, compliance with an exercise program, psychological factors, and occupational demands are important prognostic indicators for optimal function. Strong agreement was found with the use of patient education (95%) and active ROM (86%) in the acute stage while, home exercise programs (99%), active ROM (99%), stretching (97%), strengthening (97%), functional activities (ADLs and routine tasks) (97%), passive ROM (95%), and active assisted ROM (95%) were generally used in the functional stage. The most commonly used impairment measures were goniometry (99%), Jamar dynamometry (97%), and hand held dynamometry (97%). Agreement on the use of patient-reported outcome measures was very minimal (1.3%- 35.6%). Conclusions: Exercise, education, and functional activity have high consensus as components of elbo fracture rehabilitation. Future research should focus on defining the optimal dosage and type of exercise/activity, and establish core measures to monitor outcomes of these interventions. PMID:23115603

Bilateral femoral neck stress fractures in a fire academy student.

PubMed

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

2010-10-11

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

Fracture formation post impact on Enceladus?

NASA Astrophysics Data System (ADS)

Craft, Kathleen; Roberts, James

2017-10-01

Saturn’s small icy moon Enceladus was observed by the Cassini mission to have jets of ice and vapor emanating from its southern polar terrain (SPT), creating a plume. The fact that the activity is only observed in one region has not been well explained. Hypotheses include a regional sea beneath the SPT or a global ocean that is thicker beneath the SPT, which feeds a group of fractures observed there called the tiger stripes. As Enceladus orbits Saturn, stresses acting on the moon may open and close the fractures enabling interior volatiles to escape and form the plume. Here we investigate how these fractures could have formed and the activity begun. We propose that an impact could have either punctured through or caused substantial melt and fracturing in an ice shell connecting to a liquid layer below. Our goal is to determine whether a formation of fractures resembling the tiger stripes could emerge post-impact.Previous work by Roberts and Stickle (LPSC 2017, #1955) modeled an impact into an ice shell over an ocean and calculated penetration depth and melt temperatures and volumes through the shell thickness. Fracturing would occur during and after the impact, the crater would collapse, water would begin to refreeze and subsequent fluid exchange would occur. Working forward from a point after impact and as the ice shell begins refreezing, we performed finite element modeling to simulate the probable formation of fractures based on the resulting stress regime. Here we explore fracture formation for shells ranging from 1 km to 5 km thick (consistent with gravity and libration studies), to explore formation as the shell cools and thickens through time. We emplaced several fractures, penetrating either entirely or partially across the base to surface. Fracture interactions, tidal stress forcing with orbital true anomalies and ocean water pressurization are considered free parameters in the model. We present results for a number of parameter value combinations and

Nonunion of an isolated cuboid fracture: a case report.

PubMed

Britton, Ed; Fazal, Muhammad Ali

2013-01-01

Nonunion of an isolated undisplaced cuboid fracture is unusual. We report a case of symptomatic nonunion of an isolated cuboid fracture after nonoperative treatment. Fracture union was achieved with surgery, and the patient returned to full activities.

Isotopic Evidence for Microbial Activity in Crystalline Bedrock Fractures - a Case Study from Olkiluoto, SW Finland

NASA Astrophysics Data System (ADS)

Sahlstedt, E. K.; Karhu, J.; Pitkänen, P.

2015-12-01

Changes in the geochemical environment in crystalline bedrock fractures were investigated using the stable isotopes of C, O and S in fracture filling minerals as tracers. Of special interest were the possible changes which may occur in the subsurface at low temperatures. Especially, the influence of microbial activity was recognized as a catalyst for inducing changes in the geochemical environment. The study site is the Olkiluoto island located on the western coast of Finland, planned to host a geological repository for nuclear waste. Fracture surfaces were investigated to recognize the latest mineralizations at the site. These fillings were comprised of thin plates or small euhedral crystals of calcite and pyrite. The carbon and sulfur isotope compositions of calcite and pyrite were measured from bulk material by conventional IRMS, and in situ by secondary ion mass spectrometry. A notable feature of the late-stage fillings was high variabilities in the δ13C values of calcite and the δ34S values of pyrite, which ranged from -53.8 ‰ to +31.6 ‰ and from -50.4 ‰ to +77.7 ‰, respectively. Based on the isotopic compositions of the fillings, several features in the past hydrogeochemical environment could be recognized. The isotopic composition of the fracture fillings indicate an environment which was stratified with respect to depth. Characteristic features include bacterial sulfate reduction (BSR) occurring at depths <111 m (bsl), and a methanogenetic environment at depths >50 m. It appears that methanic conditions were replaced by sulfate reduction at depths >50 m likely due to infiltration of SO42--rich brackish waters. Sulfate reducing bacteria used mainly surface derived organic carbon as electron donors. Some indication of minor methanotrophic activity was recognized in anomalously low δ13C values of calcite, down to -53.8 ‰, at the depth range of 34-54 m. This methanotrophic activity may have been related to bacteria using CH4 as an electron donor in

Fathoms Below: Propagation of Deep Water-driven Fractures and Implications for Surface Expression and Temporally-varying Activity at Europa

NASA Astrophysics Data System (ADS)

Walker, C. C.; Craft, K.; Schmidt, B. E.

2015-12-01

The fracture and failure of Europa's icy shell are not only observable scars of variable stress and activity throughout its evolution, they also serve key as mechanisms in the interaction of surface and subsurface material, and thus crucial aspects of the study of crustal overturn and ice shell habitability. Galileo images, our best and only reasonable-resolution views of Europa until the Europa Multiple Flyby Mission arrives in the coming decades, illustrates a single snapshot in time in Europa's history from which we deduce many temporally-based hypotheses. One of those hypotheses, which we investigate here, is that sub-surface water-both in the form of Great Lake-sized perched water pockets in the near-surface and the larger global ocean below-drives the deformation, fracture, and failure of the surface. Using Galileo's snapshot in time, we use a 2D/3D hydraulic fracturing model to investigate the propagation of vertical fractures upward into the ice shell, motion of water within and between fractures, and the subsequent break-up of ice over shallow water, forming the chaos regions and other smaller surface features. We will present results from a cohesive fragmentation model to determine the time over which chaos formation occurs, and use a fracking model to determine the time interval required to allow water to escape from basal fractures in the ice shell. In determining the style, energy, and timescale of these processes, we constrain temporal variability in observable activity and topography at the surface. Finally, we compare these results to similar settings on Earth-Antarctica-where we have much higher resolution imagery and observations to better understand how sub-surface water can affect ice surface morphology, which most certainly have implications for future flyby and surface lander exploration.

Fracture line morphology of complex proximal humeral fractures.

PubMed

Hasan, Afsana P; Phadnis, Joideep; Jaarsma, Ruurd L; Bain, Gregory I

2017-10-01

The aim of this study was to assess proximal humeral fracture patterns using 3-dimensional computed tomography images and relate them to the normal osseous landmarks and soft-tissue attachments. Forty-eight 3-dimensional computed tomography scans of proximal humeral fractures were retrospectively collected, and the fractures were transcribed onto proximal humeral templates. We analyzed the common location and orientation of the fracture lines, with a focus on fractures of the articular surface, tuberosities, metaphysis, and proximal diaphysis. These fractures were compared with the attachments of the rotator cuff and glenohumeral capsule. Fifty-two percent of the fractures involved the articular surface. No fractures passed through the bicipital groove, and fractures were more commonly found on the posterior lesser tuberosity and on the anterior greater tuberosity, coinciding with the intervals between the rotator cuff tendon insertions. Intracapsular fractures of the calcar were more common (68%) than extracapsular fractures (32%). On the anterolateral aspect of the proximal humerus, fractures radiated from the articular margin, vertically down through the tuberosity zone between the rotator cuff footprints, meeting horizontally oriented fractures in the metaphyseal zone. On the posterior aspect, vertical fractures from the tuberosity zone continued downward to the metaphyseal zone adjacent to the infraspinatus and teres minor footprints. Fractures of the proximal humerus follow characteristic patterns. Fractures frequently split the greater tuberosity and are closely related to the intervals of the rotator cuff attachments. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Training, Muscle Fatigue, and Stress Fractures

DTIC Science & Technology

1988-07-15

fractures in the lower appendicular skeleton of new recruits. During peacetime, stress fractures are by far the most co~m~n physical injury in the...research program is to study the etiology of the stress fracture lesion, and isolate any aspects of a physical regime which may exacerbate this...34 of remodelLig, to use the model to identify those areas of the cortex at greatest risk of failure, and the activities which accelerate the deleterious

Influence of natural fractures on hydraulic fracture propagation

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

Teufel, L.W.; Warpinski, N.R.

Hydraulic fracturing has become a valuable technique for the stimulation of oil, gas, and geothermal reservoirs in a variety of reservoir rocks. In many applications, only short fractures are needed for economic production. In low-permeability reservoirs, however, long penetrating fractures are generally needed, and in this case, natural fractures can be the cause of many adverse effects during a fracture treatment. Natural fractures can influence the overall geometry and effectiveness of the hydraulic fracture by: (1) arresting the vertical or lateral growth, (2) reducing total fracture length via fluid leakoff, (3) limiting proppant transport and placement, and (4) enhancing themore » creation of multiple or secondary fractures rather than a single planar hydraulic fracture. The result may range from negligible to catastrophic depending on the values of the ancillary treatment and reservoir parameters, such as the treating pressure, in-situ stresses, pore pressure, orientations of the natural fractures relative to principal in-situ stresses, spacing and distribution of the natural fractures, permeability, etc. Field observations from mineback experiments at DOE's Nevada Test Site and the multiwell experiment in Colorado, laboratory tests, and analyses of these data are integrated to describe the complex fracture behavior found and to provide guidelines for predicting when this complex fracturing will occur.« less

Influence of natural fractures on hydraulic fracture propagation

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

Teufel, L.W.; Warpinski, N.R.

Hydraulic fracturing has become a valuable technique for the stimulation of oil, gas, and geothermal reservoirs in a variety of reservoir rocks. In many applications, only short fractures are needed for economic production. In low-permeability reservoirs, however, long penetrating fractures are generally needed, and in this case, natural fractures can be the cause of many adverse effects during a fracture treatment. Natural fractures can influence the overall geometry and effectiveness of the hydraulic fracture by: (1) arresting the vertical or lateral growth, (2) reducing total fracture length via fluid leakoff, (3) limiting proppant transport and placement, and (4) enhancing themore » creation of multiple or secondary fractures rather than a single planar hydraulic fracture. The result may range from negligible to catastrophic depending on the values of the ancillary treatment and reservoir parameters, such as the treating pressure, in-situ stresses, pore pressure, orientations of the natural fractures relative to principle in-situ stresses, spacing and distribution of the natural fractures, permeability, etc. Field observations from mineback experiments at DOE's Nevada Test Site and the multiwell experiment in Colorado, laboratory tests, and analyses of these data are integrated to describe the complex fracture behavior found to an provide guidelines for predicting when this complex fracturing occurs.« less

Tilt and strain deformation induced by hydrologically active natural fractures: application to the tiltmeters installed in Sainte-Croix-aux-Mines observatory (France)

NASA Astrophysics Data System (ADS)

Longuevergne, Laurent; Florsch, Nicolas; Boudin, Frédéric; Oudin, Ludovic; Camerlynck, Christian

2009-08-01

We investigate the deformation induced by water pressure variations in hydrologically active natural fractures, and recorded by tiltmeters and strainmeters. The deformation associated with a single fracture is derived using finite-element modelling (FEM). A range in fracture geometries is explored, first to highlight the sensitivity of each geometrical parameter to the deformation, and secondly to allow transfer to observation sites. Water level variations in the fracture are then derived from a hydrological model, driven by observed rainfall, and calibrated on fracture water flow measurements. The modelling results are explicitly applied to constrain the local hydrological contribution to observations with the 100-m-long hydrostatic tiltmeter installed at Sainte-Croix-aux-Mines (France). Our study shows that well-founded physical modelling of local hydrological effect allows a substantial correction of records in observatories.

Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture.

PubMed

Obremskey, William; Agel, Julie; Archer, Kristin; To, Philip; Tornetta, Paul

2016-03-01

To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year. Retrospective review of prospective cohort. Multicenter Academic and Community hospitals. Four hundred thirty-seven patients with an isolated tibia fracture completed a 12-month assessment on pain and self-reported activity. Infrapatellar intramedullary nail. Demographic information, comorbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being "no pain" and 7 being a "very great deal of pain." Knee pain >4 was considered clinically significant. Patients reported if they were "able," "able with difficulty," or "unable" to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. In knee pain, 11% of patients reported a "good deal" to a "very great deal" of pain (>4), and 52% of patients reported "no" or "very little" pain at 12 months. In activity at 12 months, 26% and 29% of patients were unable to kneel or run, respectively, and 31% and 35% of patients, respectively, stated they were able with difficulty or unable to use stairs or walk. Clinically significant knee pain (>4/7) was present in 11% of patients 1 year after a tibia fracture. Of note, 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing, or walking prolonged distances. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Character, Incidence, and Predictors of Knee Pain and Activity after Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

PubMed Central

Obremskey, William; Agel, Julie; Archer, Kristin; To, Philip; Tornetta, Paul

2015-01-01

Objective To study the activity and incidence of knee pain after sustaining a isolated tibia fracture treated with an infrapatellar intramedullary nail at one year. Design Retrospective review of prospective cohort Setting Multicenter Academic and Community hospitals Patients 437 patients with an isolated tibia fracture completed a 12 month assessment on pain and self-reported activity. Intervention Infrapatellar Intramedullary Nail Outcomes Demographic information co-morbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being “no pain” and 7 being a “very great deal of pain.” Knee pain > 4 was considered clinically significant. Patients reported if they were “able”, “able with difficulty” or “unable” to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. Results Knee Pain: 11% percent of patients reported a “good deal” to a “very great deal” of pain (> 4). 52% of patients reported “no” or “very little” pain at 12 months. Activity at 12 months: 26% and 29% of patients were unable to kneel or run, respectively. 31% and 35% of patients respectively stated they were able with difficulty or unable to use stairs or walk. Conclusion Clinically significant knee pain (>4/7) was present in 11% of patients one year after a tibia fracture. 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing or walking prolonged distances. PMID:26496180

Central Japan's Atera Active Fault's Wide-Fractured Zone: An Examination of the Structure and In-situ Crustal Stress

NASA Astrophysics Data System (ADS)

Ikeda, R.; Omura, K.; Matsuda, T.; Mizuochi, Y.; Uehara, D.; Chiba, A.; Kikuchi, A.; Yamamoto, T.

2001-12-01

In-situ downhole measurements and coring within and around an active fault zone are needed to better understand the structure and material properties of fault rocks as well as the physical state of active faults and intra-plate crust. Particularly, the relationship between the stress concentration state and the heterogeneous strength of an earthquake fault zone is important to estimate earthquake occurrence mechanisms which correspond to the prediction of an earthquake. It is necessary to compare some active faults in different conditions of the chrysalis stage and their relation to subsequent earthquake occurrence. To better understand such conditions, "Active Fault Zone Drilling Project" has been conducted in the central part of Japan by the National Research Institute for Earth Science and Disaster Prevention. The Nojima fault which appeared on the surface by the 1995 Great Kobe earthquake (M=7.2) and the Neodani fault created by the 1981 Nobi earthquake, the greatest inland earthquake M=8.0 in Japan, have been drilled through the fault fracture zones. During these past four years, a similar experiment and research at the Atera fault, of which some parts seem to have been dislocated by the 1586 Tensyo earthquake, has been undertaken. The features of the Atera fault are as follows: (1) total length is about 70 km, (2) general trend is NW45_Kwith a left-lateral strike slip, (3) slip rate is estimated as 3-5 m/1000 yrs. and the average recurrence time as 1700 yrs., (4) seismicity is very low at present, and (5) lithologies around the fault are basically granitic rocks and rhyolite. We have conducted integrated investigations by surface geophysical survey and drilling around the Atera fault. Six boreholes have been drilled from the depth of 400 m to 630 m. Four of these boreholes are located on a line crossing the fracture zone of the Atera fault. Resistivity and gravity structures inferred from surface geophysical surveys were compared with the physical properties

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

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

Multiwell fracturing experiments. [Nitrogen foam fracture treatment

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

Warpinski, N.

The objective of the Multiwell fracturing experiments is to test and develop the technology for the efficient stimulation of tight, lenticular gas sands. This requires basic understanding of: (1) fracture behavior and geometry in this complex lithologic environment, and (2) subsequent production into the created fracture. The intricate interplay of the hydraulic fracture with the lens geometry, the internal reservoir characteristics (fractures, reservoir breaks, etc.), the in situ stresses, and the mechanical defects (fracture, bedding, etc.) need to be defined in order to develop a successful stimulation program. The stimulation phase of the Multiwell Experiment is concerned with: (1) determiningmore » important rock/reservoir properties that influence or control fracture geometry and behavior, (2) designing fracture treatments to achieve a desired size and objectives, and (3) conducting post-treatment analyses to evaluate the effectiveness of the treatment. Background statement, project description, results and evaluation of future plans are presented. 5 refs., 2 figs., 2 tabs.« less

FRACTURING FLUID CHARACTERIZATION FACILITY

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

Subhash Shah

2000-08-01

Hydraulic fracturing technology has been successfully applied for well stimulation of low and high permeability reservoirs for numerous years. Treatment optimization and improved economics have always been the key to the success and it is more so when the reservoirs under consideration are marginal. Fluids are widely used for the stimulation of wells. The Fracturing Fluid Characterization Facility (FFCF) has been established to provide the accurate prediction of the behavior of complex fracturing fluids under downhole conditions. The primary focus of the facility is to provide valuable insight into the various mechanisms that govern the flow of fracturing fluids andmore » slurries through hydraulically created fractures. During the time between September 30, 1992, and March 31, 2000, the research efforts were devoted to the areas of fluid rheology, proppant transport, proppant flowback, dynamic fluid loss, perforation pressure losses, and frictional pressure losses. In this regard, a unique above-the-ground fracture simulator was designed and constructed at the FFCF, labeled ''The High Pressure Simulator'' (HPS). The FFCF is now available to industry for characterizing and understanding the behavior of complex fluid systems. To better reflect and encompass the broad spectrum of the petroleum industry, the FFCF now operates under a new name of ''The Well Construction Technology Center'' (WCTC). This report documents the summary of the activities performed during 1992-2000 at the FFCF.« less

High-Risk Stress Fractures: Diagnosis and Management.

PubMed

McInnis, Kelly C; Ramey, Lindsay N

2016-03-01

Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Foal Fractures: Osteochondral Fragmentation, Proximal Sesamoid Bone Fractures/Sesamoiditis, and Distal Phalanx Fractures.

PubMed

Reesink, Heidi L

2017-08-01

Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

Self organized spatio-temporal structure within the fractured Vadose Zone: The influence of dynamic overloading at fracture intersections

NASA Astrophysics Data System (ADS)

LaViolette, Randall A.; Glass, Robert J.

2004-09-01

Under low flow conditions (where gravity and capillary forces dominate) within an unsaturated fracture network, fracture intersections act as capillary barriers to integrate flow from above and then release it as a pulse below. Water exiting a fracture intersection is often thought to enter the single connected fracture with the lowest invasion pressure. When the accumulated volume varies between intersections, the smaller volume intersections can be overloaded to cause all of the available fractures exiting an intersection to flow. We included the dynamic overloading process at fracture intersections within our previously discussed model where intersections were modeled as tipping buckets connected within a two-dimensional diamond lattice. With dynamic overloading, the flow behavior transitioned smoothly from diverging to converging flow with increasing overload parameter, as a consequence of a heterogeneous field, and they impose a dynamic structure where additional pathways activate or deactivate in time.

Stress Fractures of the Foot.

PubMed

Hossain, Munier; Clutton, Juliet; Ridgewell, Mark; Lyons, Kathleen; Perera, Anthony

2015-10-01

Stress fractures of the foot and ankle may be more common among athletes than previously reported. A low threshold for investigation is warranted and further imaging may be appropriate if initial radiographs remain inconclusive. Most of these fractures can be treated conservatively with a period of non-weight-bearing mobilization followed by gradual return to activity. Early surgery augmented by bone graft may allow athletes to return to sports earlier. Risk of delayed union, nonunion, and recurrent fracture is high. Many of the patients may also have risk factors for injury that should be modified for a successful outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

Fracture toughness and fracture behavior of CLAM steel in the temperature range of 450 °C-550 °C

NASA Astrophysics Data System (ADS)

Zhao, Yanyun; Liang, Mengtian; Zhang, Zhenyu; Jiang, Man; Liu, Shaojun

2018-04-01

In order to analyze the fracture toughness and fracture behavior (J-R curves) of China Low Activation Martensitic (CLAM) steel under the design service temperature of Test Blanket Module of the International Thermonuclear Experimental Reactor, the quasi-static fracture experiment of CLAM steel was carried out under the temperature range of 450 °C-550 °C. The results indicated that the fracture behavior of CLAM steel was greatly influenced by test temperature. The fracture toughness increased slightly as the temperature increased from 450 °C to 500 °C. In the meanwhile, the fracture toughness at 550 °C could not be obtained due to the plastic deformation near the crack tip zone. The microstructure analysis based on the fracture topography and the interaction between dislocations and lath boundaries showed two different sub-crack propagation modes: growth along 45° of the main crack direction at 450 °C and growth perpendicular to the main crack at 500 °C.

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

PubMed

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

2017-05-01

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

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

PubMed Central

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

2017-01-01

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

Fracture in Hydrogen-Implanted Germanium

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

Mazen, F.; Tauzin, A.; Sanchez, L.

2008-11-03

We have studied the mechanism of fracture in hydrogen-implanted Ge. First, the as-implanted Ge state and its evolution during subsequent annealing were characterized via TEM and FTIR-MIR spectroscopy. Results showed that the extended defects formation and growth follow the same basic mechanism in Ge as in Si, which is the reference material. Nevertheless, the global damage level in the implanted Ge layer is higher compared to Si. Second, the fracture step was studied via the fracture kinetics analysis, SIMS and AFM on the transferred layer. An activation energy comparable to the reported data from blistering studies was obtained. Just likemore » in Si, the Cmax of H in Ge measured via SIMS was found to decrease during the fracture anneal. This decrease is associated with the formation of gaseous H{sub 2} that pressurizes the internal cavities and then contributes to the fracture. Finally, a high roughness of the Ge transferred layer was measured, which results from the large thickness of the implantation damaged zone.« less

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.

Evaluation of permeable fractures in rock aquifers

NASA Astrophysics Data System (ADS)

Bok Lee, Hang

2015-04-01

In this study, the practical usefulness and fundamental applicability of a self-potential (SP) method for identifying the permeable fractures were evaluated by a comparison of SP methods with other geophysical logging methods and hydraulic tests. At a 10 m-shallow borehole in the study site, the candidates of permeable fractures crossing the borehole were first determined by conventional geophysical methods such as an acoustic borehole televiwer, temperature, electrical conductivity and gamma-gamma loggings, which was compared to the analysis by the SP method. Constant pressure injection and recovery tests were conducted for verification of the hydraulic properties of the fractures identified by various logging methods. The acoustic borehole televiwer and gamma-gamma loggings detected the open space or weathering zone within the borehole, but they cannot prove the possibility of a groundwater flow through the detected fractures. The temperature and electrical conductivity loggings had limitations to detect the fractured zones where groundwater in the borehole flows out to the surrounding rock aquifers. Comparison of results from different methods showed that there is a best correlation between the distribution of hydraulic conductivity and the variation of the SP signals, and the SP logging can estimate accurately the hydraulic activity as well as the location of permeable fractures. Based on the results, the SP method is recommended for determining the hydraulically-active fractures rather than other conventional geophysical loggings. This self-potential method can be effectively applied in the initial stage of a site investigation which selects the optimal location and evaluates the hydrogeological property of fractures in target sites for the underground structure including the geothermal reservoir and radioactive waste disposal.

[From educational and health tourism for children to social tourism: vacation camps in the Province of Buenos Aires, Argentina].

PubMed

Bruno, Perla

2015-12-01

The early twentieth century saw the rise of vacation camps for frail children as educational and health-giving experiences provided by medical and philanthropic organizations. This article analyzes some of these early experiences, seen here as the predecessors of social tourism, in the Province of Buenos Aires. A combination of written sources are examined, mainly institutional reports, periodicals such as the Monitor de la Educación Común - published by the Consejo Nacional de Educación (National Board of Education) - or laws, with photographs and plans for different examples. I argue that these buildings were both physical and cultural "brands" in the places where they were located, and that their architectural structure encapsulated ideas about leisure space and cures in unique natural environments.

Transverse Stress Fracture of the Proximal Patella: A Case Report.

PubMed

Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

2016-02-01

Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws.

Skull fracture

MedlinePlus

Basilar skull fracture; Depressed skull fracture; Linear skull fracture ... Skull fractures may occur with head injuries . The skull provides good protection for the brain. However, a severe impact ...

Olecranon stress fracture in a weight lifter: a case report

PubMed Central

Rao, P; Rao, S; Navadgi, B

2001-01-01

Stress fractures have been reported in the upper limb of sportspeople involved in upper limb dominated events. Olecranon stress fractures have been cited in baseball pitchers, javelin throwers, and gymnasts. The unusual case of a stress fracture of the olecranon in a young weight lifter is reported here. The minimally displaced stress fracture was treated with tension band and two Kirschner wires. The fracture healed in four months and the patient returned to light sports activity after six months. Key Words: weight lifter; olecranon; elbow; stress fracture PMID:11157469

Bilateral femoral supracondylar stress fractures in a cross country runner.

PubMed

Ross, Kate; Fahey, Mark

2008-08-01

Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.

Ballistic fractures: indirect fracture to bone.

PubMed

Dougherty, Paul J; Sherman, Don; Dau, Nathan; Bir, Cynthia

2011-11-01

Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Twenty-eight fresh frozen cadaveric diaphyseal tibia (2) and femurs (26) were implanted into ordnance gelatin blocks. Shots were fired using 9- and 5.56-mm bullets traversing through the gelatin only, passing close to the edge of the bone, but not touching, to produce an indirect fracture. High-speed video of the impact event was collected at 20,000 frames/s. Acquisition of the strain data were synchronized with the video at 20,000 Hz. The exact time of fracture was determined by analyzing and comparing the strain gauge output and video. Twenty-eight shots were fired, 2 with 9-mm bullets and 26 with 5.56-mm bullets. Eight indirect fractures that occurred were of a simple (oblique or wedge) pattern. Comparison of the average distance of the projectile from the bone was 9.68 mm (range, 3-20 mm) for fractured specimens and 15.15 mm (range, 7-28 mm) for nonfractured specimens (Student's t test, p = 0.036). In this study, indirect fractures were produced after passage of the projectile. Thus, the temporary cavity, not the sonic wave, was responsible for the indirect fractures.

Hydraulic fracture propagation modeling and data-based fracture identification

NASA Astrophysics Data System (ADS)

Zhou, Jing

Successful shale gas and tight oil production is enabled by the engineering innovation of horizontal drilling and hydraulic fracturing. Hydraulically induced fractures will most likely deviate from the bi-wing planar pattern and generate complex fracture networks due to mechanical interactions and reservoir heterogeneity, both of which render the conventional fracture simulators insufficient to characterize the fractured reservoir. Moreover, in reservoirs with ultra-low permeability, the natural fractures are widely distributed, which will result in hydraulic fractures branching and merging at the interface and consequently lead to the creation of more complex fracture networks. Thus, developing a reliable hydraulic fracturing simulator, including both mechanical interaction and fluid flow, is critical in maximizing hydrocarbon recovery and optimizing fracture/well design and completion strategy in multistage horizontal wells. A novel fully coupled reservoir flow and geomechanics model based on the dual-lattice system is developed to simulate multiple nonplanar fractures' propagation in both homogeneous and heterogeneous reservoirs with or without pre-existing natural fractures. Initiation, growth, and coalescence of the microcracks will lead to the generation of macroscopic fractures, which is explicitly mimicked by failure and removal of bonds between particles from the discrete element network. This physics-based modeling approach leads to realistic fracture patterns without using the empirical rock failure and fracture propagation criteria required in conventional continuum methods. Based on this model, a sensitivity study is performed to investigate the effects of perforation spacing, in-situ stress anisotropy, rock properties (Young's modulus, Poisson's ratio, and compressive strength), fluid properties, and natural fracture properties on hydraulic fracture propagation. In addition, since reservoirs are buried thousands of feet below the surface, the

Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study.

PubMed

Kihlström, Caroline; Möller, Michael; Lönn, Katarina; Wolf, Olof

2017-02-15

Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. Data were retrieved from the SFR on all clavicle fractures sustained by patients ≥ 15 years of age in 2013-2014 (n = 2 422) with regards to date of injury, cause of injury, fracture classification and treatment. Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 15-24 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

Stress fractures of the foot and ankle in athletes.

PubMed

Mayer, Stephanie W; Joyner, Patrick W; Almekinders, Louis C; Parekh, Selene G

2014-11-01

Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete. Clinical review. Level 5. Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving. A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient.

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

PubMed

Beaman, Douglas N; Gellman, Richard

2014-12-01

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

Modeling of fault activation and seismicity by injection directly into a fault zone associated with hydraulic fracturing of shale-gas reservoirs

DOE PAGES

Rutqvist, Jonny; Rinaldi, Antonio P.; Cappa, Frédéric; ...

2015-03-01

We conducted three-dimensional coupled fluid-flow and geomechanical modeling of fault activation and seismicity associated with hydraulic fracturing stimulation of a shale-gas reservoir. We simulated a case in which a horizontal injection well intersects a steeply dip- ping fault, with hydraulic fracturing channeled within the fault, during a 3-hour hydraulic fracturing stage. Consistent with field observations, the simulation results show that shale-gas hydraulic fracturing along faults does not likely induce seismic events that could be felt on the ground surface, but rather results in numerous small microseismic events, as well as aseismic deformations along with the fracture propagation. The calculated seismicmore » moment magnitudes ranged from about -2.0 to 0.5, except for one case assuming a very brittle fault with low residual shear strength, for which the magnitude was 2.3, an event that would likely go unnoticed or might be barely felt by humans at its epicenter. The calculated moment magnitudes showed a dependency on injection depth and fault dip. We attribute such dependency to variation in shear stress on the fault plane and associated variation in stress drop upon reactivation. Our simulations showed that at the end of the 3-hour injection, the rupture zone associated with tensile and shear failure extended to a maximum radius of about 200 m from the injection well. The results of this modeling study for steeply dipping faults at 1000 to 2500 m depth is in agreement with earlier studies and field observations showing that it is very unlikely that activation of a fault by shale-gas hydraulic fracturing at great depth (thousands of meters) could cause felt seismicity or create a new flow path (through fault rupture) that could reach shallow groundwater resources.« less

Modeling of fault activation and seismicity by injection directly into a fault zone associated with hydraulic fracturing of shale-gas reservoirs

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

Rutqvist, Jonny; Rinaldi, Antonio P.; Cappa, Frédéric

We conducted three-dimensional coupled fluid-flow and geomechanical modeling of fault activation and seismicity associated with hydraulic fracturing stimulation of a shale-gas reservoir. We simulated a case in which a horizontal injection well intersects a steeply dip- ping fault, with hydraulic fracturing channeled within the fault, during a 3-hour hydraulic fracturing stage. Consistent with field observations, the simulation results show that shale-gas hydraulic fracturing along faults does not likely induce seismic events that could be felt on the ground surface, but rather results in numerous small microseismic events, as well as aseismic deformations along with the fracture propagation. The calculated seismicmore » moment magnitudes ranged from about -2.0 to 0.5, except for one case assuming a very brittle fault with low residual shear strength, for which the magnitude was 2.3, an event that would likely go unnoticed or might be barely felt by humans at its epicenter. The calculated moment magnitudes showed a dependency on injection depth and fault dip. We attribute such dependency to variation in shear stress on the fault plane and associated variation in stress drop upon reactivation. Our simulations showed that at the end of the 3-hour injection, the rupture zone associated with tensile and shear failure extended to a maximum radius of about 200 m from the injection well. The results of this modeling study for steeply dipping faults at 1000 to 2500 m depth is in agreement with earlier studies and field observations showing that it is very unlikely that activation of a fault by shale-gas hydraulic fracturing at great depth (thousands of meters) could cause felt seismicity or create a new flow path (through fault rupture) that could reach shallow groundwater resources.« less

Fracture structures of active Nojima fault, Japan, revealed by borehole televiewer imaging

NASA Astrophysics Data System (ADS)

Nishiwaki, T.; Lin, A.

2017-12-01

Most large intraplate earthquakes occur as slip on mature active faults, any investigation of the seismic faulting process and assessment of seismic hazards require an understanding of the nature of active fault damage zones as seismogenic source. In this study, we focus on the fracture structures of the Nojima Fault (NF) that triggered the 1995 Kobe Mw 7.2 earthquake using ultrasonic borehole televiewer (BHTV) images from a borehole wall. The borehole used in this study was drilled throughout the NF at 1000 m in depth by a science project of Drilling into Fault Damage Zone(DFDZ) in 2016 (Lin, 2016; Miyawaki et al., 2016). In the depth of <230 m of the borehole, the rocks are composed of weak consolidated sandstone and conglomerate of the Plio-Pleistocene Osaka-Group and mudstone and sandstone of the Miocene Kobe Group. The basement rock in the depth of >230 m consist of pre-Neogene granitic rock. Based on the observations of cores and analysis of the BHTV images, the main fault plane was identified at a depth of 529.3 m with a 15 cm thick fault gouge zone and a damage zone of 100 m wide developed in the both sides of the main fault plane. Analysis of the BHTV images shows that the fractures are concentrated in two groups: N45°E (Group-1), parallel to the general trend of the NF, and another strikes N70°E (Group-2), oblique to the fault with an angle of 20°. It is well known that Riedel shear structures are common within strike-slip fault zones. Previous studies show that the NF is a right-lateral strike-slip fault with a minor thrust component, and that the fault damage zone is characterized by Riedel shear structures dominated by Y shears (main faults), R shears and P foliations (Lin, 2001). We interpret that the fractures of Group (1) correspond to Y Riedel fault shears, and those of Group (2) are R shears. Such Riedel shear structures indicate that the NF is a right-lateral strike-slip fault which is activated under a regional stress field oriented to the

Tracer Methods for Characterizing Fracture Creation in Engineered Geothermal Systems

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

Rose, Peter; Harris, Joel

2014-05-08

The aim of this proposal is to develop, through novel high-temperature-tracing approaches, three technologies for characterizing fracture creation within Engineered Geothermal Systems (EGS). The objective of a first task is to identify, develop and demonstrate adsorbing tracers for characterizing interwell reservoir-rock surface areas and fracture spacing. The objective of a second task is to develop and demonstrate a methodology for measuring fracture surface areas adjacent to single wells. The objective of a third task is to design, fabricate and test an instrument that makes use of tracers for measuring fluid flow between newly created fractures and wellbores. In one methodmore » of deployment, it will be used to identify qualitatively which fractures were activated during a hydraulic stimulation experiment. In a second method of deployment, it will serve to measure quantitatively the rate of fluid flowing from one or more activated fracture during a production test following a hydraulic stimulation.« less

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

Characterisation of Fractures and Fracture Zones in a Carbonate Aquifer Using Electrical Resistivity Tomography and Pricking Probe Methodes

NASA Astrophysics Data System (ADS)

Szalai, Sandor; Kovacs, Attila; Kuslits, Lukács; Facsko, Gabor; Gribovszki, Katalin; Kalmar, Janos; Szarka, Laszlo

2018-04-01

Position, width and fragmentation level of fracture zones and position, significance and characteristic distance of fractures were aimed to determine in a carbonate aquifer. These are fundamental parameters, e.g. in hydrogeological modelling of aquifers, due to their role in subsurface water movements. The description of small scale fracture systems is however a challenging task. In the test area (Kádárta, Bakony Mts, Hungary), two methods proved to be applicable to get reasonable information about the fractures: Electrical Resistivity Tomography (ERT) and Pricking-Probe (PriP). PriP is a simple mechanical tool which has been successfully applied in archaeological investigations. ERT results demonstrated its applicability in this small scale fracture study. PriP proved to be a good verification tool both for fracture zone mapping and detecting fractures, but in certain areas, it produced different results than the ERT. The applicability of this method has therefore to be tested yet, although its problems most probably origin from human activity which reorganises the near-surface debris distribution. In the test site, both methods displayed fracture zones including a very characteristic one and a number of individual fractures and determined their characteristic distance and significance. Both methods prove to be able to produce hydrogeologically important parameters even individually, but their simultaneous application is recommended to decrease the possible discrepancies.

[CLAVICLE FRACTURES IN CHILDREN--CIRCUMSTANCES AND CAUSES OF INJURY].

PubMed

Antabak, Anko; Matković, Nikša; Papeš, Dino; Karlo, Robert; Romić, Ivan; Fuchs, Nino; Madarić, Miroslav; Stilinović, Marina; Stanić, Lana; Luetić, Tomislav

2015-01-01

Clavicle fractures in children occur twice as often as in adults. During a child's growth period they account for 10-15% of all fractures sustained. The questions which should be asked are how these fractures are sustained and under which circumstances are the children injured. In the study 256 children with clavicle fractures treated during the period 2008-2013 were analyzed. The underlying cause and place of injuries were classified using the ICD-10 classification system, using environmental causes of injury. The circumstances were in each case accidental injury. Environmental causes were traffic accidents (V01-V99) or mishaps/accidents (W00-X59). Fracture injuries were caused in traffic accidents in 24 (9.4%), and in mishaps/accidents in 232 (90.6%) children. Of the injuries caused by mishaps/accidents, in 204 children these were caused by falls (W00-W19). In 123 of them the injuries were caused by falls from a ground level, and in 81 were from a greater height. Direct blow injuries, caused by another person or a blunt instrument, weere the causes of fractures seen in 28 children. Place of fracture sustainment was dominantly at home. This was followed by injuries sustained outside in recreational areas, while least were suffered at school or kindergarden facilities. Bicycle riding was the cause of clavicle fractures in 48 children, which was 18.7% of all fractures seen. Sports related injuries and fractures were seen in 47 (18.4%) out of 256 children: 30 in football, 10 in defensive sports (wrestling, judo, karate), three in hockey, while basketball and gymnastics accounted for two each. Preschool children were injured more often while in the care of their parents while school aged children were adaquately protected, but in after-school activities they were often injured. The most common injuries after school were those suffered in traffic accidents and recreational sports activities. In the adolescent period, the most common injuries seen were again those in

Assessment of the Potential Impacts of Hydraulic Fracturing for ...

EPA Pesticide Factsheets

This assessment provides a review and synthesis of available scientific literature and data to assess the potential for hydraulic fracturing for oil and gas to impact the quality or quantity of drinking water resources, and identifies factors affecting the frequency or severity of any potential impacts. The scope of this assessment is defined by the hydraulic fracturing water cycle which includes five main activities: Water acquisition – the withdrawal of ground or surface water needed for hydraulic fracturing fluids;Chemical mixing – the mixing of water, chemicals, and proppant on the well pad to create the hydraulic fracturing fluid;Well injection – the injection of hydraulic fracturing fluids into the well to fracture the geologic formation; Flowback and Produced water – the return of injected fluid and water produced from the formation to the surface, and subsequent transport for reuse, treatment, or disposal; andWastewater treatment and waste disposal – the reuse, treatment and release, or disposal of wastewater generated at the well pad, including produced water. This report can be used by federal, tribal, state, and local officials; industry; and the public to better understand and address vulnerabilities of drinking water resources to hydraulic fracturing activities. To assess the potential impacts of hydraulic fracturing on drinking water resources, if any, and to identify the driving factors that may affect the severity and frequency of s

Fractures in sport: Optimising their management and outcome

PubMed Central

Robertson, Greg AJ; Wood, Alexander M

2015-01-01

Fractures in sport are a specialised cohort of fracture injuries, occurring in a high functioning population, in which the goals are rapid restoration of function and return to play with the minimal symptom profile possible. While the general principles of fracture management, namely accurate fracture reduction, appropriate immobilisation and timely rehabilitation, guide the treatment of these injuries, management of fractures in athletic populations can differ significantly from those in the general population, due to the need to facilitate a rapid return to high demand activities. However, despite fractures comprising up to 10% of all of sporting injuries, dedicated research into the management and outcome of sport-related fractures is limited. In order to assess the optimal methods of treating such injuries, and so allow optimisation of their outcome, the evidence for the management of each specific sport-related fracture type requires assessment and analysis. We present and review the current evidence directing management of fractures in athletes with an aim to promote valid innovative methods and optimise the outcome of such injuries. From this, key recommendations are provided for the management of the common fracture types seen in the athlete. Six case reports are also presented to illustrate the management planning and application of sport-focussed fracture management in the clinical setting. PMID:26716081

An unusual fracture of the talus in a snowboarder.

PubMed

Vlahovich, A Tanja; Mehin, Ramin; O'Brien, Peter J

2005-08-01

Fractures of the talus are uncommon. However, snow- boarding and skateboarding are 2 activities that are specifically associated with talus fractures. These patients sustain occult lateral talus process fractures that present as a severe ankle injury. The diagnosis is difficult because of subtle clinical and plain radiographic findings. Computed tomography is a very useful tool for the assessment of these injuries. Although the majority of these athletes have lateral sided talus fractures, there are variants. We present an unusual case of a displaced intra-articular fracture of the subtalar joint involving the middle articular facet of the talus with extension of the fracture into the talar head. This highlights the importance of carefully assessing snowboarders' "ankle injuries."

20 CFR 628.710 - Period of program operation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... be conducted during the school vacation period occurring duri the summer months. (b) An SDA operating... full-time basis may offer SYETP activities to participants in such a jurisdiction during the school vacation period(s) treated as the period(s) equivalent to a school summer vacation. ...

20 CFR 628.710 - Period of program operation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... be conducted during the school vacation period occurring duri the summer months. (b) An SDA operating... full-time basis may offer SYETP activities to participants in such a jurisdiction during the school vacation period(s) treated as the period(s) equivalent to a school summer vacation. ...

Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

PubMed

Hinds, Richard M; Garner, Matthew R; Lazaro, Lionel E; Warner, Stephen J; Loftus, Michael L; Birnbaum, Jacqueline F; Burket, Jayme C; Lorich, Dean G

2015-02-01

The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level III, retrospective comparative study. © The Author(s) 2014.

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

PubMed

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

2016-12-01

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

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

Targeting Transforming Growth Factor Beta to Enhance the Fracture Resistance of Bone

DTIC Science & Technology

2013-01-01

Transforming Growth Factor Beta to Enhance the Fracture Resistance of Bone is to determine whether the suppression of TGF-β activity improves the fracture...effect primarily occurred in the old rats. Effect of TGF-β suppression on fracture resistance in female mice Since the suppression of TGF-β activity by...treated mice. This suggests that 1D11 treatment depleted the osteoprogenitor pool to some extent as inhibition of TGF-β activity in vivo may favor

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

PubMed

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

2017-04-01

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

Hydraulic fracture and resilience of epithelial monolayers under stretch

NASA Astrophysics Data System (ADS)

Arroyo, Marino; Lucantonio, Alessandro; Noselli, Giovanni; Casares, Laura; Desimone, Antonio; Trepat, Xavier

Epithelial monolayers are very simple and prevalent tissues. Their functions include delimiting distinct physicochemical containers and protecting us from pathogens. Epithelial fracture disrupts the mechanical integrity of this barrier, and hence compromises these functions. Here, we show that in addition to the conventional fracture resulting from excessive tissue tension, epithelia can hydraulically fracture under stretch as a result of the poroelastic nature of the matrix. We will provide experimental evidence of this counterintuitive mechanism of fracture, in which cracks appear under compression. Intriguingly, unlike tensional fracture, which is localized and catastrophic, hydraulic epithelial fracture is distributed and reversible. We will also describe the active mechanisms responsible for crack healing, and the physical principles by which the poroelastic matrix contributes to this resilient behavior.

Stress Fractures of the Foot and Ankle in Athletes

PubMed Central

Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.

2014-01-01

Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete. Study Design: Clinical review. Level of Evidence: Level 5. Results: Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving. Conclusion: A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient. PMID:25364480

Management of Simple Clavicle Fractures by Primary Care Physicians.

PubMed

Stepanyan, Hayk; Gendelberg, David; Hennrikus, William

2017-05-01

The clavicle is the most commonly fractured bone. Children with simple fractures are often referred to orthopedic surgeons by primary care physician to ensure adequate care. The objective of this study was to show that simple clavicle fractures have excellent outcomes and are within the scope of primary care physician's practice. We performed a retrospective chart review of 16 adolescents with simple clavicle fractures treated with a sling. Primary outcomes were bony union, pain, and function. The patients with simple clavicle fractures had excellent outcomes with no complications or complaints of pain or restriction of their activities of daily living. The outcomes are similar whether treated by an orthopedic surgeon or a primary care physician. The cost to society and the patient is less when the primary care physician manages the fracture. Therefore, primary care physicians should manage simple clavicle fractures.

Post-fracture management of patients with hip fracture: a perspective.

PubMed

Bruyere, O; Brandi, M-L; Burlet, N; Harvey, N; Lyritis, G; Minne, H; Boonen, S; Reginster, J-Y; Rizzoli, R; Akesson, K

2008-10-01

Hip fracture creates a worldwide morbidity, mortality and economic burden. After surgery, many patients experience long-term disability or die as a consequence of the fracture. A fracture is a major risk factor for a subsequent fracture, which may occur within a short interval. A literature search on post-fracture management of patients with hip fracture was performed on the Medline database. Key experts convened to develop a consensus document. Management of hip-fracture patients to optimize outcome after hospital discharge requires several stages of care co-ordinated by a multidisciplinary team from before admission through to discharge. Further studies that specifically assess prevention and post-fracture management of hip fracture are needed, as only one study to date has assessed an osteoporosis medication in patients with a recent hip fracture. Proper nutrition is vital to assist bone repair and prevent further falls, particularly in malnourished patients. Vitamin D, calcium and protein supplementation is associated with an increase in hip BMD and reduction in falls. Rehabilitation is essential to improve functional disabilities and survival rates. Fall prevention and functional recovery strategies should include patient education and training to improve balance and increase muscle strength and mobility. Appropriate management can prevent further fractures and it is critical that high-risk patients are identified and treated. To foster this process, clinical pathways have been established to support orthopaedic surgeons. Although hip fracture is generally associated with poor outcomes, appropriate management can ensure optimal recovery and survival, and should be prioritized after a hip fracture to avoid deterioration of health and prevent subsequent fracture.

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.

Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

PubMed

Damrow, Derek S; Van Valin, Scott E

2017-03-01

Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

The second fracture of the same clavicle: prevalence and fracture configurations.

PubMed

Asavamongkolkul, Apichat; Harnroongroj, Thos; Suteeraporn, Wuttipon; Sudjai, Narumol; Harnroongroj, Thossart

2012-12-01

To study second fracture at the same clavicle including prevalence, fracture configurations related to malunion types of the first fracture, and healing. Between 2008 and 2011, the authors reviewed medical records and radiographs of the clavicles of patients who sustained acute clavicular fractures from motorcycle accident. Second fracture at the same clavicle and prevalence were studied. Malunion of the first fracture of the same clavicle were typed and configurations of the second fracture at the same clavicles were described related to type of the malunion. There were 552 clavicular fractures. Four cases of which sustained a second fracture at the same clavicles. Malunion of the first clavicular fracture of the four cases were typed: type I, extension, type II, flexion, and type III, bayonet. There were one, two, and one case of second clavicular fractures of the type I, II, and III clavicular malunion. The configuration of second clavicular fracture of the type I malunion clavicle is located at lateral fragment, inferior displacement, and dorsal angulation with dorsal cortex conminution. The type II malunion clavicle is located at lateral fragment with minimal displacement. For the type III malunion clavicle, the second fracture is located at medial fragment with mild inferior displacement and inferior angulation. The four cases of the second fractures of the same clavicles healed within two months without complication. The prevalence of second fracture at the same clacicles was 7.2:1000. The three types of the first fracture malunion were extension, flexion, and bayonet. The configuration of the second fracture at the same clavicles depends on malunion types of the first clavicular fracture. They healed without complication.

Stress fracture of ulna due to excessive push-ups.

PubMed

Meena, Sanjay; Rastogi, Devarshi; Solanki, Bipin; Chowdhury, Buddhadev

2014-01-01

Stress fractures are most common in the weight-bearing bones of the lower extremities and spine, but are rarely found in non-weight-bearing bones of the body. Stress fracture of the ulna is extremely rare. We report a case of complete stress fracture of ulna caused due to excessive push ups in a young athlete. Conservative management was successful in healing of fracture and returning this patient back to his previous activity level. Physician should have high index of suspicion, whenever they encounter a young athlete complaining of forearm pain.

Occult Intertrochanteric Fracture Mimicking the Fracture of Greater Trochanter.

PubMed

Chung, Phil Hyun; Kang, Suk; Kim, Jong Pil; Kim, Young Sung; Lee, Ho Min; Back, In Hwa; Eom, Kyeong Soo

2016-06-01

Occult intertrochanteric fractures are misdiagnosed as isolated greater trochanteric fractures in some cases. We investigated the utility of three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) in the diagnosis and outcome management of occult intertrochanteric fractures. This study involved 23 cases of greater trochanteric fractures as diagnosed using plain radiographs from January 2004 to July 2013. Until January 2008, 9 cases were examined with 3D-CT only, while 14 cases were screened with both 3D-CT and MRI scans. We analyzed diagnostic accuracy and treatment results following 3D-CT and MRI scanning. Nine cases that underwent 3D-CT only were diagnosed with isolated greater trochanteric fractures without occult intertrochanteric fractures. Of these, a patient with displacement received surgical treatment. Of the 14 patients screened using both CT and MRI, 13 were diagnosed with occult intertrochanteric fractures. Of these, 11 were treated with surgical intervention and 2 with conservative management. Three-dimensional CT has very low diagnostic accuracy in diagnosing occult intertrochanteric fractures. For this reason, MRI is recommended to confirm a suspected occult intertrochanteric fracture and to determine the most appropriate mode of treatment.

Altered-stress fracturing

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

Warpinski, N.R.; Branagan, P.T.

Altered-stress fracturing is a concept whereby a hydraulic fracture in one well is reoriented by another hydraulic fracture in a nearby location. The application is in tight, naturally fractured, anisotropic reservoirs in which conventional hydraulic fractures parallel the highly permeable natural fractures and little production enhancement is achieved by conventional hydraulic fracturing. Altered-stress fracturing can modify the stress field so that hydraulic fractures propagate across the permeable natural fractures. A field test was conducted in which stress changes of 250 to 300 psi (1.7 to 2.1 MPa) were measured in an offset well 120 ft (37 m) away during relativelymore » small minifracs in a production well. These results show that stress-altered fracturing is possible at this site and others. Analytic and finite element calculations quantify the effects of layers, stresses, and crack size. Reservoir calculations show significant enhancement compared to conventional treatments. 21 refs., 12 figs., 3 tabs.« less

Pediatric Facial Fractures: A Review of 2071 Fractures.

PubMed

Ferreira, Pedro Costa; Barbosa, Joselina; Braga, José Miguel; Rodrigues, Acácio; Silva, Álvaro Catarino; Amarante, José Manuel

2016-01-01

Facial fractures are infrequent in children and adolescents, and there are only few reports that review a significant number of patients. The objective of this study was to analyze the pattern of maxillofacial fractures in pediatric patients of Portugal. We reviewed the clinical records of a series of 1416 patients 18 years or younger with facial fractures, treated by the Department of Plastic Reconstructive, Aesthetic and of Maxillofacial Surgery of São João Hospital, Porto, Portugal, between 1993 and 2012. The following parameters were evaluated: age; sex; cause of the accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. A total of 2071 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (43.9%). Motor vehicle accident was the most common cause of injuries (48.7% of patients). Mandibular fractures were the most common (44.4%). Associated injuries occurred in 1015 patients (71.7%). Pediatric facial fractures are usually associated with severe trauma. There has been a highly significant decrease (P < 0.001) in pediatric facial fractures in Portugal for the past 20 years.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures.

PubMed

Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

2015-01-01

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

PubMed Central

Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

2015-01-01

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity. PMID:26175916

Safe corridors for K-wiring in phalangeal fractures.

PubMed

Rex, C; Vignesh, R; Javed, M; Balaji, Subba Chandra; Premanand, C; Zakki, Syed Ashfaque

2015-01-01

Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome. In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28). 47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept. K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing "on-table active finger movement test" at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.

Epidemiology of extremity fractures in the Netherlands.

PubMed

Beerekamp, M S H; de Muinck Keizer, R J O; Schep, N W L; Ubbink, D T; Panneman, M J M; Goslings, J C

2017-07-01

. During the study period, we observed an increasing incidence of extremity fractures and a shift towards surgical treatment. Patient numbers in university hospitals declined. If these trends continue, policy makers would be well advised to consider the changing demands in extremity fracture treatment and pro-actively increase capacity and resources. Copyright © 2017 Elsevier Ltd. All rights reserved.

Thermophysics of fractures on comet 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Höfner, S.; Vincent, J.-B.; Blum, J.; Davidsson, B. J. R.; Sierks, H.; El-Maarry, M. R.; Deller, J.; Hofmann, M.; Hu, X.; Pajola, M.; Barbieri, C.; Lamy, P. L.; Rodrigo, R.; Koschny, D.; Rickman, H.; Keller, H. U.; A'Hearn, M. F.; Auger, A.-T.; Barucci, M. A.; Bertaux, J.-L.; Bertini, I.; Bodewits, D.; Cremonese, G.; Da Deppo, V.; Debei, S.; De Cecco, M.; Fornasier, S.; Fulle, M.; Gicquel, A.; Groussin, O.; Gutiérrez, P. J.; Gutiérrez-Marqués, P.; Güttler, C.; Hviid, S. F.; Ip, W.-H.; Jorda, L.; Knollenberg, J.; Kovacs, G.; Kramm, J.-R.; Kührt, E.; Küppers, M.; La Forgia, F.; Lazzarin, M.; Lopez-Moreno, J. J.; Marzari, F.; Michalik, H.; Moissl-Fraund, R.; Moreno, F.; Mottola, S.; Naletto, G.; Oklay, N.; Preusker, F.; Scholten, F.; Shi, X.; Thomas, N.; Toth, I.; Tubiana, C.; Zitzmann, S.

2017-12-01

Context. The camera OSIRIS on board Rosetta obtained high-resolution images of the nucleus of comet 67P/Churyumov-Gerasimenko (67P). Great parts of the nucleus surface are composed of fractured terrain. Aims: Fracture formation, evolution, and their potential relationship to physical processes that drive activity are not yet fully understood. Observed temperatures and gas production rates can be explained or interpreted with the presence of fractures by applying appropriate modelling methods. Methods: We followed a transient thermophysical model approach that includes radiative, conductive, and water-ice sublimation fluxes by considering a variety of heliocentric distances, illumination conditions, and thermophysical properties for a set of characteristic fracture geometries on the nucleus of 67P. We computed diurnal temperatures, heat fluxes, and outgassing behaviour in order to derive and distinguish the influence of the mentioned parameters on fractured terrain. Results: Our analysis confirms that fractures, as already indicated by former studies about concavities, deviate from flat-terrain topographies with equivalent properties, mostly through the effect of self-heating. Compared to flat terrain, illuminated cometary fractures are generally warmer, with smaller diurnal temperature fluctuations. Maximum sublimation rates reach higher peaks, and dust mantle quenching effects on sublimation rates are weaker. Consequently, the rough structure of the fractured terrain leads to significantly higher inferred surface thermal inertia values than for flat areas with identical physical properties, which might explain the range of measured thermal inertia on 67P. Conclusions: At 3.5 AU heliocentric distance, sublimation heat sinks in fractures converge to maximum values >50 W / m2 and trigger dust activity that can be related mainly to H2O. Fractures are likely to grow through the erosive interplay of alternating sublimation and thermal fatigue.

Delayed surgical repair of penile fracture under local anesthesia.

PubMed

Nasser, Taha Abdel; Mostafa, Taymour

2008-10-01

Penile fracture is a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. To assess the efficacy of a simple delayed surgical repair of penile fracture after a conservative treatment under local anesthesia in patients presented after 24 hours. Twenty-four patients with penile fracture presented after 24 hours were subjected to history taking, clinical examination, urine analysis, and penile ultrasound. They underwent conservative treatment for 7-12 days, and then a surgical repair under local anesthesia was carried out. A follow-up for 6 months for sexual activity and any associated complaints in addition to local examination. All cases were presented with unilateral single tear, and the main cause of penile fracture was sexual intercourse. No intraoperative or postoperative complications were encountered. They regained their sexual activity 4-6 weeks after the repair. One case developed a mild penile deviation that did not interfere with sexual relation after the 6-month follow-up. Surgical repair of penile fracture after a conservative treatment is an effective method for patients with delayed presentation devoid of urethral involvement.

Subsurface Biodegradation in a Fractured Basement Reservoir, Shropshire, UK

NASA Astrophysics Data System (ADS)

Parnell, John; Baba, Mas'ud; Bowden, Stephen; Muirhead, David

2017-04-01

Subsurface Biodegradation in a Fractured Basement Reservoir, Shropshire, UK. John Parnell, Mas'ud Baba, Stephen Bowden, David Muirhead Subsurface biodegradation in current oil reservoirs is well established, but there are few examples of fossil subsurface degradation. Biomarker compositions of viscous and solid oil residues ('bitumen') in fractured Precambrian and other basement rocks below the Carboniferous cover in Shropshire, UK, show that they are variably biodegraded. High levels of 25-norhopanes imply that degradation occurred in the subsurface. Lower levels of 25-norhopanes occur in active seepages. Liquid oil trapped in fluid inclusions in mineral veins in the fractured basement confirm that the oil was emplaced fresh before subsurface degradation. A Triassic age for the veins implies a 200 million year history of hydrocarbon migration in the basement rocks. The data record microbial colonization of a fractured basement reservoir, and add to evidence in modern basement aquifers for microbial activity in deep fracture systems. Buried basement highs may be especially favourable to colonization, through channelling fluid flow to shallow depths and relatively low temperatures

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.

Reactivation of a Propped Hydraulic Fracture

NASA Astrophysics Data System (ADS)

Sarvaramini, E.; Garagash, D.

2014-12-01

The problem of massive fluid injection into a pre-existing fracture has many applications in petroleum industry including underground liquid waste disposal and waterflooding to increase recovery from a hydrocarbon reservoir. Understanding the conditions leading to the re-activation of pre-existing fractures and ensuing propagation is critical for a successful injection project design, and it may also help to mitigate potential environmental hazards, such as contamination of underground aquifers and induced seismicity. The problem of injection of a low viscosity fluid into a permeable formation can be distinguished from conventional hydraulic fracture by the mechanism of fluid leak-off. In conventional fracturing, high viscosity and cake building properties of injected fluid limit leak-off to a 1-D boundary layer incasing the crack. In the case of injection of low viscosity fluid into a fracture, leak-off and related pore fluid diffusion will take place over wider range of scales, from 1-D to 2 or 3-D. We consider a pre-existing stationary propped hydraulic fracture with constrained height into which a fluid is injected under constant flow rate. Although the net effective stress on the crack is initially compressive, the proppant keeps the crack open. It is worthwhile to note that during injection and related pressurization of a propped crack, the fracture breakdown is to be achieved prior to the fracture re-opening. Therefore, the effect of the change of the propped fracture storage on the pressurization dynamics can be neglected. The objective of this work is to study the transient pressurization and the onset of the propagation for a propped fracture. To the end, we formulate and solve a general problem of injection into a fracture accounting for viscous dissipation (i.e. non-uniform pressure distribution). We quantify how the fracture breakdown condition depends upon the rock and fluid properties, the in-situ stress and the fluid injection rate. We also

Proximal femoral fractures.

PubMed

Webb, Lawrence X

2002-01-01

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

Fracture mechanisms and fracture control in composite structures

NASA Astrophysics Data System (ADS)

Kim, Wone-Chul

Four basic failure modes--delamination, delamination buckling of composite sandwich panels, first-ply failure in cross-ply laminates, and compression failure--are analyzed using linear elastic fracture mechanics (LEFM) and the J-integral method. Structural failures, including those at the micromechanical level, are investigated with the aid of the models developed, and the critical strains for crack propagation for each mode are obtained. In the structural fracture analyses area, the fracture control schemes for delamination in a composite rib stiffener and delamination buckling in composite sandwich panels subjected to in-plane compression are determined. The critical fracture strains were predicted with the aid of LEFM for delamination and the J-integral method for delamination buckling. The use of toughened matrix systems has been recommended for improved damage tolerant design for delamination crack propagation. An experimental study was conducted to determine the onset of delamination buckling in composite sandwich panel containing flaws. The critical fracture loads computed using the proposed theoretical model and a numerical computational scheme closely followed the experimental measurements made on sandwich panel specimens of graphite/epoxy faceskins and aluminum honeycomb core with varying faceskin thicknesses and core sizes. Micromechanical models of fracture in composites are explored to predict transverse cracking of cross-ply laminates and compression fracture of unidirectional composites. A modified shear lag model which takes into account the important role of interlaminar shear zones between the 0 degree and 90 degree piles in cross-ply laminate is proposed and criteria for transverse cracking have been developed. For compressive failure of unidirectional composites, pre-existing defects play an important role. Using anisotropic elasticity, the stress state around a defect under a remotely applied compressive load is obtained. The experimentally

Diagnosis and Management of Common Foot Fractures.

PubMed

Bica, David; Sprouse, Ryan A; Armen, Joseph

2016-02-01

Foot fractures are among the most common foot injuries evaluated by primary care physicians. They most often involve the metatarsals and toes. Patients typically present with varying signs and symptoms, the most common being pain and trouble with ambulation. Diagnosis requires radiographic evaluation, although emerging evidence demonstrates that ultrasonography may be just as accurate. Management is determined by the location of the fracture and its effect on balance and weight bearing. Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities; subsequent treatment consists of a short leg walking cast or boot for four to six weeks. Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. A fifth metatarsal tuberosity avulsion fracture can be treated acutely with a compressive dressing, then the patient can be transitioned to a short leg walking boot for two weeks, with progressive mobility as tolerated after initial immobilization. A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg non-weight-bearing cast; healing time can be as long as 10 to 12 weeks. Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. Lesser toe fractures can be treated with buddy taping and a rigid-sole shoe for four to six weeks.

Multifocal humeral fractures.

PubMed

Maresca, A; Pascarella, R; Bettuzzi, C; Amendola, L; Politano, R; Fantasia, R; Del Torto, M

2014-02-01

Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Bone-density-specific fracture risk: A population-based study of the relationship between osteoporosis and vertebral fractures

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

Melton, L.J.; Wahner, H.W.; Richelson, L.S.

The search for a specific level of bone density that clearly distinguishes patients with osteoporosis from those without has been largely unsuccessful. A different, ''gradient of risk'' model was used to assess the effect of various degrees of osteoporosis on the prevalence of vertebral fractures. The authors measured spinal (L/sub 1/-L/sub 4/) bone mineral (BM) with dual photon absorptiometry in an age-stratified random sample of Rochester, Minnesota women greater than or equal to 35 years old to estimate the distribution of spinal BM in the population of adult woman. The authors also assessed BM among women in the sample whomore » had one or more vertebral fractures to estimate both the total number of women with vertebral fractures in the population and the distribution of spinal BM in such women. These population-based estimates were then used to calculate the prevalence rate of vertebral fracture at various levels of spinal BM. Women with spinal BM greater than or equal to 1.40 g/cm/sup 2/ were free of vertebral fractures. Among women with BM between 1.00 and 1.39 g/cm/sup 2/, the prevalence of vertebral fractures was about 7%. The prevalence rate increased as spinal BM decreased further. Among women with spinal BM<0.60 g/cm/sup 2/, all had at least one vertebral fracture (prevalence=100%). These data indicate that osteoporosis is a necessary cause of age-related vertebral fractures and, at certain low levels, is a sufficient cause of such fractures in conjunction with the activities of daily living.« less

Occult Intertrochanteric Fracture Mimicking the Fracture of Greater Trochanter

PubMed Central

Chung, Phil Hyun; Kang, Suk; Kim, Jong Pil; Kim, Young Sung; Back, In Hwa; Eom, Kyeong Soo

2016-01-01

Purpose Occult intertrochanteric fractures are misdiagnosed as isolated greater trochanteric fractures in some cases. We investigated the utility of three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) in the diagnosis and outcome management of occult intertrochanteric fractures. Materials and Methods This study involved 23 cases of greater trochanteric fractures as diagnosed using plain radiographs from January 2004 to July 2013. Until January 2008, 9 cases were examined with 3D-CT only, while 14 cases were screened with both 3D-CT and MRI scans. We analyzed diagnostic accuracy and treatment results following 3D-CT and MRI scanning. Results Nine cases that underwent 3D-CT only were diagnosed with isolated greater trochanteric fractures without occult intertrochanteric fractures. Of these, a patient with displacement received surgical treatment. Of the 14 patients screened using both CT and MRI, 13 were diagnosed with occult intertrochanteric fractures. Of these, 11 were treated with surgical intervention and 2 with conservative management. Conclusion Three-dimensional CT has very low diagnostic accuracy in diagnosing occult intertrochanteric fractures. For this reason, MRI is recommended to confirm a suspected occult intertrochanteric fracture and to determine the most appropriate mode of treatment. PMID:27536653

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

PubMed Central

Ganczak, Maria; Chrobrowski, Krzysztof

2018-01-01

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

Understanding hydraulic fracturing: a multi-scale problem

PubMed Central

Hyman, J. D.; Jiménez-Martínez, J.; Viswanathan, H. S.; Carey, J. W.; Porter, M. L.; Rougier, E.; Karra, S.; Kang, Q.; Frash, L.; Chen, L.; Lei, Z.; O’Malley, D.; Makedonska, N.

2016-01-01

Despite the impact that hydraulic fracturing has had on the energy sector, the physical mechanisms that control its efficiency and environmental impacts remain poorly understood in part because the length scales involved range from nanometres to kilometres. We characterize flow and transport in shale formations across and between these scales using integrated computational, theoretical and experimental efforts/methods. At the field scale, we use discrete fracture network modelling to simulate production of a hydraulically fractured well from a fracture network that is based on the site characterization of a shale gas reservoir. At the core scale, we use triaxial fracture experiments and a finite-discrete element model to study dynamic fracture/crack propagation in low permeability shale. We use lattice Boltzmann pore-scale simulations and microfluidic experiments in both synthetic and shale rock micromodels to study pore-scale flow and transport phenomena, including multi-phase flow and fluids mixing. A mechanistic description and integration of these multiple scales is required for accurate predictions of production and the eventual optimization of hydrocarbon extraction from unconventional reservoirs. Finally, we discuss the potential of CO2 as an alternative working fluid, both in fracturing and re-stimulating activities, beyond its environmental advantages. This article is part of the themed issue ‘Energy and the subsurface’. PMID:27597789

Hydraulic Fracture Induced Seismicity During A Multi-Stage Pad Completion in Western Canada: Evidence of Activation of Multiple, Parallel Faults

NASA Astrophysics Data System (ADS)

Maxwell, S.; Garrett, D.; Huang, J.; Usher, P.; Mamer, P.

2017-12-01

Following reports of injection induced seismicity in the Western Canadian Sedimentary Basin, regulators have imposed seismic monitoring and traffic light protocols for fracturing operations in specific areas. Here we describe a case study in one of these reservoirs, the Montney Shale in NE British Columbia, where induced seismicity was monitored with a local array during multi-stage hydraulic fracture stimulations on several wells from a single drilling pad. Seismicity primarily occurred during the injection time periods, and correlated with periods of high injection rates and wellhead pressures above fracturing pressures. Sequential hydraulic fracture stages were found to progressively activate several parallel, critically-stressed faults, as illuminated by multiple linear hypocenter patterns in the range between Mw 1 and 3. Moment tensor inversion of larger events indicated a double-couple mechanism consistent with the regional strike-slip stress state and the hypocenter lineations. The critically-stressed faults obliquely cross the well paths which were purposely drilled parallel to the minimum principal stress direction. Seismicity on specific faults started and stopped when fracture initiation points of individual injection stages were proximal to the intersection of the fault and well. The distance ranges when the seismicity occurs is consistent with expected hydraulic fracture dimensions, suggesting that the induced fault slip only occurs when a hydraulic fracture grows directly into the fault and the faults are temporarily exposed to significantly elevated fracture pressures during the injection. Some faults crossed multiple wells and the seismicity was found to restart during injection of proximal stages on adjacent wells, progressively expanding the seismogenic zone of the fault. Progressive fault slip is therefore inferred from the seismicity migrating further along the faults during successive injection stages. An accelerometer was also deployed close

[Treatment of periprosthetic and peri-implant fractures : modern plate osteosynthesis procedures].

PubMed

Raschke, M J; Stange, R; Kösters, C

2012-11-01

Periprosthetic fractures are increasing not only due to the demographic development with high life expectancy, the increase in osteoporosis and increased prosthesis implantation but also due to increased activity of the elderly population. The therapeutic algorithms are manifold but general valid rules for severe fractures are not available. The most commonly occurring periprosthetic fractures are proximal and distal femoral fractures but in the clinical routine fractures of the tibial head, ankle, shoulder, elbow and on the borders to other implants (peri-implant fractures) and complex interprosthetic fractures are being seen increasingly more. It is to be expected that in the mid-term further options, such as cement augmentation of cannulated polyaxial locking screws will extend the portfolio of implants for treatment of periprosthetic fractures. The aim of this review article is to present the new procedures for osteosynthesis of periprosthetic fractures.

[Treatment of periprosthetic and peri-implant fractures : modern plate osteosynthesis procedures].

PubMed

Raschke, M J; Stange, R; Kösters, C

2012-08-01

Periprosthetic fractures are increasing not only due to the demographic development with high life expectancy, the increase in osteoporosis and increased prosthesis implantation but also due to increased activity of the elderly population. The therapeutic algorithms are manifold but general valid rules for severe fractures are not available. The most commonly occurring periprosthetic fractures are proximal and distal femoral fractures but in the clinical routine fractures of the tibial head, ankle, shoulder, elbow and on the borders to other implants (peri-implant fractures) and complex interprosthetic fractures are being seen increasingly more. It is to be expected that in the mid-term further options, such as cement augmentation of cannulated polyaxial locking screws will extend the portfolio of implants for treatment of periprosthetic fractures. The aim of this review article is to present the new procedures for osteosynthesis of periprosthetic fractures.

Variability of Physical Activity Patterns by Type of Day and Season in 8-10-Year-Old Boys

ERIC Educational Resources Information Center

Rowlands, Ann V.; Hughes, Dylan R.

2006-01-01

The aims of this study were to: (a) compare physical activity across two seasons and, within those seasons, across school and vacation time, and (b) compare the proportion of children meeting the activity thresholds recommended by Tudor-Locke et al. (2004) at each time point. Thirty-six boys, between the ages of 8 and 10 years (M age = 8.8 years,…

Medial malleolar stress fracture secondary to chronic ankle impingement.

PubMed

Jowett, Andrew J L; Birks, Christopher L; Blackney, Mark C

2008-07-01

Medial malleolar stress fractures are uncommon even in the sporting population. We believe that stress fractures of the medial malleolus may be the end stage of chronic anteromedial ankle impingement in elite running and jumping athletes. We present five cases of elite athletes who presented to our institution with stress fractures of the medial malleolus over a 3-year period (2004 to 2007). In each case preoperative imaging revealed an anteromedial bony spur on the tibia. All fractures were internally fixed and at the same sitting had arthroscopic debridement of the bony spur. All fractures united without further intervention, average time to union was 10.2 (range, 6 to 16) weeks. At most recent review (average, 18 months; range, 8 to 37 months), all patients had resumed sporting activity to their previous level. No patient had suffered a recurrent fracture of the medial malleolus. We believe this region of impingement to be important in the development of the stress fracture and should be addressed at the time of fracture fixation.

First-rib stress fracture in two adolescent swimmers: a case report.

PubMed

Low, Sara; Kern, Michael; Atanda, Alfred

2016-01-01

First-rib stress fractures have been described in adolescent athletes in various sports, with only one prior case report of first-rib stress fractures in an adolescent female swimmer. There is a need for research on the cause, management, and prevention of these injuries as they lead to significant morbidity and critical time away from sport for these aspiring athletes. We aimed to describe first-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent swimmers and to discuss the different presentations, unique risk factors, treatment, and potential injury prevention strategies of such fractures. We discussed two such cases which were successfully treated with activity modification with restriction of all overhead activity, gradually progressive physical therapy and a return to swimming protocol. First-rib stress fractures can vary in presentation and should be in the differential diagnosis in adolescent swimmers with chronic shoulder pain. These injuries can be successfully managed with rest from overhead activities and physical therapy. Gradual return to competitive swimming can be achieved even with non-union of a first-rib stress fracture. Emphasis on balanced strength training in different muscle groups and proper swimming technique is essential to prevent these injuries.

Laboratory hydraulic fracturing experiments in intact and pre-fractured rock

USGS Publications Warehouse

Zoback, M.D.; Rummel, F.; Jung, R.; Raleigh, C.B.

1977-01-01

Laboratory hydraulic fracturing experiments were conducted to investigate two factors which could influence the use of the hydrofrac technique for in-situ stress determinations; the possible dependence of the breakdown pressure upon the rate of borehole pressurization, and the influence of pre-existing cracks on the orientation of generated fractures. The experiments have shown that while the rate of borehole pressurization has a marked effect on breakdown pressures, the pressure at which hydraulic fractures initiate (and thus tensile strength) is independent of the rate of borehole pressurization when the effect of fluid penetration is negligible. Thus, the experiments indicate that use of breakdown pressures rather than fracture initiation pressures may lead to an erroneous estimate of tectonic stresses. A conceptual model is proposed to explain anomalously high breakdown pressures observed when fracturing with high viscosity fluids. In this model, initial fracture propagation is presumed to be stable due to large differences between the borehole pressure and that within the fracture. In samples which contained pre-existing fractures which were 'leaky' to water, we found it possible to generate hydraulic fractures oriented parallel to the direction of maximum compression if high viscosity drilling mud was used as the fracturing fluid. ?? 1977.

Hydro-fracture in the laboratory: matching diagnostic seismic signals to fracture networks

NASA Astrophysics Data System (ADS)

Gehne, S.; Benson, P. M.; Koor, N.; Dobson, K. J.; Enfield, M.; Barber, A.

2017-12-01

Hydraulic fracturing is a key process in both natural (e.g. dyke intrusion) and engineered environments (e.g. shale gas). To better understand this process, we present new data from simulated hydraulic fracturing in a controlled laboratory environment in order to track fracture nucleation (location) and propagation (velocity) in space and time to assess the fracture mechanics and developing fracture network. Fluid overpressure is used to generate a permeable network of micro tensile fractures in an anisotropic sandstone and a highly anisotropic shale. A newly developed technique, using a steel guide arrangement to direct pressurised fluid into a sealed section of an axially drilled conduit, allows the pore fluid to contact the rock directly and to initiate tensile fractures from a pre-defined zone inside the sample. Acoustic emission location is used to record and map the nucleation and development of the micro-fracture network. For both rock types, fractures progresses parallel to the bedding plane (short-transverse) if the bedding plane is aligned with the direction of σ1 requiring breakdown pressures of approximately 7 and 13MPa respectively at a confining pressure of 8MPa. The data also indicates a more ductile behaviour of the shale than expected. We use X-Ray Computed Tomography (CT) to evaluate the evolved fracture network in terms of fracture pattern and aperture. Hydraulic fracturing produces very planar fractures in the shale, with axial fractures over the entire length of the sample broadly following the bedding. In contrast, fractures in the sandstone are more diffuse, linking pore spaces as they propagate. However, secondary micro cracking, branching of the main fracture, are also observed. These new experiments suggest that fracture pattern, fracture propagation trajectories, and fracturing fluid pressures are predominantly controlled by the interaction between the anisotropic mechanical properties of the rock and the anisotropic stress environment.

Endogenous PTH deficiency impairs fracture healing and impedes the fracture-healing efficacy of exogenous PTH(1-34).

PubMed

Ren, Yongxin; Liu, Bo; Feng, Yuxu; Shu, Lei; Cao, Xiaojian; Karaplis, Andrew; Goltzman, David; Miao, Dengshun

2011-01-01

Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s) whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH. Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth(-/-)) mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg) for 1-4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth(-/-) mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth(-/-) mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth(-/-) mice compared to vehicle-treated wild-type and Pth(-/-) mice. Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing.

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.

Interprosthetic femoral fractures treated with locking plate.

PubMed

Ebraheim, Nabil; Carroll, Trevor; Moral, Muhammad Z; Lea, Justin; Hirschfeld, Adam; Liu, Jiayong

2014-10-01

Interprosthetic fractures are challenging to manage. Although treatment of femoral fractures around a single implant has been described, there is little literature for treatment of interprosthetic femoral fractures. This study analyses the management and outcomes of 15 patients with interprosthetic femoral fractures treated with locking plates. A retrospective chart review was conducted of 17 patients with interprosthetic femur fracture treated with locking plates from 2002 to 2013. Patient demographics and comorbidities were collected. Preoperatively, patients were classified with the Vancouver or Su classification system. Intraoperative use of bone graft and/or cerclage cables was also examined. Clinical and radiographic outcomes were evaluated for union, time to full weight bearing, return to preinjury level of activity, and pain assessed with visual analog scale (VAS). There were 15 patients with interprosthetic fractures meeting criteria for this study. Average patient age was 80.53 (range, 61-92) years. Bone grafting was used in 23.5% (four of 17) and cerclage cables in 29.4% (five of 17). Patients achieved complete union and return to full weight bearing an average of 4.02 (range, two to six) months later. Average VAS pain score was 1.00 (range, zero to six). All patients returned to their preoperative ambulatory status. Locking plates could achieve satisfactory results for interprosthetic fractures. Considering an individual's fracture type, bone quality and protheses to determine the appropriate plate length and optional use of cerclage and/or bone graft was essential. In this limited sample size, interprosthetic fractures occurred at similar rates at the supracondylar region and diaphysis.

A Distal Forearm Fracture in Childhood Is Associated With an Increased Risk for Future Fragility Fractures in Adult Men, but Not Women

PubMed Central

Amin, Shreyasee; Melton, L Joseph; Achenbach, Sara J; Atkinson, Elizabeth J; Dekutoski, Mark B; Kirmani, Salman; Fischer, Philip R; Khosla, Sundeep

2014-01-01

Distal forearm fractures are among the most common fractures during childhood, but it remains unclear whether they predict an increased fracture risk later in life. We studied a population-based cohort of 1776 children ≤18 years of age, from Olmsted County, MN, USA, who had a distal forearm fracture in 1935–1992. Incident fractures occurring at age ≥35 years were identified through review of complete medical records using the linkage system of the Rochester Epidemiology Project. Observed nonpathologic fractures resulting from no more than moderate trauma (fragility fractures) were compared with expected numbers estimated from fracture site–specific incidence rates, based on age, sex, and calendar year, for Olmsted County (standardized incidence ratios [SIR]). In 1086 boys (mean ± SD age; 11 ± 4 years) and 690 girls (10 ± 4 years) followed for 27,292 person-years after the age of 35 years, subsequent fragility fractures were observed in 144 (13%) men and 74 (11%) women. There was an increased risk for future fragility fractures in boys who had a distal forearm fracture (SIR, 1.9; 95% CI, 1.6–2.3) but not girls (SIR, 1.0; 95% CI, 0.8–1.2). Fragility fractures at both major osteoporotic (hip, spine, wrist, and shoulder) sites (SIR, 2.6; 95% CI, 2.1–3.3) and remaining sites (SIR, 1.7; 95% CI, 1.3–2.0) were increased in men, irrespective of age at distal forearm fracture as boys. A distal forearm fracture in boys, but not girls, is associated with an increased risk for fragility fractures as older adults. It is necessary to determine whether the increased fractures observed in men is due to persistent deficits of bone strength, continued high fracture risk activity, or both. Until then, men should be asked about a childhood distal forearm fracture and, if so, warrant further screening and counseling on measures to optimize bone health and prevent fractures. PMID:23456800

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

Stress Fractures

MedlinePlus

Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

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

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

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

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

Influence of Natural Fractures Cohesive Properties on Geometry of Hydraulic Fracture Networks

NASA Astrophysics Data System (ADS)

Gonzalez-Chavez, M. A.; Dahi Taleghani, A.; Puyang, P.

2014-12-01

An integrated modeling methodology is proposed to analyze hydraulic fracturing jobs in the presence of the natural fracture network in the formation. A propagating hydraulic fracture may arrest, cross, or diverts into a preexisting natural crack depending on fracture properties of rock and magnitude and direction of principal rock stresses. Opening of natural fractures during fracturing treatment could define the effectiveness of the stimulation technique. Here, we present an integrated methodology initiated with lab scale fracturing properties using Double Cantilever Beam tests (DCB) to determine cohesive properties of rock and natural fractures. We used cohesive finite element models to reproduce laboratory results to verify the numerical model for the interaction of the hydraulic fracture and individual cemented natural fractures. Based on the initial investigations, we found out that distribution of pre-existing natural fractures could play a significant role in the final geometry of the induced fracture network; however in practice, there is not much information about the distribution of natural fractures in the subsurface due to the limited access. Hence, we propose a special optimization scheme to generate natural fracture geometry from the location of microseismic events. Accordingly, the criteria of evaluating the fitness of natural fracture realizations is defined as the total minimum distance squares of all microseismic events, which is the sum of minimum square distance for all microseismic events. Moreover, an additional constraint in this problem is that we need to set a minimum distance between fracture grids. Using generated natural fracture realizations, forward field-scale simulations are implemented using cohesive finite element analysis to find the best match with the recorded bottomhole pressure. To show the robustness of the proposed workflow for real field problem, we implemented this technique on available data from several well Chicontepec

Post-surgical rehabilitative approach to fragility fractures.

PubMed

Gimigliano, F; Iolascon, G; Riccio, I; Frizzi, L; Gimigliano, R

2013-10-01

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.

Management of patellar fracture with titanium cable cerclage

PubMed Central

Huang, Sheng-Li; Xue, Jian-Li; Gao, Zong-Qiang; Lan, Bin-Shang

2017-01-01

Abstract Early rehabilitation after surgery for patellar fracture is challenging. The purpose of this study was to evaluate the surgical outcome of titanium cable cerclage for patellar fracture in early functional activity. We reviewed a series of 24 patients treated at our hospital with titanium cable. Functional exercises were started early. Patients were followed up for at least 12 months. Fifteen were males and 9 were females. Fracture occurred in the right knee in 13 patients and in the left knee in 11 patients. The most common mode of injury involves a tumble. None of the patients presented with any postoperative complications. The management resulted in satisfactory outcomes. Titanium cable cerclage offers a new strategy in treating patellar fracture. PMID:29095314

Mortality Following Periprosthetic Proximal Femoral Fractures Versus Native Hip Fractures.

PubMed

Boylan, Matthew R; Riesgo, Aldo M; Paulino, Carl B; Slover, James D; Zuckerman, Joseph D; Egol, Kenneth A

2018-04-04

The number of periprosthetic proximal femoral fractures is expected to increase with the increasing prevalence of hip arthroplasties. While native hip fractures have a well-known association with mortality, there are currently limited data on this outcome among the subset of patients with periprosthetic proximal femoral fractures. Using the New York Statewide Planning and Research Cooperative System, we identified patients from 60 to 99 years old who were admitted to a hospital in the state with a periprosthetic proximal femoral fracture (n = 1,655) or a native hip (femoral neck or intertrochanteric) fracture (n = 97,231) between 2006 and 2014. Within the periprosthetic fracture cohort, the indication for the existing implant was not available in the data set. We used mixed-effects regression models to compare mortality at 1 and 6 months and 1 year for periprosthetic compared with native hip fractures. The risk of mortality for patients who sustained a periprosthetic proximal femoral fracture was no different from that for patients who sustained a native hip fracture at 1 month after injury (3.2% versus 4.6%; odds ratio [OR], 0.90; 95% confidence interval [CI], 0.68 to 1.19; p = 0.446), but was lower at 6 months (3.8% versus 6.5%; OR, 0.74; 95% CI, 0.57 to 0.95; p = 0.020) and 1 year (9.7% versus 15.9%; OR, 0.71; 95% CI, 0.60 to 0.85; p < 0.001). Among periprosthetic proximal femoral fractures, factors associated with a significantly increased risk of mortality at 1 year included advanced age, male sex, and higher Deyo comorbidity scores. In the acute phase, any type of hip fracture appears to confer a similar risk of death. Over the long term, however, periprosthetic proximal femoral fractures are associated with lower mortality rates than native hip fractures, even after accounting for age and comorbidities. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Understanding hydraulic fracturing: a multi-scale problem.

PubMed

Hyman, J D; Jiménez-Martínez, J; Viswanathan, H S; Carey, J W; Porter, M L; Rougier, E; Karra, S; Kang, Q; Frash, L; Chen, L; Lei, Z; O'Malley, D; Makedonska, N

2016-10-13

Despite the impact that hydraulic fracturing has had on the energy sector, the physical mechanisms that control its efficiency and environmental impacts remain poorly understood in part because the length scales involved range from nanometres to kilometres. We characterize flow and transport in shale formations across and between these scales using integrated computational, theoretical and experimental efforts/methods. At the field scale, we use discrete fracture network modelling to simulate production of a hydraulically fractured well from a fracture network that is based on the site characterization of a shale gas reservoir. At the core scale, we use triaxial fracture experiments and a finite-discrete element model to study dynamic fracture/crack propagation in low permeability shale. We use lattice Boltzmann pore-scale simulations and microfluidic experiments in both synthetic and shale rock micromodels to study pore-scale flow and transport phenomena, including multi-phase flow and fluids mixing. A mechanistic description and integration of these multiple scales is required for accurate predictions of production and the eventual optimization of hydrocarbon extraction from unconventional reservoirs. Finally, we discuss the potential of CO2 as an alternative working fluid, both in fracturing and re-stimulating activities, beyond its environmental advantages.This article is part of the themed issue 'Energy and the subsurface'. © 2016 The Author(s).

Impact sports and bone fractures among adolescents.

PubMed

Lynch, Kyle R; Kemper, Han C G; Turi-Lynch, Bruna; Agostinete, Ricardo R; Ito, Igor H; Luiz-De-Marco, Rafael; Rodrigues-Junior, Mario A; Fernandes, Rômulo A

2017-12-01

The objective of the present study was to investigate the effects of different sports on stress fractures among adolescents during a 9-month follow-up period. The sample was composed of 184 adolescents divided into three groups (impact sports [n = 102]; swimming [n = 35]; non-sports [n = 47]). The occurrence of stress fracture was reported by participants and coaches. As potential confounders we considered age, sex, resistance training, body composition variables and age at peak of height velocity. There were 13 adolescents who reported fractures during the 9-month period. Bone mineral density values were higher in adolescents engaged in impact sports (P-value = 0.002). Independently of confounders, the risk of stress fracture was lower in adolescents engaged in impact sports than in non-active adolescents (hazard ratio [HR] = 0.23 [95% confidence interval (CI) = 0.05 to 0.98]), while swimming practice was not associated to lower risk of fracture (HR = 0.49 [95% CI = 0.09 to 2.55]). In conclusion, the findings from this study indicate the importance of sports participation among adolescents in the reduction of stress fracture risk, especially with impact sports. More importantly, these results could be relevant for recognising adolescents in danger of not reaching their potential for peak bone mass and later an increased risk of fractures.

Worldwide research productivity in fracture surgery: A 10-year survey of publication activity.

PubMed

Sun, Jianzhong; Ding, Ren; Ma, Tai; Shi, Xiaobing; Bao, Chaolu; Guan, Huapeng

2017-08-01

Worldwide research contributions have allowed the field of fracture surgery to progress. However, to the best of our knowledge, no studies have documented the main characteristics of publications from different countries. The present study aimed to determine the quantity and quality of worldwide research in fracture surgery. The Web of Science database was searched to identify fracture articles published between 2005 and 2014. The contributions of countries were evaluated based on paper and citation numbers, and the research output of each country was adjusted according to population size. A total of 19,423 papers on the topic of fracture surgery were identified worldwide, and the total number of publications from 2005 to 2014 had significantly increased by 1.82-fold (P<0.001). The majority of papers (86.64%) were published by high-income countries (gross national income per capita ≥$12,736), 13.25% by middle-income countries ($1,046-12,735) and 0.11% by low-income countries (≤$1,045). The United States contributed the highest number of publications (33.34%), followed by the United Kingdom (9.03%), Germany (8.42%), China (5.58%) and Japan (4.18%). Furthermore, the United States ranked first according to total citations (72,640). Articles from Sweden achieved the highest average citations per paper (15.63), followed by Australia (12.84) and Canada (12.44). When the number of publications were adjusted for population size, Switzerland was the first (56.39), followed by Austria (35.43) and the Netherlands (30.68). In conclusion, the number of publications in fracture surgery increased from 2005 to 2014, and the majority of fracture papers were published by high-income countries, while few papers were published by low-income countries. The United States was the most prolific country, but based on population size, a number of smaller countries in Europe may be relatively more prolific.

High prevalence of simultaneous rib and vertebral fractures in patients with hip fracture.

PubMed

Lee, Bong-Gun; Sung, Yoon-Kyoung; Kim, Dam; Choi, Yun Young; Kim, Hunchul; Kim, Yeesuk

2017-02-01

The purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture. One hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4±4.1days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors. Simultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p=0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01-0.57). The prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

Dynamic deformation and fracture of single crystal silicon: Fracture modes, damage laws, and anisotropy

DOE PAGES

Huang, J. Y.; E, J. C.; Huang, J. W.; ...

2016-05-25

Impact fracture of single-crystal Si is critical to long-term reliability of electronic devices and solar cells for its wide use as components or substrates in semiconductor industry. Single-crystal Si is loaded along two different crystallographic directions with a split Hopkinson pressure bar integrated with an in situ x-ray imaging and diffraction system. Bulk stress histories are measured, simultaneously with x-ray phase contrast imaging (XPCI) and Laue diffraction. Damage evolution is quantified with grayscale maps from XPCI. Single-crystal Si exhibits pronounced anisotropy in fracture modes, and thus fracture strengths and damage evolution. For loading along [11¯ 0] and viewing along [001],more » (1¯1¯0)[11¯ 0] cleavage is activated and induces horizontal primary cracks followed by perpendicular wing cracks. However, for loading along [011¯] and viewing along [111], random nucleation and growth of shear and tensile-splitting crack networks lead to catastrophic failure of materials with no cleavage. The primary-wing crack mode leads to a lower characteristic fracture strength due to predamage, but a more concentrated strength distribution, i.e., a higher Weibull modulus, compared to the second loading case. Furthermore, the sequential primary cracking, wing cracking and wing-crack coalescence processes result in a gradual increase of damage with time, deviating from theoretical predictions. Particle size and aspect ratios of fragments are discussed with postmortem fragment analysis, which verifies fracture modes observed in XPCI.« less

Imbedded-Fracture Formulation of THMC Processes in Fractured Media

NASA Astrophysics Data System (ADS)

Yeh, G. T.; Tsai, C. H.; Sung, R.

2016-12-01

Fractured media consist of porous materials and fracture networks. There exist four approaches to mathematically formulating THMC (Thermal-Hydrology-Mechanics-Chemistry) processes models in the system: (1) Equivalent Porous Media, (2) Dual Porosity or Dual Continuum, (3) Heterogeneous Media, and (4) Discrete Fracture Network. The first approach cannot explicitly explore the interactions between porous materials and fracture networks. The second approach introduces too many extra parameters (namely, exchange coefficients) between two media. The third approach may make the problems too stiff because the order of material heterogeneity may be too much. The fourth approach ignore the interaction between porous materials and fracture networks. This talk presents an alternative approach in which fracture networks are modeled with a lower dimension than the surrounding porous materials. Theoretical derivation of mathematical formulations will be given. An example will be illustrated to show the feasibility of this approach.

External fixation of tibial pilon fractures and fracture healing.

PubMed

Ristiniemi, Jukka

2007-06-01

Distal tibial fractures are rare and difficult to treat because the bones are subcutaneous. External fixation is commonly used, but the method often results in delayed union. The aim of the present study was to find out the factors that affect fracture union in tibial pilon fractures. For this purpose, prospective data collection of tibial pilon fractures was carried out in 1998-2004, resulting in 159 fractures, of which 83 were treated with external fixation. Additionally, 23 open tibial fractures with significant > 3 cm bone defect that were treated with a staged method in 2000-2004 were retrospectively evaluated. The specific questions to be answered were: What are the risk factors for delayed union associated with two-ring hybrid external fixation? Does human recombinant BMP-7 accelerate healing? What is the role of temporary ankle-spanning external fixation? What is the healing potential of distal tibial bone loss treated with a staged method using antibiotic beads and subsequent autogenous cancellous grafting compared to other locations of the tibia? The following risk factors for delayed healing after external fixation were identified: post-reduction fracture gap of >3 mm and fixation of the associated fibula fracture. Fracture displacement could be better controlled with initial temporary external fixation than with early definitive fixation, but it had no significant effect on healing time, functional outcome or complication rate. Osteoinduction with rhBMP-7 was found to accelerate fracture healing and to shorten the sick leave. A staged method using antibiotic beads and subsequent autogenous cancellous grafting proved to be effective in the treatment of tibial bone loss. Healing potential of the bone loss in distal tibia was at least equally good as in other locations of the tibia.

Fracture analysis near the mid-ocean plate boundary, Reykjavik-Hvalfjördur area, Iceland

NASA Astrophysics Data System (ADS)

Jefferis, Robert G.; Voight, Barry

1981-07-01

The geometry and thermal history of fractures have been determined at 59 stations from Reykjavik to Hvalfjördur in southwestern Iceland. The data provide information on crustal stress regimes in the vicinity of mid-ocean ridges. Two major, generalized fracture orientations are present (1) a northeast system, trend 010°-030°, except on Akranes where the orientation is 040°-060° (2) a broad east—west system containing one or more sets with strike between 070°-130°. Thermal history of the host rock and fractures was determined from secondary minerals in vugs and fractures. The thermal history indicates that the northeast fracture set opened while the area was within the relatively hot axial zone of active volcanism and rifting. Some of the east—west trending fractures also opened at this time but many formed later, after the area had begun to cool and drift from the active zone. The northeast fracture set is essentially parallel to the trend of dikes and normal faults in southwestern Iceland. They have been interpreted as extension fractures (resulting in about 0.4% maximum extension) forming generally from the same stress field associated with normal faulting and dike injection in the active zone. Fracturing in an east-west direction (estimated 0.1% maximum extension), mainly near the edge and outside the active zone, indicates a reorientation of this stress field. The dominant mechanism related to the origin of the east—west fractures may be thermoelastic stresses arising from axial and basal accretion and cooling of lithospheric plates. Both fracture systems are inferred to have formed, in the Griffiths idealization, under nearly biaxial effective compressive loading on the order of 200 bar. The discrepancy between this value and the kilobar-order strengths of short-time laboratory tests reflects such factors as high temperature stress corrosion and fatigue. Fracture propagation is assumed to have been stable, but governed primarily by lateral load

Measurement of Function Post Hip Fracture: Testing a Comprehensive Measurement Model of Physical Function

PubMed Central

Gruber-Baldini, Ann L.; Hicks, Gregory; Ostir, Glen; Klinedinst, N. Jennifer; Orwig, Denise; Magaziner, Jay

2015-01-01

Background Measurement of physical function post hip fracture has been conceptualized using multiple different measures. Purpose This study tested a comprehensive measurement model of physical function. Design This was a descriptive secondary data analysis including 168 men and 171 women post hip fracture. Methods Using structural equation modeling, a measurement model of physical function which included grip strength, activities of daily living, instrumental activities of daily living and performance was tested for fit at 2 and 12 months post hip fracture and among male and female participants and validity of the measurement model of physical function was evaluated based on how well the model explained physical activity, exercise and social activities post hip fracture. Findings The measurement model of physical function fit the data. The amount of variance the model or individual factors of the model explained varied depending on the activity. Conclusion Decisions about the ideal way in which to measure physical function should be based on outcomes considered and participant Clinical Implications The measurement model of physical function is a reliable and valid method to comprehensively measure physical function across the hip fracture recovery trajectory. Practical but useful assessment of function should be considered and monitored over the recovery trajectory post hip fracture. PMID:26492866

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

Mandible Fractures.

PubMed

Pickrell, Brent B; Serebrakian, Arman T; Maricevich, Renata S

2017-05-01

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

A discrete fracture model for two-phase flow in fractured porous media

NASA Astrophysics Data System (ADS)

Gläser, Dennis; Helmig, Rainer; Flemisch, Bernd; Class, Holger

2017-12-01

A discrete fracture model on the basis of a cell-centered finite volume scheme with multi-point flux approximation (MPFA) is presented. The fractures are included in a d-dimensional computational domain as (d - 1)-dimensional entities living on the element facets, which requires the grid to have the element facets aligned with the fracture geometries. However, the approach overcomes the problem of small cells inside the fractures when compared to equi-dimensional models. The system of equations considered is solved on both the matrix and the fracture domain, where on the prior the fractures are treated as interior boundaries and on the latter the exchange term between fracture and matrix appears as an additional source/sink. This exchange term is represented by the matrix-fracture fluxes, computed as functions of the unknowns in both domains by applying adequate modifications to the MPFA scheme. The method is applicable to both low-permeable as well as highly conductive fractures. The quality of the results obtained by the discrete fracture model is studied by comparison to an equi-dimensional discretization on a simple geometry for both single- and two-phase flow. For the case of two-phase flow in a highly conductive fracture, good agreement in the solution and in the matrix-fracture transfer fluxes could be observed, while for a low-permeable fracture the discrepancies were more pronounced. The method is then applied two-phase flow through a realistic fracture network in two and three dimensions.

Water fluoridation and osteoporotic fracture.

PubMed

Hillier, S; Inskip, H; Coggon, D; Cooper, C

1996-09-01

Osteoporotic fractures constitute a major public health problem. These fractures typically occur at the hip, spine and distal forearm. Their pathogenesis is heterogeneous, with contributions from both bone strength and trauma. Water fluoridation has been widely proposed for its dental health benefits, but concerns have been raised about the balance of skeletal risks and benefits of this measure. Fluoride has potent effects on bone cell function, bone structure and bone strength. These effects are mediated by the incorporation of fluoride ions in bone crystals to form fluoroapatite, and through an increase in osteoblast activity. It is believed that a minimum serum fluoride level of 100 ng/ml must be achieved before osteoblasts will be stimulated. Serum levels associated with drinking water fluoridated to 1 ppm are usually several times lower than this value, but may reach this threshold at concentrations of 4 ppm in the drinking water. Animal studies suggest no effect of low-level (0-3 ppm) fluoride intake on bone strength, but a possible decrease at higher levels. Sodium fluoride has been used to treat established osteoporosis for nearly 30 years. Recent trials of this agent, prescribed at high doses, have suggested that despite a marked increase in bone mineral density, there is no concomitant reduction in vertebral fracture incidence. Furthermore, the increase in bone density at the lumbar spine may be achieved at the expense of bone mineral in the peripheral cortical skeleton. As a consequence, high dose sodium fluoride (80 mg daily) is not currently used to treat osteoporosis. At lower doses, recent trials have suggested a beneficial effect on both bone density and fracture. The majority of epidemiological evidence regarding the effect of fluoridated drinking water on hip fracture incidence is based on ecological comparisons. Although one Finnish study suggested that hip fracture rates in a town with fluoridated water were lower than those in a matching town

Radon (222Rn) in ground water of fractured rocks: A diffusion/ion exchange model

USGS Publications Warehouse

Wood, W.W.; Kraemer, T.F.; Shapiro, A.

2004-01-01

Ground waters from fractured igneous and high-grade sialic metamorphic rocks frequently have elevated activity of dissolved radon (222Rn). A chemically based model is proposed whereby radium (226Ra) from the decay of uranium (238U) diffuses through the primary porosity of the rock to the water-transmitting fracture where it is sorbed on weathering products. Sorption of 226Ra on the fracture surface maintains an activity gradient in the rock matrix, ensuring a continuous supply of 226Ra to fracture surfaces. As a result of the relatively long half-life of 226Ra (1601 years), significant activity can accumulate on fracture surfaces. The proximity of this sorbed 226Ra to the active ground water flow system allows its decay progeny 222Rn to enter directly into the water. Laboratory analyses of primary porosity and diffusion coefficients of the rock matrix, radon emanation, and ion exchange at fracture surfaces are consistent with the requirements of a diffusion/ion- exchange model. A dipole-brine injection/withdrawal experiment conducted between bedrock boreholes in the high-grade metamorphic and granite rocks at the Hubbard Brook Experimental Forest, Grafton County, New Hampshire, United States (42??56???N, 71??43???W) shows a large activity of 226Ra exchanged from fracture surfaces by a magnesium brine. The 226Ra activity removed by the exchange process is 34 times greater than that of 238U activity. These observations are consistent with the diffusion/ion-exchange model. Elutriate isotopic ratios of 223Ra/226Ra and 238U/226Ra are also consistent with the proposed chemically based diffusion/ion-exchange model.

Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options.

PubMed

Matcuk, George R; Mahanty, Scott R; Skalski, Matthew R; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J

2016-08-01

Stress fracture, in its most inclusive description, includes both fatigue and insufficiency fracture. Fatigue fractures, sometimes equated with the term "stress fractures," are most common in runners and other athletes and typically occur in the lower extremities. These fractures are the result of abnormal, cyclical loading on normal bone leading to local cortical resorption and fracture. Insufficiency fractures are common in elderly populations, secondary to osteoporosis, and are typically located in and around the pelvis. They are a result of normal or traumatic loading on abnormal bone. Subchondral insufficiency fractures of the hip or knee may cause acute pain that may present in the emergency setting. Medial tibial stress syndrome is a type of stress injury of the tibia related to activity and is a clinical syndrome encompassing a range of injuries from stress edema to frank-displaced fracture. Atypical subtrochanteric femoral fracture associated with long-term bisphosphonate therapy is also a recently discovered entity that needs early recognition to prevent progression to a complete fracture. Imaging recommendations for evaluation of stress fractures include initial plain radiographs followed, if necessary, by magnetic resonance imaging (MRI), which is preferred over computed tomography (CT) and bone scintigraphy. Radiographs are the first-line modality and may reveal linear sclerosis and periosteal reaction prior to the development of a frank fracture. MRI is highly sensitive with findings ranging from periosteal edema to bone marrow and intracortical signal abnormality. Additionally, a brief description of relevant clinical management of stress fractures is included.

Analysis of stress fractures in athletes based on our clinical experience

PubMed Central

Iwamoto, Jun; Sato, Yoshihiro; Takeda, Tsuyoshi; Matsumoto, Hideo

2011-01-01

AIM: To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS: We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS: During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION: The results of this analysis showed that stress fractures were seen in high

Electronics reliability fracture mechanics. Volume 2: Fracture mechanics

NASA Astrophysics Data System (ADS)

Kallis, J.; Duncan, L.; Buechler, D.; Backes, P.; Sandkulla, D.

1992-05-01

This is the second of two volumes. The other volume (WL-TR-92-3015) is 'Causes of Failures of Shop Replaceable Units and Hybrid Microcircuits.' The objective of the Electronics Reliability Fracture Mechanics (ERFM) program was to develop and demonstrate a life prediction technique for electronic assemblies, when subjected to environmental stresses of vibration and thermal cycling, based upon the mechanical properties of the materials and packaging configurations which make up an electronic system. The application of fracture mechanics to microscale phenomena in electronic assemblies was a pioneering research effort. The small scale made the experiments very difficult; for example, the 1-mil-diameter bond wires in microelectronic devices are 1/3 the diameter of a human hair. A number of issues had to be resolved to determine whether a fracture mechanics modelling approach is correct for the selected failures; specifically, the following two issues had to be resolved: What fraction of the lifetime is spent in crack initiation? Are macro fracture mechanics techniques, used in large structures such as bridges, applicable to the tiny structures in electronic equipment? The following structural failure mechanisms were selected for modelling: bondwire fracture from mechanical cycling; bondwire fracture from thermal (power) cycling; plated through hole (PTH) fracture from thermal cycling. The bondwire fracture test specimens were A1-1 percent Si wires, representative of wires used in the parts in the modules selected for detailed investigation in this program (see Vol. 1 of this report); 1-mil-diameter wires were tested in this program. The PTH test specimens were sections of 14-layer printed wiring boards of the type used.

Fractures of the proximal fifth metatarsal: percutaneous bicortical fixation.

PubMed

Mahajan, Vivek; Chung, Hyun Wook; Suh, Jin Soo

2011-06-01

Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures. Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months. Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases. The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.

Mandible Fractures

PubMed Central

Pickrell, Brent B.; Serebrakian, Arman T.; Maricevich, Renata S.

2017-01-01

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles. PMID:28496390

A distinct regulatory region of the Bmp5 locus activates gene expression following adult bone fracture or soft tissue injury.

PubMed

Guenther, Catherine A; Wang, Zhen; Li, Emma; Tran, Misha C; Logan, Catriona Y; Nusse, Roel; Pantalena-Filho, Luiz; Yang, George P; Kingsley, David M

2015-08-01

Bone morphogenetic proteins (BMPs) are key signaling molecules required for normal development of bones and other tissues. Previous studies have shown that null mutations in the mouse Bmp5 gene alter the size, shape and number of multiple bone and cartilage structures during development. Bmp5 mutations also delay healing of rib fractures in adult mutants, suggesting that the same signals used to pattern embryonic bone and cartilage are also reused during skeletal regeneration and repair. Despite intense interest in BMPs as agents for stimulating bone formation in clinical applications, little is known about the regulatory elements that control developmental or injury-induced BMP expression. To compare the DNA sequences that activate gene expression during embryonic bone formation and following acute injuries in adult animals, we assayed regions surrounding the Bmp5 gene for their ability to stimulate lacZ reporter gene expression in transgenic mice. Multiple genomic fragments, distributed across the Bmp5 locus, collectively coordinate expression in discrete anatomic domains during normal development, including in embryonic ribs. In contrast, a distinct regulatory region activated expression following rib fracture in adult animals. The same injury control region triggered gene expression in mesenchymal cells following tibia fracture, in migrating keratinocytes following dorsal skin wounding, and in regenerating epithelial cells following lung injury. The Bmp5 gene thus contains an "injury response" control region that is distinct from embryonic enhancers, and that is activated by multiple types of injury in adult animals. Copyright © 2015 Elsevier Inc. All rights reserved.

The burden of previous fractures in hip fracture patients. The Break Study.

PubMed

Maggi, Stefania; Siviero, Paola; Gonnelli, Stefano; Caffarelli, Carla; Gandolini, Giorgio; Cisari, Carlo; Rossini, Maurizio; Iolascon, Giovanni; Mauro, Giulia Letizia; Nuti, Ranuccio; Crepaldi, Gaetano

2011-06-01

A positive history of fractures in older patients with hip fracture is common. We determined the risk factors associated with a positive history of fractures and the profile of care in hip fracture patients. In the Break Study, we enrolled 1249 women aged ≥60 years, seeking care for a hip fracture. Baseline information included age, body mass index, lifestyle (smoking habit, alcohol consumption), patient's history of fracture after the age of 50 years, family history of fragility fracture and health status (presence of comorbidity, use of specific drugs, pre-fracture walking ability, type of fracture, time to surgery, type of surgery, osteoporosis treatment). In the multivariable model age, smoking, family history, treatment with antiplatelet, anticoagulants and anticonvulsants, were significant predictors of a positive history of fracture. More than 70% of patients underwent surgery more than 48 hours after admission. About 50% were discharged with a treatment for osteoporosis, but more than 30% only with calcium and vitamin D. In conclusion, factors associated with a positive history of fracture are the traditional risk factors, suggesting that they continue to have a negative impact on health even at older ages. Selected drugs, such as antiplatelet and anticoagulants, deserve further consideration as significant factors associated with fractures. Given that delay in surgery is a major cause of mortality and disability, while treatment for osteoporosis decreases significantly the risk of recurrent fractures and disability, interventions to modify these patterns of care are urgently needed.

Ankle fractures have features of an osteoporotic fracture.

PubMed

Lee, K M; Chung, C Y; Kwon, S S; Won, S H; Lee, S Y; Chung, M K; Park, M S

2013-11-01

We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures. This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury. One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (<50 years) and older age (≥50 years) groups, and mean bone attenuation and causes of injury were compared between the two groups in each gender. Proportion of low-energy trauma was higher in the older age group than in the younger age group, but the difference was only significant in female gender (p = 0.011). The older age group showed significantly lower bone attenuation in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis than the younger age group in both genders. The older age group showed more complex pattern of fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis. Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

Prevalence of Temporal Bone Fractures in Patients with Mandibular Fractures Using Multidetector-Row CT.

PubMed

Ogura, I; Kaneda, T; Sasaki, Y; Buch, K; Sakai, O

2015-06-01

Temporal bone fracture after mandibular trauma is thought to be rare, and its prevalence has not been reported in the literature. The purpose of this study was to investigate the prevalence of temporal bone fractures in patients with mandibular fractures and the relationship between temporal bone fractures and the mandibular fracture location using multidetector-row computed tomography (MDCT). A prospective study was performed in 201 patients with mandibular fractures who underwent 64-MDCT scans. The mandibular fracture locations were classified as median, paramedian, angle, and condylar types. Statistical analysis for the relationship between prevalence of temporal bone fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P-value < 0.05 was considered statistically significant. The percentage of cases with temporal bone fracture was 3.0 % of all patients with mandibular fractures and 19.0 % of those with multiple mandibular fractures of paramedian and condylar type. There was a significant relationship between the incidence of temporal bone fracture and the paramedian- and condylar-type mandibular fracture (P = 0.001). Multiple mandibular fractures of paramedian and condylar type may be a stronger indicator for temporal bone fractures. This study suggests that patients with mandibular fracture, especially the paramedian and condylar type, should be examined for coexisting temporal bone fracture using MDCT.

Pediatric maxillofacial fractures.

PubMed

Spring, P M; Cote, D N

1996-05-01

Maxillofacial trauma in the pediatric population is a relatively infrequent occurrence. Studies have demonstrated consistently that 5% of all facial fractures occur in children. The low percentage of facial fractures in this age group has been attributed, in part, to the lack of full pneumatization of the sinuses until later in childhood. Review of the literature indicates that boys are more commonly affected than girls and that the majority of pediatric facial fractures occur in children between 6 and 12 years of age. Motor vehicle accidents, falls, and blunt trauma are responsible for the largest number of pediatric facial fractures. The most common site of facial fracture is the nose and dentoalveolan complex, followed by the mandible, orbit, and midface in most pediatric cohorts. Management of the mandible is often conservative owing to the high percentage of isolated condylar fractures in children. Open reduction and internal fixation of pediatric facial fractures is indicated in complex mandible, midface, and orbital fractures. The effect of rigid fixation on facial skeleton growth is not completely understood.

Histology of 8 atypical femoral fractures: remodeling but no healing.

PubMed

Schilcher, Jörg; Sandberg, Olof; Isaksson, Hanna; Aspenberg, Per

2014-06-01

The pathophysiology behind bisphosphonate-associated atypical femoral fractures remains unclear. Histological findings at the fracture site itself may provide clues. Between 2008 and 2013, we collected bone biopsies including the fracture line from 4 complete and 4 incomplete atypical femoral fractures. 7 female patients reported continuous bisphosphonate use for 10 years on average. 1 patient was a man who was not using bisphosphonates. Dual-energy X-ray absorptiometry of the hip and spine showed no osteoporosis in 6 cases. The bone biopsies were evaluated by micro-computed tomography, infrared spectroscopy, and qualitative histology. Incomplete fractures involved the whole cortical thickness and showed a continuous gap with a mean width of 180 µm. The gap contained amorphous material and was devoid of living cells. In contrast, the adjacent bone contained living cells, including active osteoclasts. The fracture surfaces sometimes consisted of woven bone, which may have formed in localized defects caused by surface fragmentation or resorption. Atypical femoral fractures show signs of attempted healing at the fracture site. The narrow width of the fracture gap and its necrotic contents are compatible with the idea that micromotion prevents healing because it leads to strains within the fracture gap that preclude cell survival.

Spinopelvic Fixation of Sacroiliac Joint Fractures and Fracture-Dislocations: A Clinical 8 Years Follow-Up Study.

PubMed

Sobhan, Mohammad R; Abrisham, Seyed Mohammad J; Vakili, Mahmood; Shirdel, Saeed

2016-10-01

Pelvic ring injuries and sacroiliac dislocations have significant impacts on patient's quality of life. Several techniques have been described for posterior pelvic fixation. The current study has been designed to evaluate the spinopelvic method of fixation for sacroiliac fractures and fracture-dislocations. Between January 2006 and December 2014, 14 patients with sacroiliac joint fractures, dislocation and fracture-dislocation were treated by Spinopelvic fixation at Shahid Sadoughi Training Hospital, Yazd, Iran. Patients were seen in follow up, on average, out to 32 months after surgery. Computed tomographic (CT) scans of patients with sacral fractures were reviewed to determine the presence of injuries. A functional assessment of the patients was performed using Majeed's score. Patient demographics, reduction quality, loss of fixation, outcomes and complications, return to activity, and screw hardware characteristics are described. The injury was unilateral in 11 (78.5%) patients and bilateral in 3 (21.5%). Associated injuries were present in all patients, including fractures, dislocation and abdominal injuries. Lower limb length discrepancy was less than 10 mm in all patients except two. Displacement, as a measure of quality of reduction was less than 5 mm in 13 patients. The mean Majeed score was 78/100. Wound infection and hardware failure were observed in 3 (21.4%) and 1 (7.1%) cases, respectively. In this study most patients (85%) return to work postoperatively. According to the findings, spinopelvic fixation is a safe and effective technique for treatment of sacroiliac injuries. This method can obtain early partial to full weight bearing and possibly reduce the complications.

Osteoblast-derived WNT16 represses osteoclastogenesis and prevents cortical bone fragility fractures

PubMed Central

Movérare-Skrtic, Sofia; Henning, Petra; Liu, Xianwen; Nagano, Kenichi; Saito, Hiroaki; Börjesson, Anna E; Sjögren, Klara; Windahl, Sara H; Farman, Helen; Kindlund, Bert; Engdahl, Cecilia; Koskela, Antti; Zhang, Fu-Ping; Eriksson, Emma E; Zaman, Farasat; Hammarstedt, Ann; Isaksson, Hanna; Bally, Marta; Kassem, Ali; Lindholm, Catharina; Sandberg, Olof; Aspenberg, Per; Sävendahl, Lars; Feng, Jian Q; Tuckermann, Jan; Tuukkanen, Juha; Poutanen, Matti; Baron, Roland; Lerner, Ulf H; Gori, Francesca; Ohlsson, Claes

2015-01-01

The WNT16 locus is a major determinant of cortical bone thickness and nonvertebral fracture risk in humans. The disability, mortality and costs caused by osteoporosis-induced nonvertebral fractures are enormous. We demonstrate here that Wnt16-deficient mice develop spontaneous fractures as a result of low cortical thickness and high cortical porosity. In contrast, trabecular bone volume is not altered in these mice. Mechanistic studies revealed that WNT16 is osteoblast derived and inhibits human and mouse osteoclastogenesis both directly by acting on osteoclast progenitors and indirectly by increasing expression of osteoprotegerin (Opg) in osteoblasts. The signaling pathway activated by WNT16 in osteoclast progenitors is noncanonical, whereas the pathway activated in osteoblasts is both canonical and noncanonical. Conditional Wnt16 inactivation revealed that osteoblast-lineage cells are the principal source of WNT16, and its targeted deletion in osteoblasts increases fracture susceptibility. Thus, osteoblast-derived WNT16 is a previously unreported key regulator of osteoclastogenesis and fracture susceptibility. These findings open new avenues for the specific prevention or treatment of nonvertebral fractures, a substantial unmet medical need. PMID:25306233

Enhanced dichloroethene biodegradation in fractured rock under biostimulated and bioaugmented conditions

USGS Publications Warehouse

Bradley, Paul M.; Journey, Celeste A.; Kirshtein, Julie D.; Voytek, Mary A.; Lacombe, Pierre J.; Imbrigiotta, Thomas E.; Chapelle, Francis H.; Tiedeman, Claire; Goode, Daniel J.

2012-01-01

Significant microbial reductive dechlorination of [1,2 14C] cis-dichloroethene (DCE) was observed in anoxic microcosms prepared with unamended, fractured rock aquifer materials, which were colonized in situ at multiple depths in two boreholes at the Naval Air Warfare Center (NAWC) in West Trenton, New Jersey. The lack of significant reductive dechlorination in corresponding water-only treatments indicated that chlororespiration activity in unamended, fractured rock treatments was primarily associated with colonized core material. In these unamended fractured rock microcosms, activity was highest in the shallow zones and generally decreased with increasing depth. Electron-donor amendment (biostimulation) enhanced chlororespiration in some but not all treatments. In contrast, combining electron-donor amendment with KB1 amendment (bioaugmentation) enhanced chlororespiration in all treatments and substantially reduced the variability in chlororespiration activity both within and between treatments. These results indicate (1) that a potential for chlororespiration-based bioremediation exists at NAWC Trenton but is limited under nonengineered conditions, (2) that the limitation on chlororespiration activity is not entirely due to electron-donor availability, and (3) that a bioaugmentation approach can substantially enhance in situ bioremediation if the requisite amendments can be adequately distributed throughout the fractured rock matrix.

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

PubMed

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

2006-01-01

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

Formononetin promotes early fracture healing through stimulating angiogenesis by up-regulating VEGFR-2/Flk-1 in a rat fracture model.

PubMed

Huh, Jeong-Eun; Kwon, Na-Hyun; Baek, Young-Hyun; Lee, Jae-Dong; Choi, Do-Young; Jingushi, Seiya; Kim, Kang-il; Park, Dong-Suk

2009-11-01

Plant-derived phytoestrogens have bone protective effects, but the molecular mechanism behind these effects remains unclear. This study is aimed at fully characterizing the fracture healing process of formononetin, and investigating the mechanism underlying angiogenesis in calluses of a rat fracture model. Femoral fractures were produced in 2-month-old Sprague-Dawley rats. A 20 microg/kg or 200 microg/kg dose of formononetin was orally administrated once a day during the healing period of 21 days. The results showed that in the early stage of chondrogenesis (days 3), formononetin significantly increased the number of vessels, and expression of vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2/flk-1) compared with control. However, the larger dose of formononetin had no significant difference on expression of VEGF and VEGFR-2/Flk-1 compared with that of the smaller dose of formononetin. After 7 days of administration, formononetin markedly induced differentiation of mesenchymal stem cells in the fracture site. After 14 days, gene expression of mesenchymal progenitors such as alkaline phosphatase (ALP), osteocalcin (OCN), osteopontin (OPN) and collagen type I (Col I), indicating osteogenic differentiation, was markedly stimulated by formononetin compared with control. These results suggest that formononetin promotes early fracture healing through angiogenesis activation in the early stage of fracture repair, and osteogenesis acceleration in the later stages, and thus may be beneficial for fracture healing.

Worldwide research productivity in fracture surgery: A 10-year survey of publication activity

PubMed Central

Sun, Jianzhong; Ding, Ren; Ma, Tai; Shi, Xiaobing; Bao, Chaolu; Guan, Huapeng

2017-01-01

Worldwide research contributions have allowed the field of fracture surgery to progress. However, to the best of our knowledge, no studies have documented the main characteristics of publications from different countries. The present study aimed to determine the quantity and quality of worldwide research in fracture surgery. The Web of Science database was searched to identify fracture articles published between 2005 and 2014. The contributions of countries were evaluated based on paper and citation numbers, and the research output of each country was adjusted according to population size. A total of 19,423 papers on the topic of fracture surgery were identified worldwide, and the total number of publications from 2005 to 2014 had significantly increased by 1.82-fold (P<0.001). The majority of papers (86.64%) were published by high-income countries (gross national income per capita ≥$12,736), 13.25% by middle-income countries ($1,046–12,735) and 0.11% by low-income countries (≤$1,045). The United States contributed the highest number of publications (33.34%), followed by the United Kingdom (9.03%), Germany (8.42%), China (5.58%) and Japan (4.18%). Furthermore, the United States ranked first according to total citations (72,640). Articles from Sweden achieved the highest average citations per paper (15.63), followed by Australia (12.84) and Canada (12.44). When the number of publications were adjusted for population size, Switzerland was the first (56.39), followed by Austria (35.43) and the Netherlands (30.68). In conclusion, the number of publications in fracture surgery increased from 2005 to 2014, and the majority of fracture papers were published by high-income countries, while few papers were published by low-income countries. The United States was the most prolific country, but based on population size, a number of smaller countries in Europe may be relatively more prolific. PMID:28810586

Contaminant transport in fractured rocks with significant matrix permeability, using natural fracture geometries

NASA Astrophysics Data System (ADS)

Odling, Noelle E.; Roden, Julie E.

1997-09-01

Some results from numerical models of flow and contaminant transport in fractured permeable rocks, where fractures are more conductive than rock matrix, are described. The 2D flow field in the fractured and permeable rock matrix is calculated using a finite difference, 'conductance mesh' method, and the contaminant transport is simulated by particle tracking methods using an advection-biased, random walk technique. The model is applied to simulated and naturally occurring fracture patterns. The simulated pattern is an en echelon array of unconnected fractures, as an example of a common, naturally occurring fracture geometry. Two natural fracture patterns are used: one of unconnected, sub-parallel fractures and one with oblique fracture sets which is well connected. Commonly occurring matrix permeability and fracture aperture values are chosen. The simulations show that the presence of fractures creates complex and heterogeneous flow fields and contaminant distribution in the permeable rock matrix. The modelling results have shown that some effects are non-intuitive and therefore difficult to foresee without the help of a model. With respect to contaminant transport rates and plume heterogeneity, it was found that fracture connectivity (crucial when the matrix is impermeable) can play a secondary role to fracture orientation and density. Connected fracture systems can produce smooth break-through curves of contaminants summed over, for example, a bore-hole length, whereas in detail the contaminant plume is spatially highly heterogeneous. Close to a constant-pressure boundary (e.g. an extraction bore-hole), flow and contaminants can be channelled by fractures. Thus observations at a bore-hole may suggest that contaminants are largely confined to the fracture system, when, in fact, significant contamination resides in the matrix.

The influence of local bone quality on fracture pattern in proximal humerus fractures.

PubMed

Mazzucchelli, Ruben A; Jenny, Katharina; Zdravkovic, Vilijam; Erhardt, Johannes B; Jost, Bernhard; Spross, Christian

2018-02-01

Bone mineral density and fracture morphology are widely discussed and relevant factors when considering the different treatment options for proximal humerus fractures. It was the aim of this study to investigate the influence of local bone quality on fracture patterns of the Neer classification as well as on fracture impaction angle in these injuries. All acute, isolated and non-pathological proximal humerus fractures admitted to our emergency department were included. The fractures were classified according to Neer and the humeral head impaction angle was measured. Local bone quality was assessed using the Deltoid Tuberosity Index (DTI). The distribution between DTI and fracture pattern was analysed. 191 proximal humerus fractures were included (61 men, mean age 59 years; 130 women, mean age 69.5). 77 fractures (40%) were classified as one-part, 72 (38%) were two-part, 24 (13%) were three- and four-part and 18 (9%) were fracture dislocations. 30 fractures (16%) were varus impacted, whereas 45 fractures (24%) were classified as valgus impacted. The mean DTI was 1.48. Valgus impaction significantly correlated with good bone quality (DTI ≥ 1.4; p = 0.047) whereas no such statistical significance was found for the Neer fracture types. We found that valgus impaction significantly depended on good bone quality. However, neither varus impaction nor any of the Neer fracture types correlated with bone quality. We conclude that the better bone quality of valgus impacted fractures may be a reason for their historically benign amenability to ORIF. On the other hand, good local bone quality does not prevent fracture comminution. Copyright © 2017 Elsevier Ltd. All rights reserved.

The functional outcome of the fractured clavicle.

PubMed

Davies, Danielle; Longworth, Aisling; Amirfeyz, Rouin; Fox, Rebecca; Bannister, Gordon

2009-11-01

The severity of symptoms, rate and completeness of recovery after closed treatment of the fractured clavicle has not been fully explored. The severity and duration of pain, analgesic requirements, ability to perform daily activities, return to work, driving and sport along with appearance of the shoulder were recorded in 56 patients between 1 and 2 years after fracture. Radiographs were assessed by Robinson's classification [8]. Twenty-two out of 56 patients described functional restriction 1-2 years after injury. The majority of patients ceased to experience pain (34/56) and returned to work (19/46) within 3 months. Thirty-eight out of 56 patients noted cosmetic deformity, the severity of which was associated with worse functional outcome (p = 0.002). The degree of fracture displacement was associated with cosmetic deformity (p = 0.02) and functional outcome (p = 0.015). The majority of patients perceive a cosmetic deformity and 22/56 impaired function after clavicular fracture.

Austrian Moderate Altitude Studies (AMAS): benefits of exposure to moderate altitudes (1,500-2,500 m).

PubMed

Schobersberger, Wolfgang; Leichtfried, Veronika; Mueck-Weymann, Michael; Humpeler, Egon

2010-09-01

A considerable part of the millions of Alpine tourists suffer from pre-existing diseases (e.g., metabolic syndrome) and high daily stress levels. The main goal of the Austrian Moderate Altitude Study (AMAS) was to investigate (a) the consequences of an active vacation at moderate altitude on the key parameters of the metabolic syndrome (AMAS I) and (b) the effects of a short active vacation on adult progenitor cells, bio-psychological parameters, and heart rate variability (HRV). During the AMAS I pilot study (n = 22; 1,700 m a.s.l.) and AMAS I main study (n = 71; 1,700 m a.s.l. and 200 m a.s.l.), the volunteers simulated 3-week coached hiking vacations. For AMAS II, healthy volunteers (n = 13) participated in a 1-week active holiday at 1,700 m. There were significant improvements of obesity, hypertension, dyslipidemia, and insulin resistance of AMAS I patients after the vacation. In AMAS II participants, we found an increase in circulating endothelial progenitor cells as well as improvements in bio-psychological and HRV parameters. Active vacations at moderate altitude are associated with a variety of positive health effects in persons with metabolic syndrome and in healthy subjects.

[Bilateral traumatic patella fracture: a case report].

PubMed

Cırpar, Meriç; Türker, Mehmet; Aslan, Arif; Yalçınozan, Mehmet

2011-08-01

Patellar fractures are uncommon injuries and account for approximately 1% of all fractures. In this article, a 35-year-old male patient who sustained a collision deceleration accident with bilateral comminuted transverse patellar fractures is presented. For this patient, open reduction and internal fixation with tension band technique, using two Kirschner wires and cerclage wire was applied for both fractures. At the first postoperative day, isometric quadriceps and active range of motion exercises were begun and the patient was allowed to walk full weight bearing with two crutches while both extremities were immobilized in a hinged brace allowing maximum 30 degrees of flexion. At postoperative fourth week brace immobilization was terminated. However, the patient was advised to use crutches for two weeks more to prevent any complications that may arise during walking because of the bilaterally of the injury. At six weeks solid union was achieved. During the last visit at postoperative second year, the patient had no complaints and the range of motion was full. In this paper a case of bilateral patella fractures is presented as a consequence of a dashboard injury, and the pathomechanical and therapeutical aspects of such an injury is discussed.

Hydrogel delivery of lysostaphin eliminates orthopedic implant infection by Staphylococcus aureus and supports fracture healing

PubMed Central

Johnson, Christopher T.; Wroe, James A.; Agarwal, Rachit; Martin, Karen E.; Guldberg, Robert E.; Donlan, Rodney M.; Westblade, Lars F.; García, Andrés J.

2018-01-01

Orthopedic implant infections are a significant clinical problem, with current therapies limited to surgical debridement and systemic antibiotic regimens. Lysostaphin is a bacteriolytic enzyme with high antistaphylococcal activity. We engineered a lysostaphin-delivering injectable PEG hydrogel to treat Staphylococcus aureus infections in bone fractures. The injectable hydrogel formulation adheres to exposed tissue and fracture surfaces, ensuring efficient, local delivery of lysostaphin. Lysostaphin encapsulation within this synthetic hydrogel maintained enzyme stability and activity. Lysostaphin-delivering hydrogels exhibited enhanced antibiofilm activity compared with soluble lysostaphin. Lysostaphin-delivering hydrogels eradicated S. aureus infection and outperformed prophylactic antibiotic and soluble lysostaphin therapy in a murine model of femur fracture. Analysis of the local inflammatory response to infections treated with lysostaphin-delivering hydrogels revealed indistinguishable differences in cytokine secretion profiles compared with uninfected fractures, demonstrating clearance of bacteria and associated inflammation. Importantly, infected fractures treated with lysostaphin-delivering hydrogels fully healed by 5 wk with bone formation and mechanical properties equivalent to those of uninfected fractures, whereas fractures treated without the hydrogel carrier were equivalent to untreated infections. Finally, lysostaphin-delivering hydrogels eliminate methicillin-resistant S. aureus infections, supporting this therapy as an alternative to antibiotics. These results indicate that lysostaphin-delivering hydrogels effectively eliminate orthopedic S. aureus infections while simultaneously supporting fracture repair. PMID:29760099

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.

XFEM modeling of hydraulic fracture in porous rocks with natural fractures

NASA Astrophysics Data System (ADS)

Wang, Tao; Liu, ZhanLi; Zeng, QingLei; Gao, Yue; Zhuang, Zhuo

2017-08-01

Hydraulic fracture (HF) in porous rocks is a complex multi-physics coupling process which involves fluid flow, diffusion and solid deformation. In this paper, the extended finite element method (XFEM) coupling with Biot theory is developed to study the HF in permeable rocks with natural fractures (NFs). In the recent XFEM based computational HF models, the fluid flow in fractures and interstitials of the porous media are mostly solved separately, which brings difficulties in dealing with complex fracture morphology. In our new model the fluid flow is solved in a unified framework by considering the fractures as a kind of special porous media and introducing Poiseuille-type flow inside them instead of Darcy-type flow. The most advantage is that it is very convenient to deal with fluid flow inside the complex fracture network, which is important in shale gas extraction. The weak formulation for the new coupled model is derived based on virtual work principle, which includes the XFEM formulation for multiple fractures and fractures intersection in porous media and finite element formulation for the unified fluid flow. Then the plane strain Kristianovic-Geertsma-de Klerk (KGD) model and the fluid flow inside the fracture network are simulated to validate the accuracy and applicability of this method. The numerical results show that large injection rate, low rock permeability and isotropic in-situ stresses tend to lead to a more uniform and productive fracture network.

Patient Perspectives on Engagement in Recovery after Hip Fracture: A Qualitative Study

PubMed Central

Stott-Eveneshen, Sarah; Fleig, Lena; McAllister, Megan; Ashe, Maureen C.

2017-01-01

Purpose. To understand older adults' engagement in their recovery experience and rehabilitation after a fall-related hip fracture. Method. 50 community-dwelling older adults recovering from a recent (3–12 months) hip fracture (32 women, 18 men) participated in telephone interviews using a semistructured format at 6 and 12 months after recruitment into the study. Interviews were conducted as part of a mixed-methods study designed to test the effect of a postoperative hip fracture management program (B4 Clinic). Results. Three substantive themes were identified in the qualitative data: (1) managing expectations; (2) engaging in physical activity; and (3) there is life after fracture. Participants shared valuable insight into how their expectations for their recovery period compared to their lived experience and the role of physical activity in their ability to return to their prefracture activities. Conclusions. Our findings reflect older adults' expectations for recovery from hip fracture. Encouraging engagement in rehabilitative exercises and addressing expectations prior to hospital discharge may improve patients' adherence to rehabilitation programs, functional outcomes, and postoperative quality of life. Implications for rehabilitation include the necessity for early and ongoing engagement of rehabilitation professionals. PMID:28409031

Fracture in Westerly granite under AE feedback and constant strain rate loading: Nucleation, quasi-static propagation, and the transition to unstable fracture propagation

USGS Publications Warehouse

Thompson, B.D.; Young, R.P.; Lockner, D.A.

2006-01-01

New observations of fracture nucleation are presented from three triaxial compression experiments on intact samples of Westerly granite, using Acoustic Emission (AE) monitoring. By conducting the tests under different loading conditions, the fracture process is demonstrated for quasi-static fracture (under AE Feedback load), a slowly developing unstable fracture (loaded at a 'slow' constant strain rate of 2.5 ?? 10-6/s) and an unstable fracture that develops near instantaneously (loaded at a 'fast' constant strain rate of 5 ?? 10-5/s). By recording a continuous ultrasonic waveform during the critical period of fracture, the entire AE catalogue can be captured and the exact time of fracture defined. Under constant strain loading, three stages are observed: (1) An initial nucleation or stable growth phase at a rate of ??? 1.3 mm/s, (2) a sudden increase to a constant or slowly accelerating propagation speed of ??? 18 mm/s, and (3) unstable, accelerating propagation. In the ??? 100 ms before rupture, the high level of AE activity (as seen on the continuous record) prevented the location of discrete AE events. A lower bound estimate of the average propagation velocity (using the time-to-rupture and the existing fracture length) suggests values of a few m/s. However from a low gain acoustic record, we infer that in the final few ms, the fracture propagation speed increased to 175 m/s. These results demonstrate similarities between fracture nucleation in intact rock and the nucleation of dynamic instabilities in stick slip experiments. It is suggested that the ability to constrain the size of an evolving fracture provides a crucial tool in further understanding the controls on fracture nucleation. ?? Birkha??user Verlag, Basel, 2006.

Plate on plate osteosynthesis for the treatment of nonhealed periplate fractures.

PubMed

Arealis, Georgios; Nikolaou, Vassilios S; Lacon, Andrew; Ashwood, Neil; Hamlet, Mark

2014-01-01

Purpose. The purpose of this paper is to present our technique for the treatment of periplate fractures. Methods. From 2009 to 2012 we treated three patients. In all cases the existing plate was left and the new one placed over the existing. Locking screws were placed through both plates. The other screws in the new plate were used as best suited the fracture. Results. In all cases less than 6 months had passed between fractures. None of the original fractures had healed. Mean followup was 2 years. All fractures proceeded to union within 7 months. No complications were recorded. All the patients returned to their normal activities and were satisfied with the results of their treatment. Conclusion. Our plate on plate technique is effective for the treatment of periplate fractures. A solid fusion can be achieved at the new fracture site without disturbing the previous fixation.

Diabetic calcaneal fractures.

PubMed

Sagray, Bryan A; Stapleton, John J; Zgonis, Thomas

2013-01-01

Calcaneal fractures among the diabetic population are severe and complex injuries that warrant careful evaluation in an effort to carry out adequate conservative or surgical management. The complication rates associated with diabetic fracture management are increased and may include poor wound healing, deep infection, malunion, and Charcot neuroarthropathy, each of which can pose a risk for limb loss. The significant surgery-associated morbidity accompanying diabetic calcaneal fractures has led to improved methods of calcaneal fracture management. This article reviews the overall management of diabetic calcaneal fractures, complications, and outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

Hand fracture - aftercare

MedlinePlus

... this page: //medlineplus.gov/ency/patientinstructions/000552.htm Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...

Numerical Modelling of Femur Fracture and Experimental Validation Using Bone Simulant.

PubMed

Marco, Miguel; Giner, Eugenio; Larraínzar-Garijo, Ricardo; Caeiro, José Ramón; Miguélez, María Henar

2017-10-01

Bone fracture pattern prediction is still a challenge and an active field of research. The main goal of this article is to present a combined methodology (experimental and numerical) for femur fracture onset analysis. Experimental work includes the characterization of the mechanical properties and fracture testing on a bone simulant. The numerical work focuses on the development of a model whose material properties are provided by the characterization tests. The fracture location and the early stages of the crack propagation are modelled using the extended finite element method and the model is validated by fracture tests developed in the experimental work. It is shown that the accuracy of the numerical results strongly depends on a proper bone behaviour characterization.

Biochemical Predictors of Low Bone Mineral Density and Fracture Susceptibility in Maltese Postmenopausal Women.

PubMed

Formosa, Melissa M; Xuereb-Anastasi, Angela

2016-01-01

Osteoporosis and fractures are complex conditions influenced by an interplay of genetic and environmental factors. The aim of the study was to investigate three biochemical parameters including total serum calcium, total serum alkaline phosphatase (sALP) and albumin in relation to bone mineral density (BMD) at the lumbar spine and femoral neck (FN), and with all-type of low-trauma fractures in Maltese postmenopausal women. Levels were also correlated with age and physical activity. A case-control study of 1045 women was performed. Women who suffered a fracture were classified as cases whereas women without a fracture history were included as controls subdivided into normal, osteopenic, or osteoporotic according to their BMD measurements. Blood specimens were collected following good standard practice and testing was performed by spectrophotometry. Calcium and sALP levels were weakly correlated with FN BMD levels (calcium: r = -0.111, p = 0.002; sALP: r = 0.089, p = 0.013). Fracture cases had the lowest serum levels of calcium, sALP and albumin relative to all other control groups, which decreased with increasing age, possibly increasing fracture risk. Biochemical levels were lowest in women who sustained a hip fracture and more than one fracture. Biochemical parameters decreased with reduced physical activity; however, this was most evident for fracture cases. Reduced physical activity was associated with lower BMD levels at the hip, and to a lower extent at the spine. In conclusion, results suggest that levels of serum calcium and albumin could be indicative of fracture risk, whereas calcium levels and to lower extent sALP levels could be indicators of hip BMD.

Cough-induced rib fractures.

PubMed

Hanak, Viktor; Hartman, Thomas E; Ryu, Jay H

2005-07-01

To define the demographic, clinical, and radiological features of patients with cough-induced rib fractures and to assess potential risk factors. For this retrospective, single-center study, we identified all cases of cough-induced rib fractures diagnosed at the Mayo Clinic in Rochester, Minn, over a 9-year period between January 1, 1996, and January 31, 2005. Bone densitometry data from patients' medical records were analyzed, and T scores were used to classify patients into bone density categories. The mean +/- SD age of the 54 study patients at presentation was 55+/-17 years, and 42 patients (78%) were female. Patients presented with chest wall pain after onset of cough. Rib fracture was associated with chronic cough (> or =3 weeks' duration) in 85% of patients. Rib fractures were documented by chest radiography, rib radiography, computed tomography, or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 (58%). There were 112 fractured ribs in 54 patients. One half of patients had more than one fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was rib 6. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%). Cough-induced rib fractures occur primarily in women with chronic cough. Middle ribs along the lateral aspect of the rib cage are affected most commonly. Although reduced bone density is likely a risk factor, cough-induced rib fractures can occur in the presence of normal bone density.

Periprosthetic fractures of the humerus.

PubMed

McDonough, Edward B; Crosby, Lynn A

2005-12-01

Periprosthetic humeral fractures present a treatment challenge for the orthopedic surgeon. The overall incidence of fracture is between 0.5% and 3%, with the majority of fractures occurring intraoperatively and involving the humeral diaphysis. Excess torque produced during surgery is usually responsible for intraoperative fractures. Improper canal preparation or prosthetic placement may also increase the chance of sustaining a fracture. Postoperative fractures are most commonly caused by minor trauma, such as a fall. Poor bone quality, female sex, advanced age, and history of rheumatoid arthritis are the risk factors most commonly associated with periprosthetic fractures. All 4 systems used to describe periprosthetic humeral shaft fractures classify fracture patterns according to the anatomic relation of the fracture to the prosthetic stem. Treatment decisions should be made with respect to obtaining fracture stability, initiating early gleno-humeral motion, and restoring shoulder function. Intraoperative fractures and any postoperative fracture resulting in prosthetic instability should be treated with a long-stem prosthesis extending at least 2 to 3 cortical diameters past the fracture site with consideration for rigid plate fixation. Short oblique or transverse postoperative fractures should be managed with early stable fixation. There has been some support for conservative treatment of long oblique or spiral postoperative fractures. Postoperative diaphyseal fractures distal to the stem generally are well maintained with standard fracture management.

Kasei Valles Fractures

NASA Image and Video Library

2010-10-27

The fracture system shown in this image from NASA Mars Odyssey is on the northern margin of the Kasei Valles lowland. Fractures like this can become chaos with continued downdropping of blocks and widening fractures.

Approach for computing 1D fracture density: application to fracture corridor characterization

NASA Astrophysics Data System (ADS)

Viseur, Sophie; Chatelée, Sebastien; Akriche, Clement; Lamarche, Juliette

2016-04-01

Fracture density is an important parameter for characterizing fractured reservoirs. Many stochastic simulation algorithms that generate fracture networks indeed rely on the determination of a fracture density on volumes (P30) to populate the reservoir zones with individual fracture surfaces. However, only 1D fracture density (P10) are available from subsurface data and it is then important to be able to accurately estimate this entity. In this paper, a novel approach is proposed to estimate fracture density from scan-line or well data. This method relies on regression, hypothesis testing and clustering techniques. The objective of the proposed approach is to highlight zones where fracture density are statistically very different or similar. This technique has been applied on both synthetic and real case studies. These studies concern fracture corridors, which are particular tectonic features that are generally difficult to characterize from subsurface data. These tectonic features are still not well known and studies must be conducted to better understand their internal spatial organization and variability. The presented synthetic cases aim at showing the ability of the approach to extract known features. The real case study illustrates how this approach allows the internal spatial organization of fracture corridors to be characterized.

The association between childhood fractures and adolescence bone outcomes: a population-based study, the Tromsø Study, Fit Futures.

PubMed

Christoffersen, T; Emaus, N; Dennison, E; Furberg, A-S; Gracia-Marco, L; Grimnes, G; Nilsen, O A; Vlachopoulos, D; Winther, A; Ahmed, L A

2018-02-01

Childhood fracture may predict persistent skeletal fragility, but it may also reflect high physical activity which is beneficial to bone development. We observe a difference in the relationship between previous fracture and bone outcome across physical activity level and sex. Further elaboration on this variation is needed. Childhood fracture may be an early marker of skeletal fragility, or increased levels of physical activity (PA), which are beneficial for bone mineral accrual. This study investigated the association between a previous history of childhood fracture and adolescent bone mineral outcomes by various PA levels. We recruited 469 girls and 492 boys aged 15-18 years to this study. We assessed PA levels by questionnaire and measured areal bone mineral density (aBMD) and bone mineral content (BMC) using dual-energy X-ray absorptiometry (DXA) at arm, femoral neck (FN), total hip (TH), and total body (TB) and calculated bone mineral apparent density (BMAD, g/cm 3 ). Fractures from birth to time of DXA measurements were retrospectively recorded. We analyzed differences among participants with and without fractures using independent sample t test. Multiple linear regression was used to examine the association between fractures and aBMD and BMC measurements according to adolescent PA. Girls with and without a previous history of fracture had similar BMC, aBMD, and BMAD at all sites. In multiple regression analyses stratified by physical activity intensity (PAi), there was a significant negative association between fracture and aBMD-TH and BMC-FN yet only in girls reporting low PAi. There was a significant negative association between forearm fractures, BMAD-FN, and BMAD-arm among vigorously active boys. Our findings indicate a negative association between childhood fractures and aBMD/BMC in adolescent girls reporting low PAi. In boys, such an association appears only in vigorously active participants with a history of forearm fractures.

Stress fracture of the pelvis and lower limbs including atypical femoral fractures-a review.

PubMed

Tins, Bernhard J; Garton, Mark; Cassar-Pullicino, Victor N; Tyrrell, Prudencia N M; Lalam, Radhesh; Singh, Jaspreet

2015-02-01

Stress fractures, that is fatigue and insufficiency fractures, of the pelvis and lower limb come in many guises. Most doctors are familiar with typical sacral, tibial or metatarsal stress fractures. However, even common and typical presentations can pose diagnostic difficulties especially early after the onset of clinical symptoms. This article reviews the aetiology and pathophysiology of stress fractures and their reflection in the imaging appearances. The role of varying imaging modalities is laid out and typical findings are demonstrated. Emphasis is given to sometimes less well-appreciated fractures, which might be missed and can have devastating consequences for longer term patient outcomes. In particular, atypical femoral shaft fractures and their relationship to bisphosphonates are discussed. Migrating bone marrow oedema syndrome, transient osteoporosis and spontaneous osteonecrosis are reviewed as manifestations of stress fractures. Radiotherapy-related stress fractures are examined in more detail. An overview of typical sites of stress fractures in the pelvis and lower limbs and their particular clinical relevance concludes this review. Teaching Points • Stress fractures indicate bone fatigue or insufficiency or a combination of these. • Radiographic visibility of stress fractures is delayed by 2 to 3 weeks. • MRI is the most sensitive and specific modality for stress fractures. • Stress fractures are often multiple; the underlying cause should be evaluated. • Infratrochanteric lateral femoral fractures suggest an atypical femoral fracture (AFF); endocrinologist referral is advisable.

Ancient microbial activity recorded in fracture fillings from granitic rocks (Äspö Hard Rock Laboratory, Sweden).

PubMed

Heim, C; Lausmaa, J; Sjövall, P; Toporski, J; Dieing, T; Simon, K; Hansen, B T; Kronz, A; Arp, G; Reitner, J; Thiel, V

2012-07-01

Fracture minerals within the 1.8-Ga-old Äspö Diorite (Sweden) were investigated for fossil traces of subterranean microbial activity. To track the potential organic and inorganic biosignatures, an approach combining complementary analytical techniques of high lateral resolution was applied to drill core material obtained at -450 m depth in the Äspö Hard Rock Laboratory. This approach included polarization microscopy, time-of-flight secondary ion mass spectrometry (ToF-SIMS), confocal Raman microscopy, electron microprobe (EMP) and laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The fracture mineral succession, consisting of fluorite and low-temperature calcite, showed a thin (20-100 μm), dark amorphous layer lining the boundary between the two phases. Microscopic investigations of the amorphous layer revealed corrosion marks and, in places, branched tubular structures within the fluorite. Geochemical analysis showed significant accumulations of Si, Al, Mg, Fe and the light rare earth elements (REE) in the amorphous layer. In the same area, ToF-SIMS imaging revealed abundant, partly functionalized organic moieties, for example, C(x)H(y)⁺, C(x)H(y)N⁺, C(x)H(y)O⁺. The presence of such functionalized organic compounds was corroborated by Raman imaging showing bands characteristic of C-C, C-N and C-O bonds. According to its organic nature and the abundance of relatively unstable N- and O- heterocompounds, the organic-rich amorphous layer is interpreted to represent the remains of a microbial biofilm that established much later than the initial cooling of the Precambrian host rock. Indeed, δ¹³C, δ¹⁸O and ⁸⁷Sr/⁸⁶Sr isotope data of the fracture minerals and the host rock point to an association with a fracture reactivation event in the most recent geological past. © 2012 Blackwell Publishing Ltd.

Delivery and Outcomes of a Yearlong Home Exercise Program After Hip Fracture

PubMed Central

Orwig, Denise L.; Hochberg, Marc; Yu-Yahiro, Janet; Resnick, Barbara; Hawkes, William G.; Shardell, Michelle; Hebel, J. Richard; Colvin, Perry; Miller, Ram R.; Golden, Justine; Zimmerman, Sheryl; Magaziner, Jay

2011-01-01

Background Hip fracture affects more than 1.6 million persons worldwide and causes substantial changes in body composition, function, and strength. Usual care (UC) has not successfully restored function to most patients, and prior research has not identified an effective restorative program. Our objective was to determine whether a yearlong home-based exercise program initiated following UC could be administered to older patients with hip fracture and improve outcomes. Methods A randomized controlled trial of 180 community dwelling female patients with hip fracture, 65 years and older, randomly assigned to intervention (n=91) or UC (n=89). Patients were recruited within 15 days of fracture from 3 Baltimore-area hospitals from November 1998 through September 2004. Follow-up assessments were conducted at 2, 6, and 12 months after fracture. The Exercise Plus Program was administered by exercise trainers that included supervised and independently performed aerobic and resistive exercises with increasing intensity. Main outcome measures included bone mineral density of the contralateral femoral neck. Other outcomes included time spent and kilocalories expended in physical activity using the Yale Physical Activity Scale, muscle mass and strength, fat mass, activities of daily living, and physical and psychosocial functioning. The effect of intervention for each outcome was estimated by the difference in outcome trajectories 2 to 12 months after fracture. Results More than 80% of participants received trainer visits, with the majority receiving more than 3 quarters (79%) of protocol visits. The intervention group reported more time spent in exercise activity during follow-up (P<.05). Overall, small effect sizes of 0 to 0.2 standard deviations were seen for bone mineral density measures, and no significant patterns of time-specific between-group differences were observed for the remaining outcome measures. Conclusion Patients with hip fracture who participate in a yearlong

Temperament and fracture in preschool-aged children.

PubMed

Ryckman, Kandace; Richmond, Sarah A; Anderson, Laura N; Birken, Catherine S; Parkin, Patricia C; Macarthur, Colin; Maguire, Jonathon L; Howard, Andrew W

2017-07-01

Approximately one-half of all children will sustain a fracture before adulthood. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. The purpose of this study was to examine the association between temperament and fracture risk in preschool-aged children. Children aged 3 to 6 years who were diagnosed with a fracture were recruited from the Hospital for Sick Children Fracture Clinic. Using a retrospective case-control study design, the 148 cases were frequency-matched by age and sex to 426 controls from the TARGet Kids primary care paediatric cohort. The Childhood Behaviour Questionnaire, a 36-item caregiver response questionnaire was used to assess three of the following temperament factors: surgency (e.g., high activity level), negative affect (e.g., anger, fear, discomfort) and effortful control (e.g., attentional focusing). Unadjusted logistic models demonstrated no association between children with previous fracture and higher scores of surgency (unadjusted odds ratio [OR]=1.06, 95% confidence interval [CI]: 0.84, 1.34), negative affect (unadjusted OR=1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR=0.80, 95% CI: 0.63, 1.03). Further, models adjusted for covariates also demonstrated no significant association with surgency (1.00, 95% CI: 0.78, 1.29), negative affect (1.09, 95% CI: 0.86, 1.37) and effortful control (0.80, 95% CI: 0.61, 1.05). None of the three main temperament types identified by the Childhood Behaviour Questionnaire were associated with an increase in fracture risk.

Smart magnetic markers use in hydraulic fracturing.

PubMed

Zawadzki, Jarosław; Bogacki, Jan

2016-11-01

One of the main challenges and unknowns during shale gas exploration is to assess the range and efficiency of hydraulic fracturing. It is also essential to assess the distribution of proppant, which keeps the fracture pathways open. Solving these problems may considerably increase the efficiency of the shale gas extraction. Because of that, the idea of smart magnetic marker, which can be detected when added to fracturing fluid, has been considered for a long time. This study provides overview of the possibilities of magnetic marker application for shale gas extraction. The imaging methods using electromagnetic markers, are considered or developed in two directions. The first possibility is the markers' electromagnetic activity throughout the whole volume of the fracturing fluid. Thus, it can be assumed that the whole fracturing fluid is the marker. Among these type of hydraulic fracturing solutions, ferrofluid could be considered. The second possibility is marker, which is just one of many components of the fracturing fluid. In this case feedstock magnetic materials, ferrites and nanomaterials could be considered. Magnetic properties of magnetite could be too low and ferrofluids' or nanomaterials' price is unacceptably high. Because of that, ferrites, especially ZnMn ferrites seems to be the best material for magnetic marker. Because of the numerous applications in electronics, it is cheap and easily available, although the price is higher, then that of magnetite. The disadvantage of using ferrite, could be too small mechanical strength. It creates an essential need for combining magnetic marker with proppant into magnetic-ceramic composite. Copyright © 2016 Elsevier Ltd. All rights reserved.

Procedure for estimating fracture energy from fracture surface roughness

DOEpatents

Williford, Ralph E.

1989-01-01

The fracture energy of a material is determined by first measuring the length of a profile of a section through a fractured surface of the material taken on a plane perpendicular to the mean plane of that surface, then determining the fractal dimensionality of the surface. From this, the yield strength of the material, and the Young's Modulus of that material, the fracture energy is calculated.

Assessing Microbial Activity in Marcellus Shale Hydraulic Fracturing Fluids

NASA Astrophysics Data System (ADS)

Wishart, J. R.; Morono, Y.; Itoh, M.; Ijiri, A.; Hoshino, T.; Inagaki, F.; Verba, C.; Torres, M. E.; Colwell, F. S.

2014-12-01

Hydraulic fracturing (HF) produces millions of gallons of waste fluid which contains a microbial community adapted to harsh conditions such as high temperatures, high salinities and the presence of heavy metals and radionuclides. Here we present evidence for microbial activity in HF production fluids. Fluids collected from a Marcellus shale HF well were supplemented with 13C-labeled carbon sources and 15N-labeled ammonium at 25°C under aerobic or anaerobic conditions. Samples were analyzed for 13C and 15N incorporation at sub-micrometer scale by ion imaging with the JAMSTEC NanoSIMS to determine percent carbon and nitrogen assimilation in individual cells. Headspace CO2 and CH4 were analyzed for 13C enrichment using irm-GC/MS. At 32 days incubation carbon assimilation was observed in samples containing 1 mM 13C-labeled glucose under aerobic and anaerobic conditions with a maximum of 10.4 and 6.5% total carbon, respectively. Nitrogen assimilation of 15N ammonium observed in these samples were 0.3 and 0.8% of total nitrogen, respectively. Head space gas analysis showed 13C enrichment in CH4 in anaerobic samples incubated with 1mM 13C-labeled bicarbonate (2227 ‰) or methanol (98943 ‰). Lesser 13C enrichment of CO2 was observed in anaerobic samples containing 1 mM 13C-labeled acetate (13.7 ‰), methanol (29.9 ‰) or glucose (85.4 ‰). These results indicate metabolic activity and diversity in microbial communities present in HF flowback fluids. The assimilation of 13C-labeled glucose demonstrates the production of biomass, a critical part of cell replication. The production of 13CO2 and 13CH4 demonstrate microbial metabolism in the forms of respiration and methanogenesis, respectively. Methanogenesis additionally indicates the presence of an active archaeal community. This research shows that HF production fluid chemistry does not entirely inhibit microbial activity or growth and encourages further research regarding biogeochemical processes occurring in

Surgery for scapula process fractures

PubMed Central

Anavian, Jack; Wijdicks, Coen A; Schroder, Lisa K; Vang, Sandy

2009-01-01

Background Generally, scapula process fractures (coracoid and acromion) have been treated nonoperatively with favorable outcome, with the exception of widely displaced fractures. Very little has been published, however, regarding the operative management of such fractures and the literature that is available involves very few patients. Our hypothesis was that operative treatment of displaced acromion and coracoid fractures is a safe and effective treatment that yields favorable surgical results. Methods We reviewed 26 consecutive patients (27 fractures) treated between 1998 and 2007. Operative indications for these process fractures included either a painful nonunion, a concomitant ipsilateral operative scapula fracture, ≥ 1 cm of displacement on X-ray, or a multiple disruption of the superior shoulder suspensory complex. All patients were followed until they were asymptomatic, displayed radiographic fracture union, and had recovered full motion with no pain. Patients and results 21 males and 5 females, mean age 36 (18–67) years, were included in the study. 18 patients had more than one indication for surgery. Of the 27 fractures, there were 13 acromion fractures and 14 coracoid fractures. 1 patient was treated for both a coracoid and an acromion fracture. Fracture patterns for the acromion included 6 acromion base fractures and 7 fractures distal to the base. Coracoid fracture patterns included 11 coracoid base fractures and 3 fractures distal to the base. Mean follow-up was 11 (2–42) months. All fractures united and all patients had recovered full motion with no pain at the time of final follow-up. 3 patients underwent removal of hardware due to irritation from hardware components that were too prominent. There were no other complications. Interpretation While most acromion and coracoid fractures can be treated nonoperatively with satisfactory results, operative management may be indicated for displaced fractures and double lesions of the superior shoulder

A study of sports-related orbital fractures in Singapore.

PubMed

Lock, Jing Zhan; Hegde, Raghuraj; Young, Stephanie; Lim, Thiam Chye; Amrith, Shantha; Sundar, Gangadhara

2017-10-01

With an increased popularity of sport and active living worldwide, our study aims to explore the incidence and features of sports-related orbital fractures in Singapore. 1421 computer tomography (CT) imaging scans of the face and orbits done at the National University Hospital over a 24-month period from January 2013 and December 2014 were reviewed retrospectively for orbital fractures. We identified 483 orbital fractures of which sports injury was the fourth most common etiology (n = 65; 13.5%) after road traffic accident (n = 131; 27.1%), geriatric fall (n = 81; 16.8%) and workplace injury (n = 67; 13.9%). The three most common sport in orbital fractures were soccer (n = 20; 30.8%), bicycling (n = 11; 16.9%) and jogging (n = 8; 12.3%). The three most common fracture patterns were zygomatico-maxillary complex fractures (n = 24; 36.9%), isolated one wall blowout fractures (n = 19; 29.2%) and naso-orbito-ethmoid fractures (n = 7; 10.8%). Sports-related orbital fractures were associated with a low mean age of patients (45.9 years, range, 14-79 years), a higher proportion of males (n = 58; 89.2%) than that from geriatric falls (n = 37, 45.6%) (P < 0.01), a higher likelihood of unilaterality (n = 62; 95.4%) than that from traffic accidents (n = 99; 75.6%) (P < 0.01) and a lower likelihood of pan-facial involvement (n = 4; 6.15%) than that from traffic accident (n = 60; 45.8%) (P < 0.01). Sports-related orbital fractures are the fourth most common cause of orbital fractures. Though commonly seen in young male adults, in view of the aging population and people exercising more regularly, education of safety measures among sports users is paramount to preventing sports-related orbital fractures.

Pediatric mandibular fractures.

PubMed

Thaller, S R; Mabourakh, S

1991-06-01

In spite of curiosity, facial fractures, particularly mandibular fractures, in the pediatric age group embrace only a modest proportion of facial fractures that occur within the general population. Several large series report an overall incidence of approximately 1% of all facial bone fractures. A considerable volume of literature has been generated describing the pattern of injury and treatment modalities for pediatric facial bone fractures. At our institution, which is an extremely busy university-based regional trauma center, we have witnessed a persistent escalation in the number of patients requiring repair of their facial bone fractures. During the period of January 1989 through January 1990, we treated a total of 204 patients for repair of mandible fractures. An analysis of the records of this group revealed only 3 patients who were younger than 4 years of age and 2 additional patients younger than 8 years. There were another 10 patients 17 years and younger, for a total incidence of 0.08%. Additionally, we found that within this seemingly small group, there was a surprisingly high incidence of severe, associated injuries.

Prevalence and Cost of Subsequent Fractures Among U.S. Patients with an Incident Fracture.

PubMed

Weaver, Jessica; Sajjan, Shiva; Lewiecki, E Michael; Harris, Steven T; Marvos, Panagiotis

2017-04-01

The prevalence and cost of subsequent fractures among patients with an incident fracture are not well defined. To assess the prevalence of, and costs associated with, subsequent fractures in the year after an incident fracture. This was a retrospective claims database analysis using data from Humana Medicare Advantage claims (Medicare group) and Optum Insight Clinformatics Data Mart commercial claims (commercial group). Patients included in the study had a claim for a qualifying fracture occurring between January 2008 and December 2013 (index fracture), were continuously enrolled in the health plan for ≥ 1 year before and after the index fracture, and were aged ≥ 65 years in the Medicare group or ≥ 50 years in the commercial group at the time of the index fracture. Subsequent fractures were identified by ICD-9-CM codes and were defined as the second fracture occurring ≥ 3 to ≤ 12 months after the index fracture (≥ 6 to ≤ 12 months for fractures at the same site as the index fracture). Rates of subsequent fractures were calculated as the number of patients who had a subsequent fracture divided by the total sample size. After propensity matching of demographic and clinical variables, we determined the total medical and pharmacy costs accrued within 1 year of the index fracture by patients with and without a subsequent fracture. Health care costs were compared between patients with and without a subsequent fracture using McNemar's test. A total of 45,603 patients were included in the Medicare group, and 54,145 patients were included in the commercial group. In the Medicare group, 7,604 (16.7%) patients experienced a subsequent fracture. The proportion of patients with a subsequent fracture was highest among patients with multiple index fractures (26.2%, n = 905), followed by those with hip (25.5%, n = 1,280) and vertebral (20.2%, n = 1,908) index fractures. In the commercial group, 6,256 (11.6%) patients experienced a subsequent fracture. The proportion

CaMKK2 Inhibition in Enhancing Bone Fracture Healing

DTIC Science & Technology

2016-05-01

active-duty military personnel as well as aging combat veterans. Fractures associated with osteoporosis and acute trauma result in significant medical...fractures, contributing to further medical costs and patient morbidity. Established therapies that treat osteoporosis such as bisphosphonates only reduce...permeable inhibitor STO-609 protects from ovariectomy-induced osteoporosis . Moreover, treatment of 32 week old male mice with STO-609 reverses age

Anterior tibial stress fractures treated with anterior tension band plating in high-performance athletes.

PubMed

Cruz, Alexandre Santa; de Hollanda, João Paris Buarque; Duarte, Aires; Hungria Neto, José Soares

2013-06-01

The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. We describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the tibia was performed in all patients diagnosed with anterior tibial stress fracture after September 2010 at Santa Casa Hospital. All of the fractures were consolidated within a period of 3 months after surgery, allowing for an early return to pre-injury levels of competitive sports activity. There were no infection, non-union, malunion or anterior knee pain complications. Anterior tibial tension band plating leads to prompt fracture consolidation and is a good alternative for the treatment of anterior tibial cortex stress fractures. Bone grafts were shown to be unnecessary.

Fracture Patterns within the Shale Hills Critical Zone Observatory

NASA Astrophysics Data System (ADS)

Singha, K.; White, T.; Perron, J.; Chattopadhyay, P. B.; Duffy, C.

2012-12-01

Rock fractures are known to exist within the deep Critical Zone and are expected to influence groundwater flow, but there are limited data on their orientation and spatial arrangement and no general framework for systematically predicting their effects. Here, we explore fracture patterns within the Susquehanna-Shale Hills Critical Zone Observatory, and consider how they may be influenced by weathering, rock structure, and stress via field observations of variable fracture orientation within the site, with implications for the spatial variability of structural control on hydrologic processes. Based on field observations from 16-m deep boreholes and surface outcrop, we suggest that the appropriate structural model for the watershed is steeply dipping strata with meter- to decimeter-scale folds superimposed, including a superimposed fold at the mouth of the watershed that creates a short fold limb with gently dipping strata. These settings would produce an anisotropy in the hydraulic conductivity and perhaps also flow, especially within the context of the imposed stress field. Recently conducted 2-D numerical stress modeling indicates that the proxy for shear fracture declines more rapidly with depth beneath valleys than beneath ridgelines, which may produce or enhance the spatial variability in permeability. Even if topographic stresses do not cause new fractures, they could activate and cause displacement on old fractures, making the rocks easier to erode and increasing the permeability, and potentially driving a positive feedback that enhances the growth of valley relief. Calculated stress fields are consistent with field observations, which show a rapid decline in fracture abundance with increasing depth below the valley floor, and predict a more gradual trend beneath ridgetops, leading to a more consistent (and lower) hydraulic conductivity with depth on the ridgetops when compared to the valley, where values are higher but more variable with depth. Hydraulic

Clinical and economic burden of fractures in patients with renal osteodystrophy.

PubMed

Schumock, G T; Sprague, S M

2007-04-01

Renal osteodystrophy is a key cause of fractures in patients with chronic kidney disease (CKD). This article reviews the clinical and economic burden of fractures and explores the types of studies that need to be conducted in order to fully understand the impact of fractures in renal osteodystrophy. We also discuss the role that active vitamin D compounds and calcimimetics play in treating secondary hyperparathyroidism. Medline was searched for relevant articles on renal osteodystrophy and fractures. CKD-related fractures are the source of significant morbidity and costs. Extensive osteoporosis research has been utilized to guide fracture prevention and improve disease management, but further costs and outcomes analyses are needed for renal osteodystrophy. Recent research regarding newer, present-day treatment paradigms has suggested that distinct cost savings and improved patient outcomes are possible. In order to realize such economic and human benefits, the medical community must first have sufficient pathologic, pharmacoeconomic and epidemiologic data to properly understand, manage and prevent renal osteodystrophy and fractures.

Future treatment and research directions in distal radius fracture.

PubMed

Jupiter, Jesse

2012-05-01

Whether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury. Copyright © 2012. Published by Elsevier Inc.

Mechanics of Hydraulic Fractures

NASA Astrophysics Data System (ADS)

Detournay, Emmanuel

2016-01-01

Hydraulic fractures represent a particular class of tensile fractures that propagate in solid media under pre-existing compressive stresses as a result of internal pressurization by an injected viscous fluid. The main application of engineered hydraulic fractures is the stimulation of oil and gas wells to increase production. Several physical processes affect the propagation of these fractures, including the flow of viscous fluid, creation of solid surfaces, and leak-off of fracturing fluid. The interplay and the competition between these processes lead to multiple length scales and timescales in the system, which reveal the shifting influence of the far-field stress, viscous dissipation, fracture energy, and leak-off as the fracture propagates.

Seismic characteristics of tensile fracture growth induced by hydraulic fracturing

NASA Astrophysics Data System (ADS)

Eaton, D. W. S.; Van der Baan, M.; Boroumand, N.

2014-12-01

Hydraulic fracturing is a process of injecting high-pressure slurry into a rockmass to enhance its permeability. Variants of this process are used for unconventional oil and gas development, engineered geothermal systems and block-cave mining; similar processes occur within volcanic systems. Opening of hydraulic fractures is well documented by mineback trials and tiltmeter monitoring and is a physical requirement to accommodate the volume of injected fluid. Numerous microseismic monitoring investigations acquired in the audio-frequency band are interpreted to show a prevalence of shear-dominated failure mechanisms surrounding the tensile fracture. Moreover, the radiated seismic energy in the audio-frequency band appears to be a miniscule fraction (<< 1%) of the net injected energy, i.e., the integral of the product of fluid pressure and injection rate. We use a simple penny-shaped crack model as a predictive framework to describe seismic characteristics of tensile opening during hydraulic fracturing. This model provides a useful scaling relation that links seismic moment to effective fluid pressure within the crack. Based on downhole recordings corrected for attenuation, a significant fraction of observed microseismic events are characterized by S/P amplitude ratio < 5. Despite the relatively small aperture of the monitoring arrays, which precludes both full moment-tensor analysis and definitive identification of nodal planes or axes, this ratio provides a strong indication that observed microseismic source mechanisms have a component of tensile failure. In addition, we find some instances of periodic spectral notches that can be explained by an opening/closing failure mechanism, in which fracture propagation outpaces fluid velocity within the crack. Finally, aseismic growth of tensile fractures may be indicative of a scenario in which injected energy is consumed to create new fracture surfaces. Taken together, our observations and modeling provide evidence that

Hydrogel delivery of lysostaphin eliminates orthopedic implant infection by Staphylococcus aureus and supports fracture healing.

PubMed

Johnson, Christopher T; Wroe, James A; Agarwal, Rachit; Martin, Karen E; Guldberg, Robert E; Donlan, Rodney M; Westblade, Lars F; García, Andrés J

2018-05-29

Orthopedic implant infections are a significant clinical problem, with current therapies limited to surgical debridement and systemic antibiotic regimens. Lysostaphin is a bacteriolytic enzyme with high antistaphylococcal activity. We engineered a lysostaphin-delivering injectable PEG hydrogel to treat Staphylococcus aureus infections in bone fractures. The injectable hydrogel formulation adheres to exposed tissue and fracture surfaces, ensuring efficient, local delivery of lysostaphin. Lysostaphin encapsulation within this synthetic hydrogel maintained enzyme stability and activity. Lysostaphin-delivering hydrogels exhibited enhanced antibiofilm activity compared with soluble lysostaphin. Lysostaphin-delivering hydrogels eradicated S. aureus infection and outperformed prophylactic antibiotic and soluble lysostaphin therapy in a murine model of femur fracture. Analysis of the local inflammatory response to infections treated with lysostaphin-delivering hydrogels revealed indistinguishable differences in cytokine secretion profiles compared with uninfected fractures, demonstrating clearance of bacteria and associated inflammation. Importantly, infected fractures treated with lysostaphin-delivering hydrogels fully healed by 5 wk with bone formation and mechanical properties equivalent to those of uninfected fractures, whereas fractures treated without the hydrogel carrier were equivalent to untreated infections. Finally, lysostaphin-delivering hydrogels eliminate methicillin-resistant S. aureus infections, supporting this therapy as an alternative to antibiotics. These results indicate that lysostaphin-delivering hydrogels effectively eliminate orthopedic S. aureus infections while simultaneously supporting fracture repair. Copyright © 2018 the Author(s). Published by PNAS.

Outcomes of nonoperatively treated displaced scapular body fractures.

PubMed

Dimitroulias, Apostolos; Molinero, Kenneth G; Krenk, Daniel E; Muffly, Matthew T; Altman, Daniel T; Altman, Gregory T

2011-05-01

Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

Effects of medication reviews performed by a physician on treatment with fracture-preventing and fall-risk-increasing drugs in older adults with hip fracture-a randomized controlled study.

PubMed

Sjöberg, Christina; Wallerstedt, Susanna M

2013-09-01

To investigate whether medication reviews increase treatment with fracture-preventing drugs and decrease treatment with fall-risk-increasing drugs. Randomized controlled trial (1:1). Departments of orthopedics, geriatrics, and medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. One hundred ninety-nine consecutive individuals with hip fracture aged 65 and older. Medication reviews, based on assessments of risks of falls and fractures, regarding fracture-preventing and fall-risk-increasing drugs, performed by a physician, conveyed orally and in written form to hospital physicians during the hospital stay, and to general practitioners after discharge. Primary outcomes were changes in treatment with fracture-preventing and fall-risk-increasing drugs 12 months after discharge. Secondary outcomes were falls, fractures, deaths, and physicians' attitudes toward the intervention. At admission, 26% of intervention and 29% of control participants were taking fracture-preventing drugs, and 12% and 11%, respectively, were taking bone-active drugs, predominantly bisphosphonates. After 12 months, 77% of intervention and 58% of control participants were taking fracture-preventing drugs (P = .01), and 29% and 15%, respectively, were taking bone-active drugs (P = .04). Mean number of fall-risk-increasing drugs per participants was 3.1 (intervention) and 3.1 (control) at admission and 2.9 (intervention) and 3.1 (control) at 12 months (P = .62). No significant differences in hard endpoints were found. The responding physicians (n = 65) appreciated the intervention; on a scale from 1 (very bad) to 6 (very good), the median rating was 5 (interquartile range (IQR) 4-6) for the oral part and 5 (IQR 4-5.5) for the text part. Medication reviews performed and conveyed by a physician increased treatment with fracture-preventing drugs but did not significantly decrease treatment with fall-risk-increasing drugs in older adults with hip fracture. Prescribing physicians appreciated

The Aftermath of Hip Fracture: Discharge Placement, Functional Status Change, and Mortality

PubMed Central

Bentler, Suzanne E.; Liu, Li; Obrizan, Maksym; Cook, Elizabeth A.; Wright, Kara B.; Geweke, John F.; Chrischilles, Elizabeth A.; Pavlik, Claire E.; Wallace, Robert B.; Ohsfeldt, Robert L.; Jones, Michael P.; Rosenthal, Gary E.; Wolinsky, Fredric D.

2009-01-01

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993–2005. There were 495 postbaseline hip fractures among 5,511 respondents aged ≥69 years. Mean age at hip fracture was 85 years; 73% of fracture patients were white women, 45% had pertrochanteric fractures, and 55% underwent surgical pinning. Most patients (58%) were discharged to a nursing facility, with 14% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7%, 19%, and 26%, respectively. Declines in functional-status-scale scores ranged from 29% on the fine motor skills scale to 56% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture. PMID:19808632

Hip fractures in the elderly in Israel-possible impact of preventable conditions.

PubMed

Segal, Elena; Raichlin, Valentina; Rimbrot, Sophia; Zinman, Chaim; Raz, Batia; Ish-Shalom, Sophia

2009-01-01

In the present study we evaluated the possible contribution of different factors to the occurrence of hip fractures in Israel. We assessed medical history, physical activity, body mass index, smoking status, bone turnover markers and calcium regulating hormones levels of 142 consecutive elderly hip fracture patients (HFP), and compared them to 96 community dwelling elderly people without a history of hip fracture. Age and female gender were the strongest predictors of hip fracture, p<0.001 and 0.013. Stepwise logistic regression demonstrated that HFP had higher PTH and lower 25(OH)D(3) levels, p=0.002, p<0.001; they were less physically active, p<0.001, and had higher rate of vitamin D insufficiency during winter-spring, compared to summer-autumn, p=0.033. Diabetics had higher risk for hip fracture, p=0.06, OR=3.9 (95% CI 1.50-10.4). Deoxypyridinoline (DPD) cross links levels were 19.35+/-10.58mg/mg creatinine in HFP and 9.12+/-3.52 in controls, p<0.0001. Bone alkaline phosphatase (BAP)/DPD ratio was 1.5 in controls compared to 0.53 in HFP. We conclude that age and female gender were the strongest predictors for hip fracture. Diabetic patients had threefold risk for hip fracture. Bone formation/bone resorption ratio was lower in HFP. Vitamin D deficiency and physical inactivity are important preventable risk factors for hip fracture.

Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases

PubMed Central

2014-01-01

Background Impairment in activities of daily living (ADL) is an important predictor of outcomes although many administrative databases lack information on ADL function. We evaluated the impact of ADL function on predicting postoperative mortality among older adults with hip fractures in Ontario, Canada. Methods Sociodemographic and medical correlates of ADL impairment were first identified in a population of older adults with hip fractures who had ADL information available prior to hip fracture. A logistic regression model was developed to predict 360-day postoperative mortality and the predictive ability of this model were compared when ADL impairment was included or omitted from the model. Results The study sample (N = 1,329) had a mean age of 85.2 years, were 72.8% female and the majority resided in long-term care (78.5%). Overall, 36.4% of individuals died within 360 days of surgery. After controlling for age, sex, medical comorbidity and medical conditions correlated with ADL impairment, addition of ADL measures improved the logistic regression model for predicting 360 day mortality (AIC = 1706.9 vs. 1695.0; c -statistic = 0.65 vs 0.67; difference in - 2 log likelihood ratios: χ2 = 16.9, p = 0.002). Conclusions Direct measures of ADL impairment provides additional prognostic information on mortality for older adults with hip fractures even after controlling for medical comorbidity. Observational studies using administrative databases without measures of ADLs may be potentially prone to confounding and bias and case-mix adjustment for hip fracture outcomes should include ADL measures where these are available. PMID:24472282

Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?

PubMed

Boutis, Kathy; Plint, Amy; Stimec, Jennifer; Miller, Elka; Babyn, Paul; Schuh, Suzanne; Brison, Robert; Lawton, Louis; Narayanan, Unni G

2016-01-01

Lateral ankle injuries without radiographic evidence of a fracture are a common pediatric injury. These children are often presumed to have a Salter-Harris type I fracture of the distal fibula (SH1DF) and managed with immobilization and orthopedic follow-up. However, previous small studies suggest that these injuries may represent ankle sprains rather than growth plate fractures. To determine the frequency of SH1DF using magnetic resonance imaging (MRI) and compare the functional recovery of children with fractures identified by MRI vs those with isolated ligament injuries. A prospective cohort study was conducted between September 2012 and August 2014 at 2 tertiary care pediatric emergency departments. We screened 271 skeletally immature children aged 5 to 12 years with a clinically suspected SH1DF; 170 were eligible and 140 consented to participate. Children underwent MRI of both ankles within 1 week of injury. Children were managed with a removable brace and allowed to return to activities as tolerated. The proportion with MRI-confirmed SH1DF. A secondary outcome included the Activity Scale for Kids score at 1 month. Of the 135 children who underwent ankle MRI, 4 (3.0%; 95% CI, 0.1%-5.9%) demonstrated MRI-confirmed SH1DF, and 2 of these were partial growth plate injuries. Also, 108 children (80.0%) had ligament injuries and 27 (22.0%) had isolated bone contusions. Of the 108 ligament injuries, 73 (67.6%) were intermediate to high-grade injuries, 38 of which were associated with radiographically occult fibular avulsion fractures. At 1 month, the mean (SD) Activity Scale for Kids score of children with MRI-detected fibular fractures (82.0% [17.2%]) was not significantly different from those without fractures (85.8% [12.5%]) (mean difference, -3.8%; 95% CI, -1.7% to 9.2%). Salter-Harris I fractures of the distal fibula are rare in children with radiograph fracture-negative lateral ankle injuries. These children most commonly have ligament injuries (sprains

Pathological fractures in children

PubMed Central

De Mattos, C. B. R.; Binitie, O.; Dormans, J. P.

2012-01-01

Pathological fractures in children can occur as a result of a variety of conditions, ranging from metabolic diseases and infection to tumours. Fractures through benign and malignant bone tumours should be recognised and managed appropriately by the treating orthopaedic surgeon. The most common benign bone tumours that cause pathological fractures in children are unicameral bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological fractures through a primary bone malignancy are rare, these should be recognised quickly in order to achieve better outcomes. A thorough history, physical examination and review of plain radiographs are crucial to determine the cause and guide treatment. In most benign cases the fracture will heal and the lesion can be addressed at the time of the fracture, or after the fracture is healed. A step-wise and multidisciplinary approach is necessary in caring for paediatric patients with malignancies. Pathological fractures do not have to be treated by amputation; these fractures can heal and limb salvage can be performed when indicated. PMID:23610658

Thrombotic thrombocytopenic purpura presenting with pathologic fracture: a case report.

PubMed

Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Unlu, Serkan; Ertem, Kadir; Nizam, Ilknur

2014-08-01

Thrombotic thrombocytopenic purpura is an acute syndrome with abnormalities in multiple organ systems, which becomes manifest with microangiopathic hemolytic anemia and thrombocytopenia. The hereditary or acquired deficiency of ADAMTS-13 activity leads to an excess of high molecular weight von Willebrand factor multimers in plasma, leading to platelet aggregation and diffuse intravascular thrombus formation, resulting in thrombotic thrombocytopenic purpura. Thrombotic lesions occurring in TTP leads to ischemia and convulsion. Depending on the properties of the bony tissue, fractures are divided into three groups as traumatic, pathological, and stress fractures. A pathologic fracture is a broken bone caused by disease leading to weakness of the bone. This process is most commonly due to osteoporosis, but may also be due to other pathologies such as cancer, infections, inherited bone disorders, or a bone cyst. We herein report a case with a pathologic fracture due to convulsion secondary to thrombotic thrombocytopenic pupura. Thrombotic lesions occurring in TTP may lead to ischemia and convulsion, as in our patient and pathological fractures presented in our case report may occur as a result of severe muscle contractions associated with convulsive activity. Thrombotic thrombocytopenic pupura is a disease that involves many organ systems and thus may have a very wide spectrum of clinical presentations. Copyright © 2014. Published by Elsevier Ltd.

Interpretation and classification of bone scintigraphic findings in stress fractures.

PubMed

Zwas, S T; Elkanovitch, R; Frank, G

1987-04-01

A new system for classification of stress fractures identified by bone scintigraphy was developed and divided into four grades according to lesion dimension, bone extension, and tracer accumulation. The scintigraphic findings were evaluated for severity of lesions by extent of the visualized bone response, ranging from ill-defined cortical lesions with slightly increased activity (I) to well-defined intramedullary transcortical lesions with intensely increased activity (IV). Bone scintigraphies using [99mTc]MDP were obtained in 310 military recruits suspected of having stress fractures. In 235 patients, 391 stress fractures were diagnosed. Forty percent of the lesions were asymptomatic. Most of the lesions were in the tibiae (72%), and 87% of the patients had one or two lesions, while 13% had three to five lesions. Eighty-five percent of the lesions were classified as mild and showed early and more complete resolution on follow-up studies after treatment as compared to the severe grades. Furthermore, specific scintigraphic patterns have been introduced for distinguishing inflammatory shin-splints from stress fractures, allowing for their appropriate early treatment. Thus, early recognition of mild stress fracture scintigraphic patterns representing the beginning of pathologic bone response to stress enabled a prompt and effective treatment to prevent progression of lesions, protracted disability, and complications.