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Sample records for assess fracture healing

  1. CT examinations of healing fractures

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    Nutz, V.; Uexkuell-Gueldenband, V. v.

    1988-10-01

    The CT appearances of healing fractures were studied following tibial osteotomy in a dog. Traditional radiological investigations and CT were carried out until healing was complete; CT showed callus on the ninth day, whereas radiographs only showed it after 19 days. After 32 days, callus filled nearly the entire medullary cavity. Similar observations were made in several human situations. CT demonstrates interposed material in the fracture very clearly, even if there is marked callus formation within the fracture.

  2. Impaired Fracture Healing after Hemorrhagic Shock

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    Philipp Lichte

    2015-01-01

    Full Text Available Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP of 35 mmHg for 90 minutes. Serum cytokines (IL-6, KC, MCP-1, and TNF-α were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.

  3. Power Doppler assessment of the neovascularization during uncomplicated fracture healing of long bones in dogs and cats.

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    Risselada, Marije; Kramer, Martin; Saunders, Jimmy H; Verleyen, Piet; Van Bree, Henri

    2006-01-01

    The aims of this prospective study were to test the feasibility of assessing neovascularization with power Doppler ultrasonography and to investigate its usefulness to follow fracture healing of long bones in dogs and cats. A total of 51 patients (44 dogs and seven cats) were followed. Fracture types differed from simple to comminuted. Therapy ranged from external coaptation to plate osteosynthesis. Patients were followed with radiography, B-mode real time and power Doppler ultrasonography every 2-4 weeks until the fracture was healed. All fractures healed uneventfully. A semi-quantitative numerical score based on signal intensity, vessel area, and number of Doppler signals was assigned and the mean value was used to compare patients and examinations. Time postoperatively was divided into periods of 10 days. No Doppler signal was present during the first 10 days. The mean of the scores was highest between 11 and 20 days postoperatively and the median of the scores peaked between 21 and 30 days. A gradual decrease was seen thereafter. The mean of the scores was zero at 71-80 days and the median at 51-0 days postoperatively for the grouped results. In all positive power Doppler examinations, signals were present in and close to the callus. In seven patients (five dogs and two cats) signals were also present in the peripheral soft tissues in one of the follow up examinations. The normal healing process of fractured bones can be visualized using power Doppler ultrasonography and follows a distinctive time-dependent pattern.

  4. Gait and function as tools for the assessment of fracture repair - the role of movement analysis for the assessment of fracture healing.

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    Rosenbaum, Dieter; Macri, Felipe; Lupselo, Fernando Silva; Preis, Osvaldo Cristiano

    2014-06-01

    Assessment of gait and function might be as sensitive tool to monitor the progress of fracture healing. Currently available assessment tools for function use instrumented three dimensional gait analysis or pedobarography. The analysis is focused on gait or movement parameters and seeks to identify abnormalities or asymmetries between legs or arms. The additional inclusion of muscle function by electromyography can further elucidate functional performance and its temporal development. Alternative approaches abstain from directly assessing function in the laboratory but rather determine the amount of activities of daily living or the mere ability to perform defined tasks such as walking, stair climbing or running. Some of these methods have been applied to determine recovery after orthopaedic interventions including fracture repair. The combination of lab-based functional measurements and assessment of physical activities in daily live may offer a valuable level of information about the gait quality and quantity of individual patients which sheds light on functional limitations or rehabilitation of gait and mobility after a disease or injury and the respective conservative, medical or surgical treatment.

  5. The healing of fractured bones

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    Bacon, G.E. [Central Electricity Generating Board, Cheltenham (United Kingdom)

    1997-04-01

    A method utilising neutron beams of width 1 mm, used on D1B (2.4 A) and D20 (1.3 A) to study the healing of fractured bones is presented. It is found that the callus bone uniting the fractured tibia of a sheep, whose healing had been encouraged by daily mechanical vibration over a period of three months, showed no trace of the large preferential vertical orientation of the apatite crystals which is characteristic of the normal bone. Nevertheless the bone had regained about 60% of its mechanical strength and the callus bone, although not oriented, was well crystallized. It is considered that the new monochromator for D20, expected to give increased intensity at 2.5 A, will be of considerable advantage. (author). 2 refs.

  6. Ultrasound attenuation as a quantitative measure of fracture healing

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    Gheduzzi, Sabina; Humphrey, Victor F.; Dodd, Simon P.; Cunningham, James L.; Miles, Anthony W.

    2004-10-01

    The monitoring of fracture healing still relies upon the judgment of callus formation and on the manual assessment of the stiffness of the fracture. A diagnostic tool capable of quantitatively measuring healing progression of a fracture would allow the fine-tuning of the treatment regime. Ultrasound attenuation measurements were adopted as a possible method of assessing the healing process in human long bones. The method involves exciting ultrasonic waves at 200 kHz in the bone and measuring the reradiation along the bone and across the fracture zone. Seven cadaveric femora were tested in vitro in intact form and after creating a transverse fracture by sawing through the cortex. The effects of five different fracture types were investigated. A partial fracture, corresponding to a 50% cut through the cortex, a closed fracture, and fractures of widths varying between 1, 2, and 4 mm were investigated. The introduction of a fracture was found to produce a dramatic effect on the amplitude of the signal. Ultrasound attenuation was found to be sensitive to the presence of a fracture, even when the fracture was well reduced. It would therefore appear feasible to adopt attenuation across a fracture as a quantitative measurement of fracture healing.

  7. The use of {sup 18}F-fluoride and {sup 18}F-FDG PET scans to assess fracture healing in a rat femur model

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    Hsu, W.K.; Feeley, B.T.; Krenek, L.; Stout, D.B.; Chatziioannou, A.F. [David Geffen School of Medicine at UCLA, Center for Health Sciences, Department of Orthopaedic Surgery, Los Angeles, CA (United States); Lieberman, J.R. [University of Connecticut Health Center, The Musculoskeletal Institute, Department of Orthopaedic Surgery, Farmington, CT (United States)

    2007-08-15

    Currently available diagnostic techniques can be unreliable in the diagnosis of delayed fracture healing in certain clinical situations, which can lead to increased complication rates and costs to the health care system. This study sought to determine the utility of positron emission tomography (PET) scanning with {sup 18}F-fluoride ion, which localizes in regions of high osteoblastic activity, and {sup 18}F-fluorodeoxyglucose (FDG), an indicator of cellular glucose metabolism, in assessing bone healing in a rat femur fracture model. Fractures were created in the femurs of immunocompetent rats. Animals in group I had a fracture produced via a manual three-point bending technique. Group II animals underwent a femoral osteotomy with placement of a 2-mm silastic spacer at the fracture site. Fracture healing was assessed with plain radiographs, {sup 18}F-fluoride, and {sup 18}F-FDG PET scans at 1, 2, 3, and 4-week time points after surgery. Femoral specimens were harvested for histologic analysis and manual testing of torsional and bending strength 4 weeks after surgery. All fractures in group I revealed abundant callus formation and bone healing, while none of the nonunion femurs were healed via assessment with manual palpation, radiographic, and histologic evaluation at the 4-week time point. {sup 18}F-fluoride PET images of group I femurs at successive 1-week intervals revealed progressively increased signal uptake at the union site during fracture repair. In contrast, minimal tracer uptake was seen at the fracture sites in group II at all time points after surgery. Data analysis revealed statistically significant differences in mean signal intensity between groups I and II at each weekly interval. No significant differences between the two groups were seen using {sup 18}F-FDG PET imaging at any time point. This study suggests that {sup 18}F-fluoride PET imaging, which is an indicator of osteoblastic activity in vivo, can identify fracture nonunions at an early time

  8. Fracture healing: direct magnification versus conventional radiography

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    Link, T.M. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany); Kessler, T. [Dept. of Traumatic and Hand Surgery, Westfaelische Wilhelms-Univ., Muenster (Germany); Lange, T. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany); Overbeck, J. [Dept. of Traumatic and Hand Surgery, Westfaelische Wilhelms-Univ., Muenster (Germany); Fiebich, M. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany); Peters, P.E. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany)

    1994-08-01

    The aim of the study was to evaluate the potential of magnification radiography in diagnosing fracture healing and assessing its complications. Seventy-three patients with fractures or who had undergone osteotomy were radiographed with both conventional (non-magnified) and magnification (5-fold) techniques. Since 10 patients were radiographed twice and 1 three times, 83 radiographs using each technique were obtained. All radiographs were analysed and the findings correlated with the patients` follow-up studies. The microfocal X-ray unit used for magnification radiography had a focal spot size of 20-130 {mu}m. As an imaging system, digital luminescence radiography was employed with magnification, while normal film-screen systems were used with conventional radiography. Magnification radiography proved superior to conventional radiography in 47% of cases: endosteal and periosteal callus formations were seen earlier and better in 26 cases, and osseous union could be evaluated with greater certainty in 33 cases. In 49% of cases magnification radiography was equal and in 4% inferior to conventional radiography. Additionally an ``inter-observer analysis`` was carried out. Anatomical and pathological structures were classified into one of four grades. Results were significantly (P < 0.01) better using magnification radiography. We conclude that the magnification technique is a good method for monitoring fracture healing in its early stages. (orig.)

  9. Management of impaired fracture healing: Historical aspects

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    Gajdobranski Đorđe

    2005-01-01

    Full Text Available Introduction Establishing continuity of long bones in cases of impaired bone healing and pseudo-arthrosis is one of the most complex problems in orthopedics. Impaired bone healing The problem of impaired fracture healing is not new. As in other areas of human life, the roots of modern treatment of impaired bone healing lie in ancient medicine. A relatively high percentage of impaired bone healing, as well as unsatisfactory results of standard therapies of impaired bone healing and pseudoarthrosis demonstrate the actuality of this problem. This paper represents an attempt to pay respect to some of those who have dedicated their work to this problem in orthopedic surgery, and it is a historical review on impaired bone fracture healing. At the same time it should be an additional stimulus and challenge for orthopedic surgeons to further study impaired bone fracture healing, improve the existing and find new methods for their adequate treatment. Conclusion The authors are certain that the number of researchers throughout the world who have contributed to treatment modalities of impaired bone healing, is much higher, but not all are mentioned in this paper. However, it does not lessen their contributions to orthopedics.

  10. Association between timing of zoledronic acid infusion and hip fracture healing

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    Colón-Emeric, C; Nordsletten, L; Olson, S

    2010-01-01

    Patients in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial were assessed for evidence of delayed hip fracture healing. No association was observed between zoledronic acid (ZOL) and delayed healing. We conclude that ZOL has no clinically...... evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n¿=¿1...

  11. Inhibition of Midkine Augments Osteoporotic Fracture Healing.

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    Melanie Haffner-Luntzer

    Full Text Available The heparin-binding growth and differentiation factor midkine (Mdk is proposed to negatively regulate osteoblast activity and bone formation in the adult skeleton. As Mdk-deficient mice were protected from ovariectomy (OVX-induced bone loss, this factor may also play a role in the pathogenesis of postmenopausal osteoporosis. We have previously demonstrated that Mdk negatively influences bone regeneration during fracture healing. Here, we investigated whether the inhibition of Mdk using an Mdk-antibody (Mdk-Ab improves compromised bone healing in osteoporotic OVX-mice. Using a standardized femur osteotomy model, we demonstrated that Mdk serum levels were significantly enhanced after fracture in both non-OVX and OVX-mice, however, the increase was considerably greater in osteoporotic mice. Systemic treatment with the Mdk-Ab significantly improved bone healing in osteoporotic mice by increasing bone formation in the fracture callus. On the molecular level, we demonstrated that the OVX-induced reduction of the osteoanabolic beta-catenin signaling in the bony callus was abolished by Mdk-Ab treatment. Furthermore, the injection of the Mdk-Ab increased trabecular bone mass in the skeleton of the osteoporotic mice. These results implicate that antagonizing Mdk may be useful for the therapy of osteoporosis and osteoporotic fracture-healing complications.

  12. Flexible fixation and fracture healing

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    Schmal, Hagen; Strohm, Peter C; Jaeger, Martin

    2011-01-01

    to the bone surface than external fixator bars. External fixators have the advantage of being less expensive, highly flexible, and technically less demanding. They remain an integral part of orthopaedic surgery for emergent stabilization, for pediatric fractures, for definitive osteosynthesis in certain...

  13. Urine matrix metalloproteinases (MMPs) as biomarkers for the progression of fracture healing.

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    Wigner, Nathan A; Kulkarni, Nitin; Yakavonis, Mark; Young, Megan; Tinsley, Brian; Meeks, Brett; Einhorn, Thomas A; Gerstenfeld, Louis C

    2012-03-01

    Whilst the majority of fractures heal normally, it is estimated that ∼10% of fractures exhibit some level of delayed or impaired healing. Although radiography is the primary diagnostic tool to assess the progression of fracture healing, radiographic features only qualitatively correlate with tissue level increases in mineral content and do not quantitatively measure underlying biological processes that are associated with the progression of healing. Specific metaloproteinases have been shown to be essential to processes of both angiogenesis and mineralised cartilage resorption and bone remodelling at different phases of fracture healing. The aim of this study was to determine the potential of using a simple urine based assay of the activity of two MMPs as a means of assessing the biological progression of fracture healing through the endochondral phase of healing. Using a standard mid-diaphyseal murine model of femoral fracture, MMP9 and MMP13 proteins and enzymatic activity levels were quantified in the urine of mice across the time-course of fracture healing and compared to the mRNA and protein expression profiles in the calluses. Both urinary MMP9 and MMP13 protein and enzymatic activity levels, assessed by Western blot, zymogram and specific MMP fluorometric substrate assays, corresponded to mRNA expression and immunohistologic assays of the proteins within callus tissues. These studies suggest that urinary levels of MMP9 and MMP13 may have potential as metabolic markers to monitor the progression of fracture healing.

  14. Association between timing of zoledronic acid infusion and hip fracture healing

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    Colón-Emeric, C; Nordsletten, L; Olson, S

    2011-01-01

    Patients in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial were assessed for evidence of delayed hip fracture healing. No association was observed between zoledronic acid (ZOL) and delayed healing. We conclude that ZOL has no clinical...

  15. The science of ultrasound therapy for fracture healing.

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    Della Rocca, Gregory J

    2009-01-01

    Fracture healing involves a complex interplay of cellular processes, culminating in bridging of a fracture gap with bone. Fracture healing can be compromised by numerous exogenous and endogenous patient factors, and intense research is currently going on to identify modalities that can increase the likelihood of successful healing. Low-intensity pulsed ultrasound (LIPUS) has been proposed as a modality that may have a benefit for increasing reliable fracture healing as well as perhaps increasing the rate of fracture healing. We conducted a review to establish basic scince evidence of therapeutic role of lipus in fracture healing. An electronic search without language restrictions was accomplished of three databases (PubMed, Embase, Cinahl) for ultrasound-related research in osteocyte and chondrocyte cell culture and in animal fracture models, published from inception of the databases through December, 2008. Studies deemed to be most relevant were included in this review. Multiple in vitro and animal in vivo studies were identified. An extensive body of literature exists which delineates the mechanism of action for ultrasound on cellular and tissue signaling systems that may be related to fracture healing. Research on LIPUS in animal fracture models has demonstrated promising results for acceleration of fracture healing and for promotion of fracture healing in compromised tissue beds. A large body of cellular and animal research exists which reveals that LIPUS may be beneficial for accelerating normal fracture healing or for promoting fracture healing in compromised tissue beds. Further investigation of the effects of LIPUS in human fracture healing is warranted for this promising new therapy.

  16. The science of ultrasound therapy for fracture healing

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    Della Rocca Gregory

    2009-01-01

    Full Text Available Fracture healing involves a complex interplay of cellular processes, culminating in bridging of a fracture gap with bone. Fracture healing can be compromised by numerous exogenous and endogenous patient factors, and intense research is currently going on to identify modalities that can increase the likelihood of successful healing. Low-intensity pulsed ultrasound (LIPUS has been proposed as a modality that may have a benefit for increasing reliable fracture healing as well as perhaps increasing the rate of fracture healing. We conducted a review to establish basic scince evidence of therapeutic role of lipus in fracture healing. An electronic search without language restrictions was accomplished of three databases (PubMed, Embase, Cinahl for ultrasound-related research in osteocyte and chondrocyte cell culture and in animal fracture models, published from inception of the databases through December, 2008. Studies deemed to be most relevant were included in this review. Multiple in vitro and animal in vivo studies were identified. An extensive body of literature exists which delineates the mechanism of action for ultrasound on cellular and tissue signaling systems that may be related to fracture healing. Research on LIPUS in animal fracture models has demonstrated promising results for acceleration of fracture healing and for promotion of fracture healing in compromised tissue beds. A large body of cellular and animal research exists which reveals that LIPUS may be beneficial for accelerating normal fracture healing or for promoting fracture healing in compromised tissue beds. Further investigation of the effects of LIPUS in human fracture healing is warranted for this promising new therapy.

  17. Indium-111 leukocyte scanning and fracture healing

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    Mead, L.P.; Scott, A.C.; Bondurant, F.J.; Browner, B.D. (Univ. of Texas Medical School, Houston (USA))

    1990-01-01

    This study was undertaken to determine the specificity of indium-111 leukocyte scans for osteomyelitis when fractures are present. Midshaft tibial osteotomies were performed in 14 New Zealand white rabbits, seven of which were infected postoperatively with Staphylococcus aureus per Norden's protocol. All 14 rabbits were scanned following injection with 75 microCi of indium 111 at 72 h after osteotomy and at weekly intervals for 4 weeks. Before the rabbits were killed, the fracture sites were cultured to document the presence or absence of infection. The results of all infected osteotomy sites were positive, whereas no positive scans were found in the noninfected osteotomies. We concluded from this study that uncomplicated fracture healing does not result in a positive indium-111 leukocyte scan.

  18. Simulation of the nutrient supply in fracture healing.

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    Chen, G; Niemeyer, F; Wehner, T; Simon, U; Schuetz, M A; Pearcy, M J; Claes, L E

    2009-11-13

    The healing process for bone fractures is sensitive to mechanical stability and blood supply at the fracture site. Most currently available mechanobiological algorithms of bone healing are based solely on mechanical stimuli, while the explicit analysis of revascularization and its influences on the healing process have not been thoroughly investigated in the literature. In this paper, revascularization was described by two separate processes: angiogenesis and nutrition supply. The mathematical models for angiogenesis and nutrition supply have been proposed and integrated into an existing fuzzy algorithm of fracture healing. The computational algorithm of fracture healing, consisting of stress analysis, analyses of angiogenesis and nutrient supply, and tissue differentiation, has been tested on and compared with animal experimental results published previously. The simulation results showed that, for a small and medium-sized fracture gap, the nutrient supply is sufficient for bone healing, for a large fracture gap, non-union may be induced either by deficient nutrient supply or inadequate mechanical conditions. The comparisons with experimental results demonstrated that the improved computational algorithm is able to simulate a broad spectrum of fracture healing cases and to predict and explain delayed unions and non-union induced by large gap sizes and different mechanical conditions. The new algorithm will allow the simulation of more realistic clinical fracture healing cases with various fracture gaps and geometries and may be helpful to optimise implants and methods for fracture fixation.

  19. Therapeutic ultrasound in fracture healing: The mechanism of osteoinduction

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    John P

    2008-01-01

    Full Text Available Background: Ultrasound has been used therapeutically for accelerating fracture healing since many years. However, the controversy on the exact mechanism of osteoinduction still continues. In this study, we try to bring out the exact biomolecular mechanism by which ultrasound induces fracture healing. Materials and Methods: The study was conducted in two phases: animal experiments and clinical study. In the first phase, we induced fractures on the left tibia of Wistar strain rats under anaesthesia. They were divided into two groups. One of the groups was given low-intensity, pulsed ultrasound (30 MW/cm 2 20 min a day for 10 days. Tissue samples and radiographs were taken weekly for 3 weeks from both the groups. In the second phase of our study, ten patients with fractures of the distal end of the radius (ten fractures were included. Five of these were treated as cases, and five were treated as controls. Ultrasound was given 30 MW/cm 2 for 20 min every day for 2 weeks. The patients were assessed radiologically and sonologically before and after ultrasound therapy. Tissue samples were studied with thymidine incorporation test with and without adding various neurotransmitter combinations. Results: Radiological findings revealed that there was an increased callus formation in the ultrasound group. At the cellular level, there was an increased thymidine incorporation in the ultrasound group. When various neurotransmitters were added to the cells, there was an increased thymidine incorporation in the ultrasound group. In the second phase of the study, radiological and sonological assessments showed that there was an increased callus formation in the ultrasound group. In cytological study, thymidine incorporation was found to be increased in the ultrasound group. Conclusions: The results of animal and clinical studies demonstrated an early and increased callus formation in the ultrasound group. Cytological studies revealed increased thymidine

  20. Assessment of fracture risk

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    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  1. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

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    Dunn, Andrew J.; Campbell, Robert S.D. [Royal Liverpool and Broadgreen University Teaching Hospitals, Department of Medical Imaging, Liverpool (United Kingdom); Mayor, Peter E. [Leighton Hospital, Department of Medical Imaging, Crewe, Cheshire (United Kingdom); Rees, Dai [Robert Jones and Agnes-Hunt Orthopaedic Hospital, Department of Orthopaedic Surgery, Oswestry, Shropshire (United Kingdom)

    2008-05-15

    The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of

  2. The Effect of GSM Mobile Phone Electromagnetic Field on Femur Fracture Healing in a Rat Model

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    Ali Kalender

    2012-10-01

    Full Text Available Aim: Biological effects of electromagnetic field (EMF and their consequences on human health have been the subject of much interest and research in recent years. The aim of this study was to investigate the effects of 900 MHz EMF on femur fracture healing in a rat model. Material and Method: After sixty male Sprague-Dawley rats were exposed to a closed right femur fracture under anesthesia, the reduction and fixation were done with a 21 g needle. Then, 900 MHz radiation (2 W peak output power and 1.04 mW/cm2 power density was applied to EM group for one hour/day for seven days. The healing was assessed using radiological (Lane and Sandhu classification, histological (Huo scale for callus evaluation, and biomechanical (3-point bending measures at 2nd, 4th and 6th weeks after fracture. Results: Fracture healing, as assessed radiologically and histopathologically, in Group EM and control animals was similar at 2nd, 4th and 6th weeks. Fracture healing, as assessed biomechanically, was significantly better in Group EM compared to controls in those sacrificed at 2nd week post-procedure (p<0.05. Biomechanical strength was not different between the groups at 4th and 6th weeks. Discussion: 900 MHz EMF from a mobile phone in this rat femur fracture model resulted in no significant difference in healing from controls not exposed to EM radiation.

  3. Effects of anti-osteoporosis medications on fracture healing

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    Jørgensen, Niklas R; Schwarz, Peter

    2011-01-01

    A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, postmenopausal women, and in people with malnutrition. At present, no pharmacologic treatments are available. Thus, there is an unmet need for medications that can...... stimulate bone healing. Parathyroid hormone (PTH) is the first bone anabolic drug approved for the treatment of osteoporosis and, intriguingly, a number of animal studies prove the ability of PTH to induce fracture healing. PTH may therefore be a potential novel treatment option in humans with impaired...

  4. Considerations on evolution and healing of vertebral fractures.

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    Klumpp, Raymond; Trevisan, Carlo; Nava, Veronica; Riccardi, Domenico; Recalcati, Wilmer

    2013-10-01

    Only little is known when talking about the evolution of a vertebral fracture. From the few studies available in the literature, we can deduce that the risk a vertebral compression fracture has to worsen its deformity is consistent. It is important to try to make a prognosis on how the fracture is going to heal based on the type of fracture encountered. A chapter of its own is the occurrence of a vertebral fracture non-union that is difficult to diagnose and treat, but comes along with a poor prognosis.

  5. A first order system model of fracture healing

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    WANG Xiao-ping; ZHANG Xian-long; LI Zhu-guo; YU Xin-gang

    2005-01-01

    A first order system model is proposed for simulating the influence of stress stimulation on fracture strength during fracture healing. To validate the model, the diaphyses of bilateral tibiae in 70 New Zealand rabbits were osteotomized and fixed with rigid plates and stress-relaxation plates, respectively. Stress shielding rate and ultimate bending strength of the healing bone were measured at 2 to 48 weeks postoperatively. Ratios of stress stimulation and fracture strength of the healing bone to those of intact bone were taken as the system input and output. The assumed first order system model can approximate the experimental data on fracture strength from the input of stress stimulation over time, both for the rigid plate group and the stress-relaxation plate group, with different system parameters of time constant and gain. The fitting curve indicates that the effect of mechanical stimulus occurs mainly in late stages of healing. First order system can model the stress adaptation process of fracture healing. This approach presents a simple bio-mathematical model of the relationship between stress stimulation and fracture strength, and has the potential to optimize planning of functional exercises and conduct parametric studies.

  6. Radiographic features of teriparatide-induced healing of femoral fractures

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    Youngwoo Kim

    2015-12-01

    Full Text Available Teriparatide is a drug that is used to increase bone remodeling, formation, and density for the treatment of osteoporosis. We present three cases of patients with a femoral insufficiency fracture. The patients were administered teripatatide in an attempt to treat severe osteoporosis and to enhance fracture healing. We found several radiographic features around the femoral fractures during the healing period. 1 Callus formation was found at a very early stage in the treatment. Teriparatide substantially increased the unusually abundant callus formation around the fracture site at 2 weeks. Moreover, this callus formation continued for 8 weeks and led to healing of the fracture. 2 Abundant callus formation was found circumferentially around the cortex with a ‘cloud-like’ appearance. 3 Remodeling of the teriparatide-induced callus formation was found to be part of the normal fracture healing process. After 1 year, normal remodeling was observed on plain radiographs. These findings indicate that teriparatide can be used as an adjuvant therapy in the management of femoral insufficiency fractures.

  7. Systemic treatment with telmisartan improves femur fracture healing in mice.

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    Xiong Zhao

    Full Text Available Recent clinical studies indicated that angiotensin receptor blockers (ARBs would decrease the risk of bone fractures in the elderly populations. There is little known about the role of the ARBs in the process of fracture healing. The purpose of the present study was to verify the hypothesis that systemic treatment with telmisartan has the ability to promote fracture healing. In this study, femur fractures were produced in 96 mature male BALB/c mice. Animals were treated with the ARBs telmisartan or vehicle. Fracture healing was analysed after 2, 5 and 10 weeks postoperatively using X-ray, biomechanical testing, histomorphometry, immunohistochemistry and micro-computed tomography (micro-CT. Radiological analysis showed the diameter of the callus in the telmisartan treated animals was significantly increased when compared with that of vehicle treated controls after two weeks of fracture healing. The radiologically observed promotion of callus formation was confirmed by histomorphometric analyses, which revealed a significantly increased amount of bone formation when compared with vehicle-treated controls. Biomechanical testing further showed a significantly greater peak torque at failure, and a higher torsional stiffness in telmisartan-treated animals compared with controls. There was an increased fraction of PCNA-positive cells and VEGF-positive cells in telmisartan-treated group compared with vehicle-treated controls. From the three-dimensional reconstruction of the bony callus, telmisartan-treated group significantly increased the values of BV/TV by 21.7% and CsAr by 26.0% compared to the vehicle-treated controls at 5 weeks post-fracture. In summary, we demonstrate in the current study that telmisartan could promote fracture healing in a mice model via increasing mechanical strength and improving microstructure. The most mechanism is probably by an increase of cell proliferation and neovascularization associated with a decreased VEGF expression

  8. Accelerated fracture healing in transgenic mice overexpressing an anabolic isoform of fibroblast growth factor 2.

    Science.gov (United States)

    Hurley, Marja M; Adams, Douglas J; Wang, Liping; Jiang, Xi; Burt, Patience Meo; Du, Erxia; Xiao, Liping

    2016-03-01

    The effect of targeted expression of an anabolic isoform of basic fibroblast growth factor (FGF2) in osteoblastic lineage on tibial fracture healing was assessed in mice. Closed fracture of the tibiae was performed in Col3.6-18 kDaFgf2-IRES-GFPsaph mice in which a 3.6 kb fragment of type I collagen promoter (Col3.6) drives the expression of only the 18 kD isoform of FGF2 (18 kDaFgf2/LMW) with green fluorescent protein-sapphire (GFPsaph) as well as Vector mice (Col3.6-IRES-GFPsaph, Vector) that did not harbor the FGF2 transgene. Radiographic, micro-CT, DEXA, and histologic analysis of fracture healing of tibiae harvested at 3, 10 and 20 days showed a smaller fracture callus but accelerated fracture healing in LMWTg compared with Vector mice. At post fracture day 3, FGF receptor 3 and Sox 9 mRNA were significantly increased in LMWTg compared with Vector. Accelerated fracture healing was associated with higher FGF receptor 1, platelet derived growth factors B, C, and D, type X collagen, vascular endothelial cell growth factor, matrix metalloproteinase 9, tartrate resistant acid phosphatase, cathepsin K, runt-related transcription factor-2, Osterix and Osteocalcin and lower Sox9, and type II collagen expression at 10 days post fracture. We postulate that overexpression of LMW FGF2 accelerated the fracture healing process due to its effects on factors that are important in chondrocyte and osteoblast differentiation and vascular invasion.

  9. Changes in the Serum Level of Vitamin D During Healing of Tibial and Femoral Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Ettehad

    2014-01-01

    Full Text Available Background: Several systemic factors and hormones are thought to regulate the fracture healing process. Vitamin D has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism. Objectives: The aim of this study is to determine the serum changes in the level of vitamin D during the acute healing period of tibial and femoral shaft fractures. Patients and Methods: This cross-sectional study included of 73 patients with tibial and femoral shaft fractures referred to the Poursina Hospital between February 2011 and February 2012. Changes in the serum levels of vitamin D were assessed three times in a period of three weeks (at the first visit, end of first week, and end of the third week. Variables such as age, gender, fractured bone, concomitant fracture of tibia and fibula, type of fracture, time of measurement and serum levels of 25-hydroxyvitamin D were assessed. All statistical analyses were performed using the SPSS software. Results: Forty tibial fractures and 33 femoral fractures were recorded. Mean vitamin D levels at the time of admission, after one week and at the end of the third week for the 73 participants included in the study were 39.23, 31.49, and 28.57 ng/mL, respectively. The overall reduction of vitamin D level was significantly more evident in the first week versus the following (P < 0.0001. Conclusions: Serum levels of vitamin D in patients with tibial or femoral fractures were reduced during the curative period of the fracture. This can be related the role of vitamin D in the formation and mineralization of the callus. Patients with tibial or femoral shaft fractures may benefit from the administration of vitamin D supplements during the fracture healing process.

  10. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Chuang, Po-Yao; Lin, Shih-Jie; Lee, Chien-Yin; Huang, Kuo-Chin; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-05-01

    Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications

  11. Novel perfused compression bioreactor system as an in vitro model to investigate fracture healing

    Directory of Open Access Journals (Sweden)

    Waldemar eHoffmann

    2015-02-01

    Full Text Available Secondary bone fracture healing is a physiological process that leads to functional tissue regeneration via endochondral bone formation. In vivo studies have demonstrated that early mobilization and the application of mechanical loads enhances the process of fracture healing. However, the influence of specific mechanical stimuli and particular effects during specific phases of fracture healing remain to be elucidated. In this work, we have developed and provided proof-of-concept of an in vitro human organotypic model of physiological loading of a cartilage callus, based on a novel perfused compression bioreactor system (PCB. We then used the fracture callus model to investigate the regulatory role of dynamic mechanical loading. Our findings provide a proof-of-principle that dynamic mechanical loading applied by the PCB can enhance the maturation process of mesenchymal stromal cells towards late hypertrophic chondrocytes and the mineralization of the deposited extracellular matrix. The PCB provides a promising tool to study fracture healing and for the in vitro assessment of alternative fracture treatments based on engineered tissue grafts or pharmaceutical compounds, allowing for the reduction of animal experiments.

  12. Low-intensity pulsed ultrasound affects RUNX2 immunopositive osteogenic cells in delayed clinical fracture healing

    NARCIS (Netherlands)

    Rutten, S.; Nolte, P.A.; Korstjens, C.M.; Klein-Nulend, J.

    2009-01-01

    Introduction: Osteogenic cell proliferation and differentiation play an important role in adequate fracture healing, and is target for osteoinductive therapies in delayed fracture healing. The aim of this study was to investigate whether low-intensity pulsed ultrasound enhances fracture healing at t

  13. Computational simulation of bone fracture healing under inverse dynamisation.

    Science.gov (United States)

    Wilson, Cameron J; Schütz, Michael A; Epari, Devakara R

    2017-02-01

    Adaptive finite element models have allowed researchers to test hypothetical relationships between the local mechanical environment and the healing of bone fractures. However, their predictive power has not yet been demonstrated by testing hypotheses ahead of experimental testing. In this study, an established mechano-biological scheme was used in an iterative finite element simulation of sheep tibial osteotomy healing under a hypothetical fixation regime, "inverse dynamisation". Tissue distributions, interfragmentary movement and stiffness across the fracture site were compared between stiff and flexible fixation conditions and scenarios in which fixation stiffness was increased at a discrete time-point. The modelling work was conducted blind to the experimental study to be published subsequently. The simulations predicted the fastest and most direct healing under constant stiff fixation, and the slowest healing under flexible fixation. Although low fixation stiffness promoted more callus formation prior to bridging, this conferred little additional stiffness to the fracture in the first 5 weeks. Thus, while switching to stiffer fixation facilitated rapid subsequent bridging of the fracture, no advantage of inverse dynamisation could be demonstrated. In vivo data remains necessary to conclusively test this treatment protocol and this will, in turn, provide an evaluation of the model's performance. The publication of both hypotheses and their computational simulation, prior to experimental testing, offers an appealing means to test the predictive power of mechano-biological models.

  14. The effect of immunonutrition (glutamine, alanine on fracture healing

    Directory of Open Access Journals (Sweden)

    Abdullah Küçükalp

    2014-11-01

    Full Text Available Background: There have been various studies related to fracture healing. Glutamine is an amino acid with an important role in many cell and organ functions. This study aimed to make a clinical, radiological, and histopathological evaluation of the effects of glutamine on fracture healing. Methods: Twenty rabbits were randomly allocated into two groups of control and immunonutrition. A fracture of the fibula was made to the right hind leg. All rabbits received standard food and water. From post-operative first day for 30 days, the study group received an additional 2 ml/kg/day 20% L-alanine L-glutamine solution via a gastric catheter, and the control group received 2 ml/kg/day isotonic via gastric catheter. At the end of 30 days, the rabbits were sacrificed and the fractures were examined clinically, radiologically, and histopathologically in respect to the degree of union. Results: Radiological evaluation of the control group determined a mean score of 2.5 according to the orthopaedists and 2.65 according to the radiologists. In the clinical evaluation, the mean score was 1.875 for the control group and 2.0 for the study group. Histopathological evaluation determined a mean score of 8.5 for the control group and 9.0 for the study group. Conclusion: One month after orally administered glutamine–alanine, positive effects were observed on fracture healing radiologically, clinically, and histopathologically, although no statistically significant difference was determined.

  15. Early period of fracture healing in ovariectomized rats

    Institute of Scientific and Technical Information of China (English)

    徐少文; 喻任; 赵光锋; 王建卫

    2003-01-01

    Objective: To evaluate the effect of osteoporosis on fracture healing through observing the histomorphological changes, bone mineral density of callus and expression and distribution of transforming growth factor beta 1 (TGF-β1),basic fibroblast growth factor (bFGF) and bone morphogenetic protein-2 (BMP-2) in ovariectomized rats.Methods: Sixty female Sprague-Dawley rats (aged 12 weeks and weighing 235 g on average) were randomly divided into an ovariectomized (OVX) group (n=30) and a sham-operated (SO) group (n=30). Ovariectomy was performed in the OVX rats and same incision was made in the SO rats. Three months later, fracture of femoral shaft was made on all the rats. Then they were killed at different time points. Callus formation was observed with histological and immunohistochemical methods.Results: A reduction in callus and bone mineral density in the healing femur and a decrease of osteoblasts expressing TGF-β1 near the bone trabecula were observed in the OVX rats 3-4 weeks after fracture. Histomorphological analysis revealed a higher content of soft callus in the OVX rats than that in the SO rats. Immunohistochemistry results showed that no remarkable difference in expression and distribution of BMP-2 and bFGF between the OVX and SO groups was found.Conclusions: Osteoporosis influences the quantity and quality of callus during the early period of fracture healing. The effect of osteoporosis on fracture healing has no relationship with the expression of BMP-2 or bFGF. The decreased expression of TGF-β1 in osteoblasts may cause a decrease in quality of facture healing after osteoporosis.

  16. Fracture and Healing of Rock Salt Related to Salt Caverns

    Energy Technology Data Exchange (ETDEWEB)

    Chan, K.S.; Fossum, A.F.; Munson, D.E.

    1999-03-01

    In recent years, serious investigations of potential extension of the useful life of older caverns or of the use of abandoned caverns for waste disposal have been of interest to the technical community. All of the potential applications depend upon understanding the reamer in which older caverns and sealing systems can fail. Such an understanding will require a more detailed knowledge of the fracture of salt than has been necessary to date. Fortunately, the knowledge of the fracture and healing of salt has made significant advances in the last decade, and is in a position to yield meaningful insights to older cavern behavior. In particular, micromechanical mechanisms of fracture and the concept of a fracture mechanism map have been essential guides, as has the utilization of continuum damage mechanics. The Multimechanism Deformation Coupled Fracture (MDCF) model, which is summarized extensively in this work was developed specifically to treat both the creep and fracture of salt, and was later extended to incorporate the fracture healing process known to occur in rock salt. Fracture in salt is based on the formation and evolution of microfractures, which may take the form of wing tip cracks, either in the body or the boundary of the grain. This type of crack deforms under shear to produce a strain, and furthermore, the opening of the wing cracks produce volume strain or dilatancy. In the presence of a confining pressure, microcrack formation may be suppressed, as is often the case for triaxial compression tests or natural underground stress situations. However, if the confining pressure is insufficient to suppress fracture, then the fractures will evolve with time to give the characteristic tertiary creep response. Two first order kinetics processes, closure of cracks and healing of cracks, control the healing process. Significantly, volume strain produced by microfractures may lead to changes in the permeability of the salt, which can become a major concern in

  17. Muscle-bone Interactions During Fracture Healing

    Science.gov (United States)

    2015-03-01

    physical trauma31, orthopaedic surgery32, or due to disease like fibrodysplasia ossificans progressiva, which has been identified to be a result of a...responsible for bone healing may provide opportunities to develop therapies to augment normal physiologic mechanisms underlying bone regeneration. Current... osteoporosis in premenopausal and postmenopausal women. J Bone Miner Metab 2008; 26:159-64. 70. Hill M, Goldspink G. Expression and splicing of the in- sulin

  18. Leptin Influences Healing in the Sprague Dawley Rat Fracture Model

    Science.gov (United States)

    Liu, Pengcheng; Cai, Ming

    2017-01-01

    Background Leptin plays a crucial role in bone metabolism, and its level is related to bone callus formation in the fracture repair process. The objective of this study was to evaluate the effect of recombinant leptin on the healing process of femoral fractures in rats. Material/Methods Forty-eight male Sprague Dawley (SD) rats with an average body weight of 389 g (range: 376–398 g) and an average age of 10 weeks were included in this animal research, and all rats were randomly divided into two major groups. Then standardized femur fracture models were implemented in all SD rats. Rats in the control group were treated with only 0.5 mL of physiological saline, and rats in the experimental group were treated with recombinant leptin 5 μg/kg/d along with the same 0.5 mL of physiological saline for 42 days intraperitoneally. At the same time, each major group was evenly divided into three parallel subgroups for each parallel bone evaluation separately at the second, fourth, and sixth weeks. Each subgroup included eight rats. Results The total radiological evaluation results showed that the healing progress of femoral fracture in the experimental group was superior to that in the control group from the fourth week. At the sixth week, experimental group rats began to present significantly better femoral fracture healing progress than that of the control group rats. Results of biomechanics show the ultimate load (N) and deflection ultimate load (mm) of the experimental group rats was significantly increased compared with that of the control group rats from the fourth week. Conclusions Our results suggest that leptin may have a positive effect on SD rat femur fracture healing. PMID:28088810

  19. Relationship between microstructure, material distribution, and mechanical properties of sheep tibia during fracture healing process.

    Science.gov (United States)

    Gao, Jiazi; Gong, He; Huang, Xing; Fang, Juan; Zhu, Dong; Fan, Yubo

    2013-01-01

    The aim of this study was to investigate the relationship between microstructural parameters, material distribution, and mechanical properties of sheep tibia at the apparent and tissue levels during the fracture healing process. Eighteen sheep underwent tibial osteotomy and were sacrificed at 4, 8, and 12 weeks. Radiographs and micro-computed tomography (micro-CT) scanning were taken for microstructural assessment, material distribution evaluation, and micro-finite element analysis. A displacement of 5% compressive strain on the longitudinal direction was applied to the micro-finite element model, and apparent and tissue-level mechanical properties were calculated. Principle component analysis and linear regression were used to establish the relationship between principle components (PCs) and mechanical parameters. Visible bony callus formation was observed throughout the healing process from radiographic assessment. Apparent mechanical property increased at 8 weeks, but tissue-level mechanical property did not increase significantly until 12 weeks. Three PCs were extracted from microstructural parameters and material distribution, which accounted for 87.592% of the total variation. The regression results showed a significant relationship between PCs and mechanical parameters (R>0.8, PCT imaging could efficiently predict bone strength and reflect the bone remodeling process during fracture healing, which provides a basis for exploring the fracture healing mechanism and may be used as an approach for fractured bone strength assessment.

  20. Excess dietary methionine does not affect fracture healing in mice

    Science.gov (United States)

    Holstein, Joerg H.; Schmalenbach, Julia; Herrmann, Markus; Ölkü, Ilona; Garcia, Patric; Histing, Tina; Herrmann, Wolfgang; Menger, Michael D.; Pohlemann, Tim; Claes, Lutz

    2012-01-01

    Summary Background An elevated serum concentration of homocysteine (hyperhomocysteinemia) has been shown to disturb fracture healing. As the essential amino acid, methionine, is a precursor of homocysteine, we aimed to investigate whether excess methionine intake affects bone repair. Material/Methods We analyzed bone repair in 2 groups of mice. One group was fed a methionine-rich diet (n=13), and the second group received an equicaloric control diet without methionine supplementation (n=12). Using a closed femoral fracture model, bone repair was analyzed by histomorphometry and biomechanical testing at 4 weeks after fracture. Blood was sampled to measure serum concentrations of homocysteine, the bone formation marker osteocalcin, and the bone resorption marker collagen I C-terminal crosslaps Results Serum concentrations of homocysteine were significantly higher in the methionine group than in the control group, while serum markers of bone turnover did not differ significantly between the 2 groups. Histomorphometry revealed no significant differences in size and tissue composition of the callus between animals fed the methionine-enriched diet and those receiving the control diet. Accordingly, animals of the 2 groups showed a comparable bending stiffness of the healing bones. Conclusions We conclude that excess methionine intake causes hyperhomocysteinemia, but does not affect fracture healing in mice. PMID:23197225

  1. [Bone fracture and the healing mechanisms. Fragility fracture and bone quality].

    Science.gov (United States)

    Mawatari, Taro; Iwamoto, Yukihide

    2009-05-01

    Fracture occurs in bone having less than normal elastic resistance without any violence. Numerous terms have been used to classify various types of fractures from low trauma events; "fragility fracture", "stress fracture", "insufficiency fracture", "fatigue fracture", "pathologic fracture", etc. The definitions of these terms and clinical characteristics of these fractures are discussed. Also state-of-the-art bone quality assessments; Finite element analysis of clinical CT scans, assessments of the Microdamage, and the Cross-links of Collagen are introduced in this review.

  2. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    Science.gov (United States)

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis.

  3. Locally applied Simvastatin improves fracture healing in mice

    Directory of Open Access Journals (Sweden)

    Aspenberg Per

    2007-09-01

    Full Text Available Abstract Background HMG-CoA reductase inhibitors, statins, are widely prescribed to lower cholesterol. High doses of orally administered simvastatin has previously been shown to improve fracture healing in a mouse femur fracture model. In this study, simvastatin was administered either subcutaneously or directly to the fracture area, with the goal of stimulating fracture repair at acceptable doses. Methods Femur fractures were produced in 70 mature male Balb-C mice and stabilized with marrow-nailing. Three experiments were performed. Firstly, 20 mice received subcutaneous injections of either simvastatin (20 mg or vehicle. Secondly, 30 mice were divided into three groups of 10 mice receiving continuous subcutaneous delivery of the vehicle substance, the vehicle with 5 mg or with 10 mg of simvastatin per kg bodyweight per day. Finally, in 20 mice, a silicone tube was led from an osmotic mini-pump to the fracture area. In this way, 10 mice received an approximate local dose of simvastatin of 0.1 mg per kg per day for the duration of the experiment and 10 mice received the vehicle compound. All treatments lasted until the end of the experiment. Bilateral femurs were harvested 14 days post-operative. Biomechanical tests were performed by way of three-point bending. Data was analysed with ANOVA, Scheffé's post-hoc test and Student's unpaired t-test. Results With daily simvastatin injections, no effects could be demonstrated for any of the parameters examined. Continuous systemic delivery resulted in a 160% larger force at failure. Continuous local delivery of simvastatin resulted in a 170% larger force at failure as well as a twofold larger energy uptake. Conclusion This study found a dramatic positive effect on biomechanical parameters of fracture healing by simvastatin treatment directly applied to the fracture area.

  4. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    Science.gov (United States)

    2006-12-01

    MJ, Goll SR, Nichols CE, 3rd, Pollack SR: Prevention and treatment of sciatic denervation disuse osteoporosis in the rat tibia with capacitively...the healing of fractures. J Bone Joint Surg Am 83-A:259-70, 2001 40. Rubin CT, McLeod KJ, Lanyon LE: Prevention of osteoporosis by pulsed...USA Corresponding author Belinda R. Beck, Ph.D. Griffith University School of Physiotherapy and Exercise Science, PMB 50 Gold Coast Mail Centre Q

  5. CaMKK2 Inhibition in Enhancing Bone Fracture Healing

    Science.gov (United States)

    2016-05-01

    mm) retrograde through the distal condyle of the femur. Radiographic analyses were performed to confirm the location and quality of the fractures...costs, loss of productivity and most importantly, loss of patient quality of life. Prolonged healing time and non-union occur in 5-10% of these...male C57BL6 (50) were purchased from Harlan Laboratories (Indianapolis) and housed under a 12-hr light and dark cycle, with food and water provided ad

  6. Effects of Boric Acid on Fracture Healing: An Experimental Study.

    Science.gov (United States)

    Gölge, Umut Hatay; Kaymaz, Burak; Arpaci, Rabia; Kömürcü, Erkam; Göksel, Ferdi; Güven, Mustafa; Güzel, Yunus; Cevizci, Sibel

    2015-10-01

    Boric acid (BA) has positive effects on bone tissue. In this study, the effects of BA on fracture healing were evaluated in an animal model. Standard closed femoral shaft fractures were created in 40 male Sprague-Dawley rats under general anesthesia. The rats were allocated into five groups (n = 8 each): group 1, control with no BA; groups 2 and 3, oral BA at doses of 4 and 8 mg/kg/day, respectively; group 4, local BA (8 mg/kg); and group 5, both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally). After closed fracture creation, the fracture line was opened with a mini-incision, and BA was locally administered to the fracture area in groups 4 and 5. In groups 2, 3, and 5, BA was administered by gastric gavage daily until sacrifice. The rats were evaluated by clinical, radiological, and histological examinations. The control group (group 1) significantly differed from the local BA-exposed groups (groups 4 and 5) in the clinical evaluation. Front-rear and lateral radiographs revealed significant differences between the local BA-exposed groups and the control and other groups (p < 0.05). Clinical and radiological evaluations demonstrated adequate agreement between observers. The average histological scores significantly differed across groups (p = 0.007) and were significantly higher in groups 4 and 5 which were the local BA (8 mg/kg) and both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally), respectively, compared to the controls. This study suggests that BA may be useful in fracture healing. Further research is required to demonstrate the most effective local dosage and possible use of BA-coated implants.

  7. Exposure to 100% Oxygen Abolishes the Impairment of Fracture Healing after Thoracic Trauma.

    Directory of Open Access Journals (Sweden)

    Julia Kemmler

    Full Text Available In polytrauma patients a thoracic trauma is one of the most critical injuries and an important trigger of post-traumatic inflammation. About 50% of patients with thoracic trauma are additionally affected by bone fractures. The risk for fracture malunion is considerably increased in such patients, the pathomechanisms being poorly understood. Thoracic trauma causes regional alveolar hypoxia and, subsequently, hypoxemia, which in turn triggers local and systemic inflammation. Therefore, we aimed to unravel the role of oxygen in impaired bone regeneration after thoracic trauma. We hypothesized that short-term breathing of 100% oxygen in the early post-traumatic phase ameliorates inflammation and improves bone regeneration. Mice underwent a femur osteotomy alone or combined with blunt chest trauma 100% oxygen was administered immediately after trauma for two separate 3 hour intervals. Arterial blood gas tensions, microcirculatory perfusion and oxygenation were assessed at 3, 9 and 24 hours after injury. Inflammatory cytokines and markers of oxidative/nitrosative stress were measured in plasma, lung and fracture hematoma. Bone healing was assessed on day 7, 14 and 21. Thoracic trauma induced pulmonary and systemic inflammation and impaired bone healing. Short-term exposure to 100% oxygen in the acute post-traumatic phase significantly attenuated systemic and local inflammatory responses and improved fracture healing without provoking toxic side effects, suggesting that hyperoxia could induce anti-inflammatory and pro-regenerative effects after severe injury. These results suggest that breathing of 100% oxygen in the acute post-traumatic phase might reduce the risk of poorly healing fractures in severely injured patients.

  8. Cosmos caudatus enhances fracture healing in ovariectomised rats: A preliminary biomechanical evaluation

    Directory of Open Access Journals (Sweden)

    Pamela Godspower Rufus

    2015-01-01

    Full Text Available Summary. Osteoporotic fractures occur in osteoporotic states and affect patients’ quality of life. Cosmos caudatus (ulam raja is a local plant known for its high calcium content and anti-oxidant properties. The present study aimed to investigate the fracture healing properties of C. caudatus water extract in ovariectomised rats by studying the biomechanical properties of tibia. Twenty-four female Sprague-Dawley rats were divided into 4 groups: (i sham operated (ii ovariectomised control (iii ovariectomised + estrogen (100µg/kg/day and (iv ovariectomised + C. caudatus (500mg/kg. Following six weeks of sham operation or ovariectomy, the right tibia of the rats were fractured. Rats were then given their respective treatment for 8 weeks with body weight monitored weekly. Biomechanical analysis indicated that the maximum load, stress and Young’s modulus of the ovariectomised control group (36.2 ± 4.7N, 10.01 ± 1.41MPa, 29.2 ± 9.39MPa respectively were significantly lower compared to sham operated (150.32 ± 32. 6N, 36.75 ± 7.98MPa, 183 ± 53.2MPa respectively and the C. caudatus treated group (136.86 ± 16.95N, 33.45 ± 4.14MPa, 155.13± 58.58MPa respectively. Therefore, C. caudatus extract improved the biomechanical property of the healed bone and may be beneficial for fracture healing in the estrogen deficient state.Industrial Relevance. Post-menopausal osteoporosis is a debilitating disease affecting women worldwide. Hormone replacement therapy (HRT, commonly used for the prevention and treatment of post-menopausal osteoporosis has been associated with several side effects. Thus, in finding alternatives in the treatment of osteoporosis, C. caudatus is a plant of interest. Previous study showed that C. caudatus improved bone histomorphometry in ovariectomized rats by increasing double-labeled surface (dLS/BS, mineral appositional rate (MAR, osteoid volume (OV/BV and osteoblast surface (Ob.S/BS. Therefore, the present study aimed to assess

  9. Effect of early or delayed treatment upon healing of mandibular fractures: a systematic literature review

    DEFF Research Database (Denmark)

    Hermund, Niels Ulrich; Hillerup, Søren; Kofod, Thomas

    2008-01-01

    The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus...

  10. Neutrophils contribute to fracture healing by synthesizing fibronectin+ extracellular matrix rapidly after injury

    NARCIS (Netherlands)

    Bastian, Okan W.; Koenderman, Leo; Alblas, Jacqueline; Leenen, Luke P H; Blokhuis, Taco J.

    2016-01-01

    The role of inflammatory cells in bone regeneration remains unclear. We hypothesize that leukocytes contribute to fracture healing by rapidly synthesizing an "emergency extracellular matrix (ECM)" before stromal cells infiltrate the fracture hematoma (FH) and synthesize the eventual collagenous bone

  11. Increase in bone protein components with healing rat fractures: enhancement by zinc treatment.

    Science.gov (United States)

    Igarashi, A; Yamaguchi, M

    1999-12-01

    The alteration in bone components in the femoral-diaphyseal tissues with fracture healing was investigated. Rats were sacrificed 7 and 14 days after the femoral fracture. Protein content in the femoral-diaphyseal tissues was markedly elevated by fracture healing. Analysis with sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed that many protein molecules were induced in the diaphyseal tissues with fracture healing. Moreover, when the femoral-diaphyseal tissues with fracture healing were cultured for 24 and 48 h in a serum-free medium, many proteins in the bone tissues were released into the medium. Also, the culture of the diaphyseal tissues with fracture healing caused a significant increase in bone alkaline phosphatase activity and deoxyribonucleic acid (DNA) content. Meanwhile, the presence of zinc acexamate (10-5 and 10-4 M), a stimulator of bone formation, in a culture medium induced a significant elevation of protein content and alkaline phosphatase activity in the diaphyseal tissues with fracture healing. Such an effect was completely abolished by the presence of cycloheximide (10-6 M), an inhibitor of protein synthesis. The present study suggests that fracture healing induces a newly synthesized bone protein component including stimulatory factor(s) for bone formation. Zinc supplementation may stimulate the healing of femoral fracture.

  12. Computational techniques for the assessment of fracture repair.

    Science.gov (United States)

    Anderson, Donald D; Thomas, Thaddeus P; Campos Marin, Ana; Elkins, Jacob M; Lack, William D; Lacroix, Damien

    2014-06-01

    The combination of high-resolution three-dimensional medical imaging, increased computing power, and modern computational methods provide unprecedented capabilities for assessing the repair and healing of fractured bone. Fracture healing is a natural process that restores the mechanical integrity of bone and is greatly influenced by the prevailing mechanical environment. Mechanobiological theories have been proposed to provide greater insight into the relationships between mechanics (stress and strain) and biology. Computational approaches for modelling these relationships have evolved from simple tools to analyze fracture healing at a single point in time to current models that capture complex biological events such as angiogenesis, stochasticity in cellular activities, and cell-phenotype specific activities. The predictive capacity of these models has been established using corroborating physical experiments. For clinical application, mechanobiological models accounting for patient-to-patient variability hold the potential to predict fracture healing and thereby help clinicians to customize treatment. Advanced imaging tools permit patient-specific geometries to be used in such models. Refining the models to study the strain fields within a fracture gap and adapting the models for case-specific simulation may provide more accurate examination of the relationship between strain and fracture healing in actual patients. Medical imaging systems have significantly advanced the capability for less invasive visualization of injured musculoskeletal tissues, but all too often the consideration of these rich datasets has stopped at the level of subjective observation. Computational image analysis methods have not yet been applied to study fracture healing, but two comparable challenges which have been addressed in this general area are the evaluation of fracture severity and of fracture-associated soft tissue injury. CT-based methodologies developed to assess and quantify

  13. Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Shi, Zhongju; Zhou, Hengxing; Pan, Bin; Lu, Lu; Liu, Jun; Kang, Yi; Yao, Xue; Feng, Shiqing

    2016-01-01

    Purpose Nowadays, the efficacy of teriparatide in treating osteoporosis was widely accepted, but the discussion about using teriparatide to enhance fracture healing hasn’t come to an agreement. This meta-analysis was conducted to evaluate the effectiveness of teriparatide for fracture healing. Methods We searched PubMed, the Cochrane Library, and Embase in August 2016 for randomized controlled trials (RCTs) which concerned the treatment of teriparatide for fracture healing. Results Finally, a total of 380 patients were randomly assigned in the 5 trials included in this meta-analysis. There was a significant effectiveness with regards to function improvement in patients following fracture, however, there was no significant effectiveness with regards to time of radiographic fracture healing, fracture healing rate and reduction in pain. Conclusions This analysis showed that administration of teriparatide following fracture lacked the effectiveness for fracture healing. Moreover, teriparatide administration had no apparent adverse effects. These results should be interpreted with caution because of some clear limitations. If we want to confirm whether teriparatide improves fracture healing, more high-quality randomized controlled trials are needed. PMID:27997614

  14. Immunohistochemical localization of key arachidonic acid metabolism enzymes during fracture healing in mice.

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    Hsuan-Ni Lin

    Full Text Available This study investigated the localization of critical enzymes involved in arachidonic acid metabolism during the initial and regenerative phases of mouse femur fracture healing. Previous studies found that loss of cyclooxygenase-2 activity impairs fracture healing while loss of 5-lipoxygenase activity accelerates healing. These diametric results show that arachidonic acid metabolism has an essential function during fracture healing. To better understand the function of arachidonic acid metabolism during fracture healing, expression of cyclooxygenase-1 (COX-1, cyclooxygenase -2 (COX-2, 5-lipoxygenase (5-LO, and leukotriene A4 hydrolase (LTA4H was localized by immunohistochemistry in time-staged fracture callus specimens. All four enzymes were detected in leukocytes present in the bone marrow and attending inflammatory response that accompanied the fracture. In the tissues surrounding the fracture site, the proportion of leukocytes expressing COX-1, COX-2, or LTA4H decreased while those expressing 5-LO remained high at 4 and 7 days after fracture. This may indicate an inflammation resolution function for 5-LO during fracture healing. Only COX-1 was consistently detected in fracture callus osteoblasts during the later stages of healing (day 14 after fracture. In contrast, callus chondrocytes expressed all four enzymes, though 5-LO appeared to be preferentially expressed in newly differentiated chondrocytes. Most interestingly, osteoclasts consistently and strongly expressed COX-2. In addition to bone surfaces and the growth plate, COX-2 expressing osteoclasts were localized at the chondro-osseous junction of the fracture callus. These observations suggest that arachidonic acid mediated signaling from callus chondrocytes or from callus osteoclasts at the chondro-osseous junction regulate fracture healing.

  15. Healing patterns of clavicular birth injuries as a guide to fracture dating in cases of possible infant abuse

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    Walters, Michele M.; Forbes, Peter W.; Buonomo, Carlo; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States)

    2014-10-15

    Dating fractures is critical in cases of suspected infant abuse. There are little scientific data to guide radiologists, and dating is generally based on personal experience and conventional wisdom. Since birth-related clavicular fractures are not immobilized and their age is known, we propose that an assessment of these injuries may serve as a guide for dating inflicted fractures in young infants, acknowledging that patterns observed in the clavicle may not be entirely generalizable to other bones injured in the setting of abuse. One hundred thirty-one radiographs of presumed birth-related clavicular fractures in infants between 0 and 3 months of age were reviewed by two pediatric radiologists with 30 and 15 years' experience. Readers were asked to evaluate images based on several parameters of fracture healing, with a focus on subperiosteal new bone formation (SPNBF) and callus formation. SPNBF and callus were each evaluated with regard to presence, thickness and character. Responses were correlated with known fracture ages. SPNBF was rarely seen in fractures less than 7 days old and was most often present by 10 days. Callus formation was rarely seen in fractures less than 9 days old and was most often present by 15 days. SPNBF thickness increased with fracture age and the character of SPNBF evolved from single-layered to solid/multilayered. Callus thickness decreased with fracture age and callus matrix evolved from soft to intermediate to hard in character. There is an evolution in clavicular fracture healing in young infants that follows a predictable pattern. These findings afford the prospect that predictable patterns of infant clavicular fracture healing can provide an evidence base that may be applicable in cases of suspected infant abuse. (orig.)

  16. Three-dimensional evaluation of healing joint morphology after closed treatment of condylar fractures.

    Science.gov (United States)

    Yamashita, Y; Inoue, M; Aijima, R; Danjo, A; Goto, M

    2016-03-01

    Closed treatment for condylar fractures has long been widely accepted. With closed treatment, the deviated bone fragments heal in their new positions, and this may subsequently cause a range of functional impairments. The association between healing morphology and post-treatment functional impairment is unclear. In this study, computed tomography images of 26 patients (35 sides) who had undergone closed treatment for condylar fractures were used to perform a comparative investigation of three-dimensional (3D) bone morphology before and after treatment. As a result, the morphology of the condylar process after treatment was classified into four different patterns: unchanged, spherical, L-shaped, and detached. In terms of the association between fracture types and healing morphology, fractures of the condylar head healed in the spherical pattern, simple fractures of the condylar neck healed in the spherical or L-shaped pattern, and comminuted fractures of the condylar neck healed in the spherical, L-shaped, or detached pattern. The association between mandibular deviation and healing morphology was also investigated, and it was found that deviation was greater for the spherical and detached patterns than for the L-shaped pattern. The present findings indicate that 3D evaluation of the fractured condylar process is required to elucidate the association with functional impairment after healing.

  17. Transcriptional Analysis of Fracture Healing and the Induction of Embryonic Stem Cell–Related Genes

    OpenAIRE

    Bais, Manish; McLean, Jody; Sebastiani, Paola; Young, Megan; Wigner, Nathan; Smith, Temple; Kotton, Darrell N.; Einhorn, Thomas A; Gerstenfeld, Louis C.

    2009-01-01

    Fractures are among the most common human traumas. Fracture healing represents a unique temporarily definable post-natal process in which to study the complex interactions of multiple molecular events that regulate endochondral skeletal tissue formation. Because of the regenerative nature of fracture healing, it is hypothesized that large numbers of post-natal stem cells are recruited and contribute to formation of the multiple cell lineages that contribute to this process. Bayesian modeling ...

  18. A Feasibility study on Monitoring of Fracture Healing by Electric Stimulation-A study on 2 tibial fracture cases

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    S. Kumaravel

    2010-09-01

    Full Text Available Sufferings associated with broken limbs have been on an exponential increase in India, mainly due to road accidents. Conventional healing and uniting methods takes any where between 1 ½ to 6 months depending on the nature of the fracture and the speed of reporting for medical care .In an effort to speed up the healing process low voltage electric stimulation has been tried and has been found to cut down the healing time by nearly 30% depending on the fracture-history. Also the course of fracture healing has been traced and definite trends during the process identified.Two case studies of fractures of the leg bone through electric stimulation indicate identical trends in the healingprocess.

  19. Transcriptional analysis of fracture healing and the induction of embryonic stem cell-related genes.

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    Manish Bais

    Full Text Available Fractures are among the most common human traumas. Fracture healing represents a unique temporarily definable post-natal process in which to study the complex interactions of multiple molecular events that regulate endochondral skeletal tissue formation. Because of the regenerative nature of fracture healing, it is hypothesized that large numbers of post-natal stem cells are recruited and contribute to formation of the multiple cell lineages that contribute to this process. Bayesian modeling was used to generate the temporal profiles of the transcriptome during fracture healing. The temporal relationships between ontologies that are associated with various biologic, metabolic, and regulatory pathways were identified and related to developmental processes associated with skeletogenesis, vasculogenesis, and neurogenesis. The complement of all the expressed BMPs, Wnts, FGFs, and their receptors were related to the subsets of transcription factors that were concurrently expressed during fracture healing. We further defined during fracture healing the temporal patterns of expression for 174 of the 193 genes known to be associated with human genetic skeletal disorders. In order to identify the common regulatory features that might be present in stem cells that are recruited during fracture healing to other types of stem cells, we queried the transcriptome of fracture healing against that seen in embryonic stem cells (ESCs and mesenchymal stem cells (MSCs. Approximately 300 known genes that are preferentially expressed in ESCs and approximately 350 of the known genes that are preferentially expressed in MSCs showed induction during fracture healing. Nanog, one of the central epigenetic regulators associated with ESC stem cell maintenance, was shown to be associated in multiple forms or bone repair as well as MSC differentiation. In summary, these data present the first temporal analysis of the transcriptome of an endochondral bone formation process

  20. Disadvantages of interfragmentary shear on fracture healing--mechanical insights through numerical simulation.

    Science.gov (United States)

    Steiner, Malte; Claes, Lutz; Ignatius, Anita; Simon, Ulrich; Wehner, Tim

    2014-07-01

    The outcome of secondary fracture healing processes is strongly influenced by interfragmentary motion. Shear movement is assumed to be more disadvantageous than axial movement, however, experimental results are contradictory. Numerical fracture healing models allow simulation of the fracture healing process with variation of single input parameters and under comparable, normalized mechanical conditions. Thus, a comparison of the influence of different loading directions on the healing process is possible. In this study we simulated fracture healing under several axial compressive, and translational and torsional shear movement scenarios, and compared their respective healing times. Therefore, we used a calibrated numerical model for fracture healing in sheep. Numerous variations of movement amplitudes and musculoskeletal loads were simulated for the three loading directions. Our results show that isolated axial compression was more beneficial for the fracture healing success than both isolated shearing conditions for load and displacement magnitudes which were identical as well as physiological different, and even for strain-based normalized comparable conditions. Additionally, torsional shear movements had less impeding effects than translational shear movements. Therefore, our findings suggest that osteosynthesis implants can be optimized, in particular, to limit translational interfragmentary shear under musculoskeletal loading. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  1. Simulated microgravity alters the expression of key genes involved in fracture healing

    Science.gov (United States)

    McCabe, N. Patrick; Androjna, Caroline; Hill, Esther; Globus, Ruth K.; Midura, Ronald J.

    2013-11-01

    Fracture healing in animal models has been shown to be altered in both ground based analogs of spaceflight and in those exposed to actual spaceflight. The molecular mechanisms behind altered fracture healing as a result of chronic exposure to microgravity remain to be elucidated. This study investigates temporal gene expression of multiple factors involved in secondary fracture healing, specifically those integral to the development of a soft tissue callus and the transition to that of hard tissue. Skeletally mature female rats were subjected to a 4 week period of simulated microgravity and then underwent a closed femoral fracture procedure. Thereafter, they were reintroduced to the microgravity and allowed to heal for a 1 or 2 week period. A synchronous group of weight bearing rats was used as a normal fracture healing control. Utilizing Real-Time quantitative PCR on mRNA from fracture callus tissue, we found significant reductions in the levels of transcripts associated with angiogenesis, chondrogenesis, and osteogenesis. These data suggest an altered fracture healing process in a simulated microgravity environment, and these alterations begin early in the healing process. These findings may provide mechanistic insight towards developing countermeasure protocols to mitigate these adaptations.

  2. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

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    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  3. Fracture behaviour of a self-healing microcapsule-loaded epoxy system

    Directory of Open Access Journals (Sweden)

    2011-03-01

    Full Text Available The effect of temperature on the fracture behaviour of a microcapsule-loaded epoxy matrix was investigated. Microencapsulated epoxy and mercaptan-derivative healing agents were incorporated into an epoxy matrix to produce a polymer composite capable of self-healing. Maximum fracture loads were measured using the double-torsion method. Thermal aging at 55 and 110°C for 17 hours [hrs] was applied to heal the pre-cracked samples. The addition of microcapsules appeared to increase significantly the load carrying capacity of the epoxy after healing. Once healed, the composites achieved as much as 93–171% of its virgin maximum fracture load at 18, 55 and 110°C. The fracture behavior of the microcapsule- loaded epoxy matrix was influenced by the healing temperature. The high self-healing efficiency may be attributed to the result of the subsurface micro-crack pinning or deviation, and to a stronger microencapsulated epoxy and mercaptanderivative binder than that of the bulk epoxy. The results show that the healing temperature has a significant effect on recovery of load transferring capability after fracture.

  4. AN ULTRASTRUCTURE INVESTIGATION OF OSTEOPORO-SIS FRACTURE HEALING IN OVARIECTOMIZED RAT

    Institute of Scientific and Technical Information of China (English)

    楼国祥; 张先龙

    2003-01-01

    Objective To elucidate the influence of osteoporosis on the fracture healing in ovariectomized rat. Methods 24 females 8-month-old SD rats were divided randomly into two groups.12 were sham-operated(Sham)and 12 were bilaterally ovariectomized(OVX) 3 months later.The femoral fracture model were made in both groups,the healing process was observed by transmission electron microscopy(TEM) on d3,d7,d14,d21,d28,and d42 after making fracture in control groups(Sham) and the osteoporosis group(OVX).Results According to the TEM findings,the types of fracture healing cells,their ultrastructure changes and functional states were almost identical in both groups till d21 after making fracture.In OVX group,the calcified cartilage was not resorbed and replaced by new woven bone,a lot of necrosis chondrocytes were found being embedded in a calcified chondroid matrix on d28;after this period,osteoclastic bone resorption become severe gra-dually accompanied by osteocytic osteolysis during d28 to d42 of fracture healing. Conclusion Osteoporosis greatly affect the fracture healing in the later period of healing proess.It demonstrated as endochondral bone formation delayed and increased osteoclastic bone resorption which was made even more severed by osteocytic osteolysis during the period of bone callus remodelling.

  5. Increase in bone growth factors with healing rat fractures: the enhancing effect of zinc.

    Science.gov (United States)

    Igarashi, A; Yamaguchi, M

    2001-10-01

    The effect of zinc, a stimulator of bone formation, on bone protein components in the femoral-diaphyseal tissues with fracture healing was investigated. Rats were sacrificed between 1 and 7 days after the femoral fracture, and the diaphyseal tissues were cultured in a serum-free Dulbecco's modified Eagle's medium for 24 h. Protein content in the femoral-diaphyseal tissues was markedly elevated by fracture healing. The amount of protein in the medium cultured with the diaphyseal tissues obtained from fracture healing rats was markedly elevated as compared with that of normal rats, indicating that bone protein components were secreted into culture medium. Analysis with sodium dodecyl sulfate-polyacrylamide gel elecrophoresis (SDS-PAGE) showed that many protein molecules were secreted from the diaphyseal tissues with fracture healing. Especially, protein molecule of about 66 kDa was markedly secreted by fracture healing. The presence of zinc acexamate (10(-5) and 10(-4) M) in culture medium induced a significant elevation of medium protein content; the zinc effect was enhanced by culture with the diaphyseal tissues of fracture healing rats. Also, the culture of diaphyseal tissues with fracture healing caused a significant increase in insulin-like growth factor-I (IGF-I) and transforming growth factor-beta1 (TGF-beta1) in culture medium. The production of IGF-I and TGF-beta1 from bone tissues with fracture healing was significantly enhanced in the presence of zinc acexamate (10(-6)-10(-4) M). Moreover, the addition of IGF-I (10(-8) M) or TGF-beta1 (10(-10) M) in a culture medium caused a significant elevation of protein content in the medium cultured with the femoral-diaphyseal tissues from normal and fracture healing rats. The effect of IGF-I or TGF-beta1 was significantly enhanced in the presence of zinc acexamate (10(-4) M). Also, deoxyribonucleic acid (DNA) content in the diaphyseal tissues from normal and fracture healing rats was significantly raised by the

  6. Mice lacking pten in osteoblasts have improved intramembranous and late endochondral fracture healing.

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    Travis A Burgers

    Full Text Available The failure of an osseous fracture to heal (development of a non-union is a common and debilitating clinical problem. Mice lacking the tumor suppressor Pten in osteoblasts have dramatic and progressive increases in bone volume and density throughout life. Since fracture healing is a recapitulation of bone development, we investigated the process of fracture healing in mice lacking Pten in osteoblasts (Ocn-cre(tg/+;Pten(flox/flox . Mid-diaphyseal femoral fractures induced in wild-type and Ocn-cre(tg/+;Pten(flox/flox mice were studied via micro-computed tomography (µCT scans, biomechanical testing, histological and histomorphometric analysis, and protein expression analysis. Ocn-cre(tg/+;Pten(flox/flox mice had significantly stiffer and stronger intact bones relative to controls in all cohorts. They also had significantly stiffer healing bones at day 28 post-fracture (PF and significantly stronger healing bones at days 14, 21, and 28 PF. At day 7 PF, the proximal and distal ends of the Pten mutant calluses were more ossified. By day 28 PF, Pten mutants had larger and more mineralized calluses. Pten mutants had improved intramembranous bone formation during healing originating from the periosteum. They also had improved endochondral bone formation later in the healing process, after mature osteoblasts are present in the callus. Our results indicate that the inhibition of Pten can improve fracture healing and that the local or short-term use of commercially available Pten-inhibiting agents may have clinical application for enhancing fracture healing.

  7. Relationship among bone mineral density, collagen composition, and biomechanical properties of callus in the healing of osteoporotic fracture

    Institute of Scientific and Technical Information of China (English)

    SHEN Bin; MU Jian-xiong; PEI Fu-xing

    2007-01-01

    Objective: To study the change and relationship among bone mineral density (BMD), collagen composition and biomechanical properties of the callus in the healing process of osteoporotic fracture.Methods: The osteoporotic rat model and fracture model were established through bilateral ovariectomy(OVX) and osteotomy of the middle shaft of the right hind tibiae, respectively. Ninety female SD rats were randomly divided into OVX group and sham group. With the samples of blood and callus, roentgenoraphic and histological observation were performed for the assessment of the healing progress of the fracture, and the serum concentration of TRAP-5b, proportion of type Ⅰ collagen,BMD and biomechanical properties of the callus were measured.Results: The OVX group experienced a significant delay of fracture healing. The mean serum concentration of TRAP-5b of rats in the OVX group was much higher than that in the sham group after the operation (P < 0.05), but the difference at the same time point after fracture was smaller than that before fracture (P < 0.05 ). The BMD of the callus in both groups reached the peak value at the 6 th week after fracture while the proportion of the type Ⅰ collagen and the biomechanical strength reached the peak at the 8th week.Conclusions: The deficiency of estrogen after the ovariectomy could induce the up-regulation of the osteoclasts activities, whereas the potency of further activation after fracture was depressed. Although the synthesis of collagen together with its mineralization determines the biomechanical properties of new bone, the accumulation of collagen could be assessed as an index in the prediction of biomechanical strength of bones independent of the bone mineral deposition.

  8. Healing of multiple fractured thoracic dorsal spinous processes in a Quarter horse

    OpenAIRE

    Molnar, Rebeccah; Barber, Spencer M.; Pharr, John W.; Panizzi, Luca; Plaxton, Andrea

    2012-01-01

    A Quarter horse gelding sustained fracture and displacement of spinous processes T2–T10. Radiographic evidence of healing was seen 3 mo following injury, and at 2 years post-injury all spinous processes had healed and undergone partial re-alignment. This re-alignment has not been reported before.

  9. Healing of multiple fractured thoracic dorsal spinous processes in a Quarter horse.

    Science.gov (United States)

    Molnar, Rebeccah; Barber, Spencer M; Pharr, John W; Panizzi, Luca; Plaxton, Andrea

    2012-03-01

    A Quarter horse gelding sustained fracture and displacement of spinous processes T2-T10. Radiographic evidence of healing was seen 3 mo following injury, and at 2 years post-injury all spinous processes had healed and undergone partial re-alignment. This re-alignment has not been reported before.

  10. The Changed Route of Anterior Tibial Artery due to Healed Fracture

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    Kemal Gökkuş

    2016-01-01

    Full Text Available We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia.

  11. Role of Medicinal Plants and Natural Products on Osteoporotic Fracture Healing

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    Mohd Azri Abd Jalil

    2012-01-01

    Full Text Available Popularly known as “the silent disease” since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases—hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world’s largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali, Labisia pumila (Kacip Fatimah, and Piper sarmentosum (Kaduk are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  12. Targeted delivery of lovastatin and tocotrienol to fracture site promotes fracture healing in osteoporosis model: micro-computed tomography and biomechanical evaluation.

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    Nurul 'Izzah Ibrahim

    Full Text Available Osteoporosis is becoming a major health problem that is associated with increased fracture risk. Previous studies have shown that osteoporosis could delay fracture healing. Although there are potential agents available to promote fracture healing of osteoporotic bone such as statins and tocotrienol, studies on direct delivery of these agents to the fracture site are limited. This study was designed to investigate the effects of two potential agents, lovastatin and tocotrienol using targeted drug delivery system on fracture healing of postmenopausal osteoporosis rats. The fracture healing was evaluated using micro CT and biomechanical parameters. Forty-eight Sprague-Dawley female rats were divided into 6 groups. The first group was sham-operated (SO, while the others were ovariectomized (OVx. After two months, the right tibiae of all rats were fractured at metaphysis region using pulsed ultrasound and were fixed with plates and screws. The SO and OVxC groups were given two single injections of lovastatin and tocotrienol carriers. The estrogen group (OVx+EST was given daily oral gavages of Premarin (64.5 µg/kg. The Lovastatin treatment group (OVx+Lov was given a single injection of 750 µg/kg lovastatin particles. The tocotrienol group (OVx+TT was given a single injection of 60 mg/kg tocotrienol particles. The combination treatment group (OVx+Lov+TT was given two single injections of 750 µg/kg lovastatin particles and 60 mg/kg tocotrienol particles. After 4 weeks of treatment, the fractured tibiae were dissected out for micro-CT and biomechanical assessments. The combined treatment group (OVx+Lov+TT showed significantly higher callus volume and callus strength than the OVxC group (p<0.05. Both the OVx+Lov and OVx+TT groups showed significantly higher callus strength than the OVxC group (p<0.05, but not for callus volume. In conclusion, combined lovastatin and tocotrienol may promote better fracture healing of osteoporotic bone.

  13. Midkine-deficiency delays chondrogenesis during the early phase of fracture healing in mice.

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    Melanie Haffner-Luntzer

    Full Text Available The growth and differentiation factor midkine (Mdk plays an important role in bone development and remodeling. Mdk-deficient mice display a high bone mass phenotype when aged 12 and 18 months. Furthermore, Mdk has been identified as a negative regulator of mechanically induced bone formation and it induces pro-chondrogenic, pro-angiogenic and pro-inflammatory effects. Together with the finding that Mdk is expressed in chondrocytes during fracture healing, we hypothesized that Mdk could play a complex role in endochondral ossification during the bone healing process. Femoral osteotomies stabilized using an external fixator were created in wildtype and Mdk-deficient mice. Fracture healing was evaluated 4, 10, 21 and 28 days after surgery using 3-point-bending, micro-computed tomography, histology and immunohistology. We demonstrated that Mdk-deficient mice displayed delayed chondrogenesis during the early phase of fracture healing as well as significantly decreased flexural rigidity and moment of inertia of the fracture callus 21 days after fracture. Mdk-deficiency diminished beta-catenin expression in chondrocytes and delayed presence of macrophages during early fracture healing. We also investigated the impact of Mdk knockdown using siRNA on ATDC5 chondroprogenitor cells in vitro. Knockdown of Mdk expression resulted in a decrease of beta-catenin and chondrogenic differentiation-related matrix proteins, suggesting that delayed chondrogenesis during fracture healing in Mdk-deficient mice may be due to a cell-autonomous mechanism involving reduced beta-catenin signaling. Our results demonstrated that Mdk plays a crucial role in the early inflammation phase and during the development of cartilaginous callus in the fracture healing process.

  14. Mode II fracture toughening and healing of composites using supramolecular polymer interlayers

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    V. Kostopoulos

    2016-11-01

    Full Text Available This study focuses on the transfer of the healing functionality of supramolecular polymers (SP to fibre reinforced composites through interleaving. SPs exhibiting self-healing based on hydrogen bonds were formed into films and were successfully incorporated into carbon fibre composites. The effect of the SP interleaves on in-plane fracture toughness and the subsequent healing capability of the hybrid composites were investigated under mode II fracture loading. The fracture toughness showed considerable increase since the maximum load (Pmax of the hybrid composite approximately doubled, and consequently the mode II interlaminar fracture toughness energy (GIIC exhibited an increase reaching nearly 100% compared to the reference composite. The healing component was activated using external heat. Pmax and GIIC recovery after activation were measured, exhibiting a healing efficiency after the first healing cycle close to 85% for Pmax and 100% for GIIC, eventually dropping to 80% for Pmax while GIIC was retained around 100% even after the fourth healing cycle. Acoustic Emission activity during the tests was monitored and was found to be strongly reduced due to the presence of the SP.

  15. Pulsed electromagnetic field treatment enhances healing callus biomechanical properties in an animal model of osteoporotic fracture.

    Science.gov (United States)

    Androjna, Caroline; Fort, Brian; Zborowski, Maciej; Midura, Ronald J

    2014-09-01

    Delayed bone healing has been noted in osteoporosis patients and in the ovariectomized (OVX) rat model of estrogen-depletion osteopenia. Pulsed electromagnetic field (PEMF) devices are clinically approved as an adjunct to cervical fusion surgery in patients at high risk for non-fusion and for the treatment of fracture non-unions. These bone growth stimulating devices also accelerate the healing of fresh fracture repair in skeletally mature normal rats but have not been tested for efficacy to accelerate and/or enhance the delayed bone repair process in OVX rats. The current study tested the hypothesis that daily PEMF treatments would improve the fracture healing response in skeletally mature OVX rats. By 6 weeks of healing, PEMF treatments resulted in improved hard callus elastic modulus across fibula fractures normalizing the healing process in OVX rats with respect to this mechanical property. Radiographic evidence showed an improved hard callus bridging across fibula fractures in OVX rats treated with PEMF as compared to sham treatments. These findings provide a scientific rationale for investigating whether PEMF might improve bone-healing responses in at-risk osteoporotic patients.

  16. The Effect of Osteoporosis on Healing of Distal Radius Fragility Fractures.

    Science.gov (United States)

    Tulipan, Jacob; Jones, Christopher M; Ilyas, Asif M

    2015-10-01

    Although the decision for operative versus nonoperative treatment of distal radius fractures remains subjective and is performed on a case-by-case basis, evaluation and treatment of patients with concomitant osteoporosis requires understanding of the behavior of this injury as a distinct subset of distal radius fractures. Age, infirmity, and osteoporosis affect every aspect of the fracture. Understanding what makes these fractures unique assists surgeons in more effective and efficient treatment. The authors present the current understanding of osteoporotic fragility fractures of the distal radius, focusing on epidemiology, biomechanics of bone healing, and its implication on strategies for management.

  17. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  18. Assessment of bone healing on tibial fractures treated with wire osteosynthesis associated or not with infrared laser light and biphasic ceramic bone graft (HATCP) and guided bone regeneration (GBR): Raman spectroscopy study

    Science.gov (United States)

    Bastos de Carvalho, Fabíola; Aciole, Gilberth Tadeu S.; Aciole, Jouber Mateus S.; Silveira, Landulfo, Jr.; Nunes dos Santos, Jean; Pinheiro, Antônio L. B.

    2011-03-01

    The aim of this study was to evaluate, through Raman spectroscopy, the repair of complete tibial fracture in rabbits fixed with wire osteosynthesis - WO, treated or not with infrared laser light (λ 780nm, 50mW, CW) associated or not to the use of HATCP and GBR. Surgical fractures were created under general anesthesia (Ketamine 0.4ml/Kg IP and Xilazine 0.2ml/Kg IP), on the tibia of 15 rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with WO. Animals of groups III and V were grafted with hydroxyapatite + GBR technique. Animals of groups IV and V were irradiated at every other day during two weeks (16J/cm2, 4 x 4J/cm2). Observation time was that of 30 days. After animal death the specimens were kept in liquid nitrogen for further analysis by Raman spectroscopy. Raman spectroscopy showed significant differences between groups (p<0.001). It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of calcium hydroxyapatite.

  19. Strontium Is Incorporated into the Fracture Callus but Does Not Influence the Mechanical Strength of Healing Rat Fractures

    DEFF Research Database (Denmark)

    Brüel, Annemarie; Olsen, Jakob; Birkedal, Henrik

    2011-01-01

    to study fracture healing in rats after 3 and 8 weeks of healing. Two groups of rats were treated with SrR (900 mg/kg/day) mixed into the food, while two groups served as control animals. The healing fractures were investigated by three-point bending, dual energy X-ray absorptiometry, energy-dispersive X......Strontium ranelate (SrR) is a new agent used in the treatment of osteoporosis and is suggested to reduce bone resorption and increase bone formation. We investigated whether SrR influences the macro- and nanomechnical properties of healing fractures in rats. A closed tibia fracture model was used......-ray spectroscopy (EDX), and nanoindentation. There was a 100-fold increase (P\\0.001) in serum Sr after 3 and 8 weeks of SrR treatment. The callus volume was significantly higher in the SrR-treated group than in control animals (P\\0.01) after 3 weeks of healing. This was accompanied by a significant increase...

  20. Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root.

    Science.gov (United States)

    Cvek, Miomir; Mejàre, Ingegerd; Andreasen, Jens Ove

    2002-04-01

    Healing and long-term prognosis of 94 cervical root fractures were evaluated. The teeth were divided into two groups according to type of fracture: transverse fractures limited to the cervical third of the root (51 incisors) and oblique fractures involving both the cervical and middle parts of the root (43 incisors). Neither the frequency nor the type of fracture healing differed significantly between the two groups. In the material as a whole, healing of the fracture with hard tissue formation was observed in 17 teeth (18%), and healing with interposition of periodontal ligament (PDL) and, in some cases, hard tissue between the fragments in 62 teeth (66%). Fifteen teeth (16%) showed no healing and a radiolucency adjacent to the fracture. Statistical analyses revealed that incomplete root formation and a positive sensibility test at the time of injury were significantly related to both healing and hard tissue repair. The same applied to concussion or subluxation compared with dislocation of coronal fragment, as well as optimal compared with suboptimal reposition of displaced coronal fragments. The type and duration of splinting (or no splinting) appeared to be of no significance for frequency or type of healing of cervical root fractures. During the observation time (mean = 75 months), 19 (44%) of the teeth with transverse fractures and 3 (8%) of those with oblique fractures were lost after healing. In conclusion, fractures in the cervical part of the root had a healing potential and the predictive parameters identified for fractures in other parts of the root seemed to be valid for the healing of cervical root fractures. Transverse fractures appeared to have a significantly poorer long-term prognosis compared to oblique fractures, apparently due to a marked post-treatment mobility, which often led to new luxation caused by even minor impacts.

  1. Analyzing the cellular contribution of bone marrow to fracture healing using bone marrow transplantation in mice.

    Science.gov (United States)

    Colnot, C; Huang, S; Helms, J

    2006-11-24

    The bone marrow is believed to play important roles during fracture healing such as providing progenitor cells for inflammation, matrix remodeling, and cartilage and bone formation. Given the complex nature of bone repair, it remains difficult to distinguish the contributions of various cell types. Here we describe a mouse model based on bone marrow transplantation and genetic labeling to track cells originating from bone marrow during fracture healing. Following lethal irradiation and engraftment of bone marrow expressing the LacZ transgene constitutively, wild type mice underwent tibial fracture. Donor bone marrow-derived cells, which originated from the hematopoietic compartment, did not participate in the chondrogenic and osteogenic lineages during fracture healing. Instead, the donor bone marrow contributed to inflammatory and bone resorbing cells. This model can be exploited in the future to investigate the role of inflammation and matrix remodeling during bone repair, independent from osteogenesis and chondrogenesis.

  2. Upregulation of inflammatory genes and downregulation of sclerostin gene expression are key elements in the early phase of fragility fracture healing.

    Directory of Open Access Journals (Sweden)

    Joana Caetano-Lopes

    Full Text Available BACKGROUND: Fracture healing is orchestrated by a specific set of events that culminates in the repair of bone and reachievement of its biomechanical properties. The aim of our work was to study the sequence of gene expression events involved in inflammation and bone remodeling occurring in the early phases of callus formation in osteoporotic patients. METHODOLOGY/PRINCIPAL FINDINGS: Fifty-six patients submitted to hip replacement surgery after a low-energy hip fracture were enrolled in this study. The patients were grouped according to the time interval between fracture and surgery: bone collected within 3 days after fracture (n = 13; between the 4(th and 7(th day (n = 33; and after one week from the fracture (n = 10. Inflammation- and bone metabolism-related genes were assessed at the fracture site. The expression of pro-inflammatory cytokines was increased in the first days after fracture. The genes responsible for bone formation and resorption were upregulated one week after fracture. The increase in RANKL expression occurred just before that, between the 4(th-7(th days after fracture. Sclerostin expression diminished during the first days after fracture. CONCLUSIONS: The expression of inflammation-related genes, especially IL-6, is highest at the very first days after fracture but from day 4 onwards there is a shift towards bone remodeling genes, suggesting that the inflammatory phase triggers bone healing. We propose that an initial inflammatory stimulus and a decrease in sclerostin-related effects are the key components in fracture healing. In osteoporotic patients, cellular machinery seems to adequately react to the inflammatory stimulus, therefore local promotion of these events might constitute a promising medical intervention to accelerate fracture healing.

  3. Effect of Cervus and Cucumis Peptides on Osteoblast Activity and Fracture Healing in Osteoporotic Bone

    Directory of Open Access Journals (Sweden)

    Ai-Yuan Wang

    2014-01-01

    Full Text Available Osteoporosis is associated with delayed and/or reduced fracture healing. As cervus and cucumis are the traditional Chinese treatments for rheumatoid arthritis, we investigated the effect of supplementation of these peptides (CCP on bone fracture healing in ovariectomized (OVX osteoporotic rats in vitro and in vivo. CCP enhanced osteoblast proliferation and increased alkaline phosphatase activity, matrix mineralization, and expression of runt-related transcription factor 2 (Runx2, bone morphogenetic protein 4 (BMP4, and osteopontin. In vivo, female Sprague-Dawley rats underwent ovariectomy and the right femora were fractured and fixed by intramedullary nailing 3 months later. Rats received intraperitoneal injections of either CCP (1.67 mg/kg or physiological saline every day for 30 days. Fracture healing and callus formation were evaluated by radiography, micro-CT, biomechanical testing, and histology. At 12 weeks after fracture, calluses in CCP-treated bones showed significantly higher torsional strength and greater stiffness than control-treated bones. Bones in CCP-treated rats reunified and were thoroughly remodeled, while two saline-treated rats showed no bone union and incomplete remodeling. Taken together, these results indicate that use of CCP after fracture in osteoporotic rats accelerates mineralization and osteogenesis and improves fracture healing.

  4. Laboratory tests of hydraulic fracturing and swell healing

    DEFF Research Database (Denmark)

    Thunbo, Christensen Claes; Foged, Christensen Helle; Foged, Niels

    1998-01-01

    New laboratory test set-ups and test procedures are described - for testing the formation of hydraulically induced fractures as well as the potential for subsequent fracture closurefrom the relase of a swelling potential. The main purpose with the tests is to provide information on fracturing...

  5. Interface contact profiles of a novel locking plate and its effect on fracture healing in goat

    Institute of Scientific and Technical Information of China (English)

    WEI Da-cheng; ZHAO Yu-feng; XING Shu-xing; WANG Ai-min

    2010-01-01

    Objective: To evaluate the interface characteristics of the new-designed locking plate (LP) and limited contact-dynamic compression plate (LC-DCP) and compare the fracture healing between LP and LC-DCP in a goat tibia fracture model.Methods: Eight-hole LP and LC-DCP were applied to fix flesh goat tibiae in a reproducible manner. The average pressure, force and interface contact area were calculated using Fuji prescale pressure sensitive film interposed among the plate and the bone and image analysis system. Eighthole LP and LC-DCP were applied to each tibia in a goat tibia fracture model. The fracture healing was evaluated by X-ray photography at postoperative 8 weeks. The goats were sacrificed at postoperative 12 weeks. Three-point bending test was conducted in the tibiae.Results: The interface contact of LP system was smaller than that ofLC-DCP (P<0.05), while interface contact force of LP system was higher than that of LC-DCP (P<0.05). Radiographs revealed that the fracture line disappeared in the LP group, while the fracture line was visible in DCP group at postoperative 8 weeks. At postoperative 12 weeks, the bending strength and bending load of fractured tibia were higher in LP group than in DCP group, respectively.Conclusion: The new-designed locking plate can significantly decrease the contact area on the bone interface,which further provides better fracture healing than conventional plates.

  6. The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation.

    Science.gov (United States)

    Miramini, Saeed; Zhang, Lihai; Richardson, Martin; Mendis, Priyan; Oloyede, Adekunle; Ebeling, Peter

    2016-03-01

    Interfragmentary movement (IFM) at the fracture site plays an important role in fracture healing, particularly during its early stage, via influencing the mechanical microenvironment of mesenchymal stem cells within the fracture callus. However, the effect of changes in IFM resulting from the changes in the configuration of locking plate fixation on cell differentiation has not yet been fully understood. In this study, mechanical experiments on surrogate tibia specimens, manufactured from specially formulated polyurethane, were conducted to investigate changes in IFM of fractures under various locking plate fixation configurations and loading magnitudes. The effect of the observed IFM on callus cell differentiation was then further studied using computational simulation. We found that during the early stage, cell differentiation in the fracture callus is highly influenced by fracture gap size and IFM, which in turn, is highly sensitive to locking plate fixation configuration. The computational model predicted that a small gap size (e.g. 1 mm) under a relatively flexible configuration of locking plate fixation (larger bone-plate distances and working lengths) could experience excessive strain and fluid flow within the fracture site, resulting in excessive fibrous tissue differentiation and delayed healing. By contrast, a relatively flexible configuration of locking plate fixation was predicted to improve cartilaginous callus formation and bone healing for a relatively larger gap size (e.g. 3 mm). If further confirmed by animal and human studies, the research outcome of this paper may have implications for orthopaedic surgeons in optimising the application of locking plate fixations for fractures in clinical practice.

  7. Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review

    Science.gov (United States)

    Kim, Sang-Min; Kang, Kyung-Chung; Kim, Ji Wan; Lim, Seung-Jae

    2017-01-01

    Background The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. Methods We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. Results This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. Conclusions Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials. PMID:28326303

  8. Extracorporeal shock wave therapy for non-unions and delayed fracture healing

    Science.gov (United States)

    Schaden, Wolfgang; Fischer, Andreas; Sailler, Andreas; Karadas, Ender

    2005-04-01

    Although the primary management of fractures is highly developed in Central Europe 1% of fractures develop a non-union. After successful pilot studies the Traumacenter Meidling started in December 1998 to treat non-unions regularly with shock wave therapy. From December 1998 to August 2004, 1153 patients with non-union and delayed healing fractures were treated. The results of 755 patients are available up to September 2004. The patients consisted of 250 (33%) female and 505 (67%) male. The mean age was 44.1 years (10; 90). The mean age of the non-union was 15.5 months. In 74 (10%) osteomyelitis was present before shockwave therapy. Out of 755 non-unions 593 (79%) achieved bony healing. As expected, the subgroup of 284 delayed unions (shockwave therapy 3-6 months after the trauma or the last surgery concerning the bone) showed the best results. 245 (86%) healed. Out of 471 non-unions being older than 6 months 348 (72%) achieved bony healing. Because of the efficacy and the lack of complications as well as the economic advantage in comparison to surgery, shockwave therapy is considered as therapy of first choice in the treatment of non-union and delayed healing fractures.

  9. Vitamin E and the Healing of Bone Fracture: The Current State of Evidence

    Directory of Open Access Journals (Sweden)

    Boekhtiar Borhanuddin

    2012-01-01

    Full Text Available Background. The effect of vitamin E on health-related conditions has been extensively researched, with varied results. However, to date, there was no published review of the effect of vitamin E on bone fracture healing. Purpose. This paper systematically audited past studies of the effect of vitamin E on bone fracture healing. Methods. Related articles were identified from Medline, CINAHL, and Scopus databases. Screenings were performed based on the criteria that the study must be an original study that investigated the independent effect of vitamin E on bone fracture healing. Data were extracted using standardised forms, followed by evaluation of quality of reporting using ARRIVE Guidelines, plus recalculation procedure for the effect size and statistical power of the results. Results. Six animal studies fulfilled the selection criteria. The study methods were heterogeneous with mediocre reporting quality and focused on the antioxidant-related mechanism of vitamin E. The metasynthesis showed α-tocopherol may have a significant effect on bone formation during the normal bone remodeling phase of secondary bone healing. Conclusion. In general, the effect of vitamin E on bone fracture healing remained inconclusive due to the small number of heterogeneous and mediocre studies included in this paper.

  10. Enhancement of albumin expression in bone tissues with healing rat fractures.

    Science.gov (United States)

    Yamaguchi, Masayoshi; Igarashi, Aki; Misawa, Hiroyuki; Tsurusaki, Yoshinori

    2003-05-15

    The characterization of 66 kDa protein molecule, a major protein component which is produced from femoral-diaphyseal tissues with fracture healing (Igarashi and Yamaguchi [2002] Int. J. Mol. Med. 9:503-508), was investigated. Weaning rats were killed at 7 and 14 days after femoral fracture. When the femoral-diaphyseal tissues with fracture healing were cultured for 48 h in a serum-free medium, many proteins in the bone tissues were released into the medium. Analysis with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed that a protein molecule of approximately 66 kDa was markedly increased in culture medium from bone tissues with fracture healing. N-terminal sequencing of 66 kDa protein indicated that its N-terminus was identical to that of rat albumin. Western blot analysis of medium 66 kDa protein showed expression of albumin. This expression was significantly enhanced by fracture healing. The expression of albumin was seen in the diaphyseal (cortical bone) and metaphyseal (trabecular bone) tissues of rat femur. When the femoral-diaphyseal tissues obtained at 7 days after femoral fracture were cultured in a serum-free medium containing either vehicle, parathyroid hormone (1-34) (10(-7) M), insulin-like growth factor-I (10(-8) M) or zinc acexamate (10(-4) M), medium albumin was significantly increased in the presence of those bone-stimulating factors. The addition of albumin (0.5 or 1.0 mg/ml of medium) caused a significant increase in calcium and deoxyribonucleic acid contents in the femoral-diaphyseal and -metaphyseal tissues obtained from normal rats in vitro. The present study demonstrates that fracture healing induces a remarkable production of albumin which is a major protein component produced from femoral-diaphyseal tissues of rats, and that albumin has an anabolic effect on bone components.

  11. Routine functional assessment for hip fracture patients

    DEFF Research Database (Denmark)

    Pedersen, Tonny J; Lauritsen, Jens M

    2016-01-01

    Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4...... months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new...... investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted....

  12. AN IMMUNOCYTOCHEMICAL STUDY OF BONEMORPHOGENETIC PROTEIN IN EXPERIMENTAL FRACTURE HEALING OF THE RABBIT MANDIBLE

    Institute of Scientific and Technical Information of China (English)

    金岩; 杨连甲; FrankH.White

    1994-01-01

    A monoclonal antibody raised against bone morphogenetic protein (BMP-McAb)has been used to demonstrate the presence of bone mrphogenetic protein(BMP) in experimental fracture healing.Rabbit mandibles were frac-tured using standrdized methods and left to heal for 3,7,14,21and 24 d,respectively.The avidin-biotin com- plex(ABC)method demonstrated an accumulation of positively stained primitive mesenchyman cells at the fracture site in the hematoma stage of bone repair.These cells appeared to undergo differentiation into positively-stained chondroblasts and osteoblasts during the phase of callus formation.Undifferentiated mesenchymal cells showed a high positive reactivity in the early post-fracture stages but a much lower reactivity during the remodelling phase.The results of our study suggest that bone inductive processes are accompanied by the presence of BMP in osteopro-genitor cells during fracture healing of the mandible and that BMP may plqy a significant role in osteogenesis dur-ing bone healing.

  13. Does Anticoagulant Medication Alter Fracture-Healing? A Morphological and Biomechanical Evaluation of the Possible Effects of Rivaroxaban and Enoxaparin Using a Rat Closed Fracture Model.

    Directory of Open Access Journals (Sweden)

    Peter Michael Prodinger

    Full Text Available Low molecular weight heparin (LMWH is routinely used to prevent thromboembolism in orthopaedic surgery, especially in the treatment of fractures or after joint-replacement. Impairment of fracture-healing due to increased bone-desorption, delayed remodelling and lower calcification caused by direct osteoclast stimulation is a well-known side effect of unfractioned heparin. However, the effect of LMWH is unclear and controversial. Recent studies strongly suggest impairment of bone-healing in-vitro and in animal models, characterized by a significant decrease in volume and quality of new-formed callus. Since October 2008, Rivaroxaban (Xarelto is available for prophylactic use in elective knee- and hip-arthroplasty. Recently, some evidence has been found indicating an in vitro dose independent reduction of osteoblast function after Rivaroxaban treatment. In this study, the possible influence of Rivaroxaban and Enoxaparin on bone-healing in vivo was studied using a standardized, closed rodent fracture-model. 70 male Wistar-rats were randomized to Rivaroxaban, Enoxaparin or control groups. After pinning the right femur, a closed, transverse fracture was produced. 21 days later, the animals were sacrificed and both femora harvested. Analysis was done by biomechanical testing (three-point bending and micro CT. Both investigated substances showed histomorphometric alterations of the newly formed callus assessed by micro CT analysis. In detail the bone (callus volume was enhanced (sign. for Rivaroxaban and the density reduced. The bone mineral content was enhanced accordingly (sign. for Rivaroxaban. Trabecular thickness was reduced (sign. for Rivaroxaban. Furthermore, both drugs showed significant enlarged bone (callus surface and degree of anisotropy. In contrast, the biomechanical properties of the treated bones were equal to controls. To summarize, the morphological alterations of the fracture-callus did not result in functionally relevant deficits.

  14. Does Anticoagulant Medication Alter Fracture-Healing? A Morphological and Biomechanical Evaluation of the Possible Effects of Rivaroxaban and Enoxaparin Using a Rat Closed Fracture Model

    Science.gov (United States)

    Prodinger, Peter Michael; Burgkart, Rainer; Kreutzer, Kilian; Liska, Franz; Pilge, Hakan; Schmitt, Andreas; Knödler, Martina; Holzapfel, Boris Michael; Hapfelmeier, Alexander; Tischer, Thomas; Bissinger, Oliver

    2016-01-01

    Low molecular weight heparin (LMWH) is routinely used to prevent thromboembolism in orthopaedic surgery, especially in the treatment of fractures or after joint-replacement. Impairment of fracture-healing due to increased bone-desorption, delayed remodelling and lower calcification caused by direct osteoclast stimulation is a well-known side effect of unfractioned heparin. However, the effect of LMWH is unclear and controversial. Recent studies strongly suggest impairment of bone-healing in-vitro and in animal models, characterized by a significant decrease in volume and quality of new-formed callus. Since October 2008, Rivaroxaban (Xarelto) is available for prophylactic use in elective knee- and hip-arthroplasty. Recently, some evidence has been found indicating an in vitro dose independent reduction of osteoblast function after Rivaroxaban treatment. In this study, the possible influence of Rivaroxaban and Enoxaparin on bone-healing in vivo was studied using a standardized, closed rodent fracture-model. 70 male Wistar-rats were randomized to Rivaroxaban, Enoxaparin or control groups. After pinning the right femur, a closed, transverse fracture was produced. 21 days later, the animals were sacrificed and both femora harvested. Analysis was done by biomechanical testing (three-point bending) and micro CT. Both investigated substances showed histomorphometric alterations of the newly formed callus assessed by micro CT analysis. In detail the bone (callus) volume was enhanced (sign. for Rivaroxaban) and the density reduced. The bone mineral content was enhanced accordingly (sign. for Rivaroxaban). Trabecular thickness was reduced (sign. for Rivaroxaban). Furthermore, both drugs showed significant enlarged bone (callus) surface and degree of anisotropy. In contrast, the biomechanical properties of the treated bones were equal to controls. To summarize, the morphological alterations of the fracture-callus did not result in functionally relevant deficits. PMID:27455072

  15. Is Sonic Hedgehog Involved in Human Fracture Healing? - A Prospective Study on Local and Systemic Concentrations of SHH

    Science.gov (United States)

    Eipeldauer, Stefan; Thomas, Anita; Hoechtl-Lee, Leonard; Kecht, Mathias; Binder, Harald; Koettstorfer, Julia; Gregori, Markus; Sarahrudi, Kambiz

    2014-01-01

    Introduction Sonic Hedgehog (SHH) is a new signalling pathway in bone repair. Evidence exist that SHH pathway plays a significant role in vasculogenesis and limb development during embryogenesis. Some in vitro and animal studies has already proven its potential for bone regeneration. However, no data on the role of SHH in the human fracture healing have been published so far. Methods Seventy-five patients with long bone fractures were included into the study and divided in 2 groups. First group contained 69 patients with normal fracture healing. Four patients with impaired fracture healing formed the second group. 34 volunteers donated blood samples as control. Serum samples were collected over a period of 1 year following a standardized time schedule. In addition, SHH levels were measured in fracture haematoma and serum of 16 patients with bone fractures. Results Fracture haematoma and patients serum both contained lower SHH concentrations compared to control serum. The comparison between the patients' serum SHH level and the control serum revealed lower levels for the patients at all measurement time points. Significantly lower concentrations were observed at weeks 1 and 2 after fracture. SHH levels were slightly decreased in patients with impaired fracture healing without statistical significance. Conclusion This is the first study to report local and systemic concentration of SHH in human fracture healing and SHH serum levels in healthy adults. A significant reduction of the SHH levels during the inflammatory phase of fracture healing was found. SHH concentrations in fracture haematoma and serum were lower than the concentration in control serum for the rest of the healing period. Our findings indicate that there is no relevant involvement of SHH in human fracture healing. Fracture repair process seem to reduce the SHH level in human. Further studies are definitely needed to clarify the underlying mechanisms. PMID:25501422

  16. Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study.

    Science.gov (United States)

    Estai, Mohamed Abdalla; Suhaimi, Farihah Haji; Das, Srijit; Fadzilah, Fazalina Mohd; Alhabshi, Sharifah Majedah Idrus; Shuid, Ahmad Nazrun; Soelaiman, Ima-Nirwana

    2011-01-01

    Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties. To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state. A total of 24 female Sprague-Dawley rats (200-250 g) were randomly divided into 4 groups: (i) the sham-operated group; (ii) the ovariectomized-control group; (iii) the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy) group, which was supplemented with estrogen (100 μg/kg/day); and (iv) the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum) group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg). Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment. The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2 ± 11.74 mm³) than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4 ± 4.05, 22.4 ± 4.14 and 17.5 ± 3.68 mm³, respectively). The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value) as 1.0 (0 - 2), 1.0 (1 - 2) and 1.0 (1 - 2), respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3). The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4), 3.0 (2 - 3) and 3.0 (2 - 3), respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2) (pPiper sarmentosum extract improved fracture healing, as assessed by the reduced callus volumes and

  17. An Assessment of Self-Healing Fiber Reinforced Composites

    Science.gov (United States)

    Smith, Joseph G., Jr.

    2012-01-01

    Several reviews and books have been written concerning self-healing polymers over the last few years. These have focused primarily on the types of self-healing materials being studied, with minor emphasis given to composite properties. The purpose of this review is to assess the self-healing ability of these materials when utilized in fiber reinforced composites

  18. Naringin promotes fracture healing through stimulation of angiogenesis by regulating the VEGF/VEGFR-2 signaling pathway in osteoporotic rats.

    Science.gov (United States)

    Song, Nan; Zhao, Zhihu; Ma, Xinlong; Sun, Xiaolei; Ma, Jianxiong; Li, Fengbo; Sun, Lei; Lv, Jianwei

    2017-01-05

    Postmenopausal osteoporosis is characterized by a reduction in the number of sinusoidal and arterial capillaries in the bone marrow and reduced bone perfusion. Thus, osteogenesis and angiogenesis are coupled in the process of osteoporosis formation and fracture healing. Naringin is the main ingredient of the root Rhizoma Drynariae, a traditional Chinese medicine, and it has potential effects on promoting fracture healing. However, whether naringin stimulates angiogenesis in the process of bone healing is unclear. Here, we show that naringin promotes fracture healing through stimulating angiogenesis by regulating the VEGF/VEGFR-2 signaling pathway in osteoporotic rats.

  19. The Difference between Growth Factor Expression after Single and Multiple Fractures: Preliminary Results in Human Fracture Healing

    Science.gov (United States)

    Binder, Harald; Eipeldauer, Stefan; Gregori, Markus; Höchtl-Lee, Leonard; Thomas, Anita; Tiefenboeck, Thomas M.; Hajdu, Stefan; Sarahrudi, Kambiz

    2015-01-01

    Objectives. Circulating levels of VEGF-A (Vascular Endothelia Growth Factor-A), TGF-β1 (Transforming Growth Factor-beta 1), and M-CSF (Macrophage-Colony Stimulating Factor) were found to be predictors of bone healing and therefore prognostic criteria of delayed bone healing or nonunion. The aim of this study was to evaluate a potential rise of these markers in patients with multiple fractures of long bones compared to patients with single fractured long bone. Methods. 92 patients were included in the study and finally after excluding all female patients 45 male patients were left for final analysis and divided into the single or multiple fracture group. TGF-β1, M-CSF, and VEGF-A serum levels were analysed over a time period of two weeks. Results. MCSF serum concentrations were higher in the group with multiple fractures as also TGF-β1 serum concentrations were at one and two weeks after trauma. No statistically significant difference was observed in the VEGF-A serum concentrations of both groups at either measurement point. Conclusion. We did observe a correlation between the quantity of the M-CSF and TGF-β1 expressions in serum and the number of fractured bones; surprisingly there was no statistically significant difference in the serum levels between patients with single and multiple fractures of long bones. PMID:26246654

  20. Influence of mechanical rock properties and fracture healing rate on crustal fluid flow dynamics

    Science.gov (United States)

    Sachau, Till; Bons, Paul; Gomez-Rivas, Enrique; Koehn, Daniel; de Riese, Tamara

    2016-04-01

    Fluid flow in the Earth's crust is very slow over extended periods of time, during which it occurs within the connected pore space of rocks. If the fluid production rate exceeds a certain threshold, matrix permeability alone is insufficient to drain the fluid volume and fluid pressure builds up, thereby reducing the effective stress supported by the rock matrix. Hydraulic fractures form once the effective pressure exceeds the tensile strength of the rock matrix and act subsequently as highly effective fluid conduits. Once local fluid pressure is sufficiently low again, flow ceases and fractures begin to heal. Since fluid flow is controlled by the alternation of fracture permeability and matrix permeability, the flow rate in the system is strongly discontinuous and occurs in intermittent pulses. Resulting hydraulic fracture networks are largely self-organized: opening and subsequent healing of hydraulic fractures depends on the local fluid pressure and on the time-span between fluid pulses. We simulate this process with a computer model and describe the resulting dynamics statistically. Special interest is given to a) the spatially and temporally discontinuous formation and closure of fractures and fracture networks and b) the total flow rate over time. The computer model consists of a crustal-scale dual-porosity setup. Control parameters are the pressure- and time-dependent fracture healing rate, and the strength and the permeability of the intact rock. Statistical analysis involves determination of the multifractal properties and of the power spectral density of the temporal development of the total drainage rate and hydraulic fractures. References Bons, P. D. (2001). The formation of large quartz veins by rapid ascent of fluids in mobile hydrofractures. Tectonophysics, 336, 1-17. Miller, S. a., & Nur, A. (2000). Permeability as a toggle switch in fluid-controlled crustal processes. Earth and Planetary Science Letters, 183(1-2), 133-146. Sachau, T., Bons, P. D

  1. Exogenous PTHrP Repairs the Damaged Fracture Healing of PTHrP+/− Mice and Accelerates Fracture Healing of Wild Mice

    Directory of Open Access Journals (Sweden)

    Yinhe Wang

    2017-02-01

    Full Text Available Bone fracture healing is a complicated physiological regenerative process initiated in response to injury and is similar to bone development. To demonstrate whether an exogenous supply of parathyroid hormone–related protein (PTHrP helps in bone fracture healing, closed mid-diaphyseal femur fractures were created and stabilized with intramedullary pins in eight-week-old wild-type (WT PTHrP+/+ and PTHrP+/− mice. After administering PTHrP for two weeks, callus tissue properties were analyzed at one, two, and four weeks post-fracture (PF by various methods. Bone formation–related genes and protein expression levels were evaluated by real-time reverse transcriptase–polymerase chain reaction and Western blots. At two weeks PF, mineral density of callus, bony callus areas, mRNA levels of alkaline phosphatase (ALP, type I collagen, Runt-related transcription factor 2 (Runx-2, and protein levels of Runx-2 and insulin-like growth factor-1 decreased in PTHrP+/− mice compared with WT mice. At four weeks PF, total collagen-positive bony callus areas, osteoblast number, ALP-positive areas, and type I collagen-positive areas all decreased in PTHrP+/− mice. At both two and four weeks PF, tartrate-resistant acid phosphatase–positive osteoclast number and surface decreased a little in PTHrP+/− mice. The study indicates that exogenous PTHrP provided by subcutaneous injection could redress impaired bone fracture healing, leading to mutation of activated PTHrP by influencing callus areas, endochondral bone formation, osteoblastic bone formation, and bone turnover.

  2. Influence of fracture gap size on the pattern of long bone healing: a computational study.

    Science.gov (United States)

    Gómez-Benito, M J; García-Aznar, J M; Kuiper, J H; Doblaré, M

    2005-07-07

    Following fractures, bones restore their original structural integrity through a complex process in which several cellular events are involved. Among other factors, this process is highly influenced by the mechanical environment of the fracture site. In this study, we present a mathematical model to simulate the effect of mechanical stimuli on most of the cellular processes that occur during fracture healing, namely proliferation, migration and differentiation. On the basis of these three processes, the model then simulates the evolution of geometry, distributions of cell types and elastic properties inside a healing fracture. The three processes were implemented in a Finite Element code as a combination of three coupled analysis stages: a biphasic, a diffusion and a thermoelastic step. We tested the mechano-biological regulatory model thus created by simulating the healing patterns of fractures with different gap sizes and different mechanical stimuli. The callus geometry, tissue differentiation patterns and fracture stiffness predicted by the model were similar to experimental observations for every analysed situation.

  3. CaMKK2 Inhibition in Enhancing Bone Fracture Healing

    Science.gov (United States)

    2014-08-01

    study to establish the following: (1) Reliable and reproducible surgical procedures for creating a transverse femoral fracture and fixing it with an...Reliable and reproducible surgical procedures for creating a transverse femoral fracture and fixing it with an intramedullary device. 2) The treatment...disinfected with alternating scrubs of betadine and alcohol. Sterile instruments were used to make a small incision (approximately 2 mm). A 25 gauge

  4. Laboratory study of fracture healing in Topopah Spring tuff: Implications for near field hydrology

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Wunan; Daily, W.D.

    1989-09-01

    Seven Topopah Spring tuff samples were studied to determine water permeability in this rock under pressure and temperature conditions similar to those expected in the near field of a nuclear waste package. Six of the seven samples were studied under isothermal condition; the other was subjected to a thermal gradient. Four of the six fractured samples contained a reopened, healed, natural fracture; one contained an induced tensile fracture and the other contained a saw-cut. The fracture surfaces were examined using scanning electron microscope (SEM) before and after the experiments and the water that flowed through the samples was sampled for chemical analysis. The experimental durations ranged from about 3 months to almost 6 months. Water permeability of the fractured samples was found to decrease by more than three orders of magnitude when the sample temperature increased to 150{degree}C. The sharpest decrease in permeability occurred when the temperature was increased above 90{degree}C. Permeability of the intact sample did not change significantly under the similar experimental conditions. When the temperature returned to room conditions, the water permeability did not recover. The mechanical strength of one healed sample was about half that of the intact rock. SEM studies of the fracture surfaces and water chemical analysis of the water suggested that both dissolution and deposition occurred on the fracture surfaces. Smoothing of fracture asperities because of dissolution and deposition was probably the main cause of the permeability decrease. Deposition of dissolved silica was probably the main cause of fracture healing. 12 refs., 6 figs., 1 tab.

  5. Treatment with Carnitine Enhances Bone Fracture Healing under Osteoporotic and/or Inflammatory Conditions.

    Science.gov (United States)

    Aydin, Ali; Halici, Zekai; Albayrak, Abdulmecit; Polat, Beyzagul; Karakus, Emre; Yildirim, Omer Selim; Bayir, Yasin; Cadirci, Elif; Ayan, Arif Kursad; Aksakal, Ahmet Murat

    2015-09-01

    The aim of this study was to examine the effects of carnitine on bone healing in ovariectomy (OVX) and inflammation (INF)-induced osteoporotic rats. The rats were randomly divided into nine groups (n = 8 animals per group): sham-operated (Group 1: SHAM); sham + magnesium silicate (Mg-silicate) (Group 2: SHAM + INF); ovariectomy (Group 3: OVX); ovariectomy + femoral fracture (Group 4: OVX + FRC); ovariectomy + femoral fracture + Mg-silicate (Group 5: OVX + FRC + INF); ovariectomy + femoral fracture + carnitine 50 mg/kg (Group 6: OVX + FRC + CAR50); ovariectomy + femoral fracture + carnitine 100 mg/kg (Group 7: OVX + FRC + CAR100); ovariectomy + femoral fracture + Mg-silicate + carnitine 50 mg/kg (Group 8: OVX + FRC + INF + CAR50); and ovariectomy + femoral fracture + Mg-silicate + carnitine 100 mg/kg (Group 9: OVX + FRC + INF + CAR100). Eight weeks after OVX, which allowed for osteoporosis to develop, INF was induced with subcutaneous Mg-silicate. On day 80, all of the rats in groups 4-9 underwent fracture operation on the right femur. Bone mineral density (BMD) showed statistically significant improvements in the treatment groups. The serum markers of bone turnover (osteocalcin and osteopontin) and pro-inflammatory cytokines (tumour necrosis factor α, interleukin 1β and interleukin 6) were decreased in the treatment group. The X-ray images showed significantly increased callus formation and fracture healing in the groups treated with carnitine. The present results show that in a rat model with osteoporosis induced by ovariectomy and Mg-silicate, treatment with carnitine improves the healing of femur fractures.

  6. Analysis of fracture healing in osteopenic bone caused by disuse: experimental study.

    Science.gov (United States)

    Paiva, A G; Yanagihara, G R; Macedo, A P; Ramos, J; Issa, J P M; Shimano, A C

    2016-03-01

    Osteoporosis has become a serious global public health issue. Hence, osteoporotic fracture healing has been investigated in several previous studies because there is still controversy over the effect osteoporosis has on the healing process. The current study aimed to analyze two different periods of bone healing in normal and osteopenic rats. Sixty, 7-week-old female Wistar rats were randomly divided into four groups: unrestricted and immobilized for 2 weeks after osteotomy (OU2), suspended and immobilized for 2 weeks after osteotomy (OS2), unrestricted and immobilized for 6 weeks after osteotomy (OU6), and suspended and immobilized for 6 weeks after osteotomy (OS6). Osteotomy was performed in the middle third of the right tibia 21 days after tail suspension, when the osteopenic condition was already set. The fractured limb was then immobilized by orthosis. Tibias were collected 2 and 6 weeks after osteotomy, and were analyzed by bone densitometry, mechanical testing, and histomorphometry. Bone mineral density values from bony calluses were significantly lower in the 2-week post-osteotomy groups compared with the 6-week post-osteotomy groups (multivariate general linear model analysis, Pbones 6 weeks after osteotomy compared with 2 weeks after osteotomy (multivariate general linear model analysis, Pbone healing. Results showed that osteopenia did not influence the bone healing process, and that time was an independent determinant factor regardless of whether the fracture was osteopenic. This suggests that the body is able to compensate for the negative effects of suspension.

  7. Erythropoietin (EPO): EPO-receptor signaling improves early endochondral ossification and mechanical strength in fracture healing.

    Science.gov (United States)

    Holstein, Joerg H; Menger, Michael D; Scheuer, Claudia; Meier, Christoph; Culemann, Ulf; Wirbel, Rainer J; Garcia, Patric; Pohlemann, Tim

    2007-02-13

    Beyond its role in the regulation of red blood cell proliferation, the glycoprotein erythropoietin (EPO) has been shown to promote cell regeneration and angiogenesis in a variety of different tissues. In addition, EPO has been indicated to share significant functional and structural homologies with the vascular endothelial growth factor (VEGF), a cytokine essential in the process of fracture healing. However, there is complete lack of information on the action of EPO in bone repair and fracture healing. Therefore, we investigated the effect of EPO treatment on bone healing in a murine closed femur fracture model using radiological, histomorphometric, immunohistochemical, biomechanical and protein biochemical analysis. Thirty-six SKH1-hr mice were treated with daily i.p. injections of 5000 U/kg EPO from day 1 before fracture until day 4 after fracture. Controls received equivalent amounts of the vehicle. After 2 weeks of fracture healing, we could demonstrate expression of the EPO-receptor (EPOR) in terminally differentiating chondrocytes within the callus. At this time point EPO-treated animals showed a higher torsional stiffness (biomechanical analysis: 39.6+/-19.4% of the contralateral unfractured femur) and an increased callus density (X-ray analysis (callus density/spongiosa density): 110.5+/-7.1%) when compared to vehicle-treated controls (14.3+/-8.2% and 105.9+/-6.6%; pEPO treatment had vanished at 5 weeks after fracture. We conclude that EPO-EPOR signaling is involved in the process of early endochondral ossification, enhancing the transition of soft callus to hard callus.

  8. Effect of extracorporeal shock wave therapy on fracture healing in rat femural fractures with intact and excised periosteum.

    Science.gov (United States)

    Oktaş, Birhan; Orhan, Zafer; Erbil, Barış; Değirmenci, Erdem; Ustündağ, Nil

    2014-01-01

    The aim of this study is to compare the effect of extracorporeal shock wave therapy (ESWT) on fractures with intact periosteum and excised periosteum. Thirty-seven Wistar albino rats were randomized into four groups. Osteotomy and intramedullary Kirschner wire fixation were performed on all right femurs under ketamin anesthesia. The first group (n=10) was identified as control group. In the second group (n=10), periosteum located at the osteotomy site was excised circumferentially during surgery. In the third group (n=9), periosteum was left intact and ESWT was applied. In the forth group (n=8), periosteums of all rats were excised and ESWT was applied. All fracture lines were evaluated radiographically each two weeks and histologically at the sixth week. Results were evaluated statistically. In periosteum excised group which represents a model of open fractures with soft tissue defect, ESWT application had a significantly positive histologic effect on bone healing. However, radiological evaluation did not reveal any statistically significant difference between groups with intact and excised periosteums. According to our findings, ESWT can be used to improve fracture healing and prevent pseudoarthrosis in the treatment of open fractures with accompanying soft tissue and periosteum damage. However, further clinical studies are required to include ESWT in routine practice.

  9. Stimulation of bone formation and fracture healing with pulsed electromagnetic fields: biologic responses and clinical implications.

    Science.gov (United States)

    Chalidis, B; Sachinis, N; Assiotis, A; Maccauro, G

    2011-01-01

    Pulsed electromagnetic fields (PEMF) have been used for several years to supplement bone healing. However, the mode of action of this non-invasive method is still debated and quantification of its effect on fracture healing is widely varied. At cellular and molecular level, PEMF has been advocated to promote the synthesis of extracellular matrix proteins and exert a direct effect on the production of proteins that regulate gene transcription. Electromagnetic fields may also affect several membrane receptors and stimulate osteoblasts to secrete several growth factors such as bone morphogenic proteins 2 and 4 and TGF-beta. They could also accelerate intramedullary angiogenesis and improve the load to failure and stiffness of the bone. Although healing rates have been reported in up to 87 % of delayed unions and non-unions, the efficacy of the method is significantly varied while patient or fracture related variables could not be clearly associated with a successful outcome.

  10. Expression and Role of Sonic Hedgehog in the Process of Fracture Healing with Aging.

    Science.gov (United States)

    Matsumoto, Kenichi; Shimo, Tsuyoshi; Kurio, Naito; Okui, Tatsuo; Obata, Kyoichi; Masui, Masanori; Pang, Pai; Horikiri, Yuu; Sasaki, Akira

    2016-01-01

    Aging is one of the risk factors for delayed fracture healing. Sonic hedgehog (SHH) protein, an inducer of embryonic development, has been demonstrated to be activated in osteoblasts at the dynamic remodeling site of a bone fracture. Herein, we compared and examined the distribution patterns of SHH and the functional effect of SHH signaling on osteogenesis and osteoclastogenesis between young (5-week-old) and aged (60-week-old) mice during fracture healing. We found that SHH was expressed in bone marrow cells from the fractured site of the rib of young mice on day 5, but was barely detectable in the corresponding cells from the rib of aged mice. SHH was also detected in osteoblasts and bone marrow cells at the callus remodeling stage on days 14 and 28 in both young and aged mice. The number of alkaline phosphatase (ALP)-positive osteoblasts was significantly higher in young mice on days 5 and 14, whereas the number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts was significantly higher in aged mice. SHH stimulated significantly more osteoblast formation in the young compared to old mice. SHH stimulated the osteoclast formation directly in the aged mice and suppressed the formation indirectly through osteoprotegerin expression in the young mice. Results indicate that an aged-related delay of fracture healing may contribute to the unbalanced bone formation and resorption, regulated by hedgehog signaling.

  11. Chondrocyte BMP2 signaling plays an essential role in bone fracture healing.

    Science.gov (United States)

    Mi, Meng; Jin, Hongting; Wang, Baoli; Yukata, Kiminori; Sheu, Tzong-Jen; Ke, Qiao Han; Tong, Peijian; Im, Hee-Jeong; Xiao, Guozhi; Chen, Di

    2013-01-10

    The specific role of endogenous Bmp2 gene in chondrocytes and in osteoblasts in fracture healing was investigated by generation and analysis of chondrocyte- and osteoblast-specific Bmp2 conditional knockout (cKO) mice. The unilateral open transverse tibial fractures were created in these Bmp2 cKO mice. Bone fracture callus samples were collected and analyzed by X-ray, micro-CT, histology analyses, biomechanical testing and gene expression assays. The results demonstrated that the lack of Bmp2 expression in chondrocytes leads to a prolonged cartilage callus formation and a delayed osteogenesis initiation and progression into mineralization phase with lower biomechanical properties. In contrast, when the Bmp2 gene was deleted in osteoblasts, the mice showed no significant difference in the fracture healing process compared to control mice. These findings suggest that endogenous BMP2 expression in chondrocytes may play an essential role in cartilage callus maturation at an early stage of fracture healing. Our studies may provide important information for clinical application of BMP2.

  12. Enhancement of fracture healing in the rat, modulated by compounds that stimulate inducible nitric oxide synthase

    Science.gov (United States)

    Rajfer, R. A.; Kilic, A.; Neviaser, A. S.; Schulte, L. M.; Hlaing, S. M.; Landeros, J.; Ferrini, M. G.; Ebramzadeh, E.

    2017-01-01

    Objectives We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days. Materials and Methods Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density of the callus were measured by quantitative CT on days 14 and 42. Expression of iNOS was measured by immunohistochemistry. Results When compared with the control group, the COMB-4 group exhibited 46% higher maximum strength (t-test, p = 0.029) and 92% higher stiffness (t-test, p = 0.023), but no significant changes were observed in the tadalafil group. At days 14 and 42, there was no significant difference between the three groups with respect to callus volume, mineral content and bone density. Expression of iNOS at day 14 was significantly higher in the COMB-4 group which, as expected, had returned to baseline levels at day 42. Conclusion This study demonstrates an enhancement in fracture healing by an oral natural product known to augment iNOS expression. Cite this article: R. A. Rajfer, A. Kilic, A. S. Neviaser, L. M. Schulte, S. M. Hlaing, J. Landeros, M. G. Ferrini, E. Ebramzadeh, S-H. Park. Enhancement of fracture healing in the rat, modulated by compounds that stimulate inducible nitric oxide synthase: Acceleration of fracture healing via inducible nitric oxide synthase. Bone Joint Res 2017:6:–97. DOI: 10.1302/2046-3758.62.BJR-2016-0164.R2. PMID:28188129

  13. Effect of recombinant human basic fibroblast growth factor on angiogenesis during mandible fracture healing in rabbits

    Institute of Scientific and Technical Information of China (English)

    龚振宇; 周树夏; 顾晓明; 李涤尘; 孙明林

    2003-01-01

    Objective: To investigate the effect of recombinant human basic fibroblast growth factor (rhbFGF) on angiogenesis during mandible fracture healing in rabbit. Methods: Fifty adult white rabbits were used for animal model and randomly divided into a control group (25 rabbits) and an experimental group (25 rabbits). The membranous complex of rhbFGF and bovine type I collagen was prepared and implanted into the rabbit mandible fracture site under periosteum. The animals were sacrificed on 7, 14, 28, 56 and 84 days respectively after operation and the whole mandibles were harvested. The expression of factor VIII related antigen (F8-RA) in callus was examined with immunohistochemical staining. Results: The amounts of microvascular formation in calluses in the rhbFGF-treating group on days 7, 14, 28 and 56 were more than those of the control group (P<0.01).Conclusions: The results indicated that rhbFGF could stimulate microvascular formation during mandible fracture healing in rabbits.

  14. Experimental fracture healing: evaluation using radionuclide bone imaging: concise communication. [/sup 99m/Tc-methylene diphosphonate; rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Gumerman, L.W.; Fogel, S.R.; Goodman, M.A.; Hanley, E.N. Jr.; Kappakas, G.S.; Rutkowski, R.; Levine, G.

    1978-12-01

    Radionuclide bone imaging was performed in a rabbit model to observe the course of fracture healing and to establish criteria for distinguishing nonunion and delayed healing from normal healing. Sequential gamma-camera images (with pinhole collimator) were collected and subjected to computer analysis. Five groups were established: (a) control--immobilization; (b) control--immobilization plus periosteal stripping; (c) simple fracture--osteotomy; (d) delayed union--osteotomy plus periosteal stripping; and (e) nonunion--osteotomy, periosteal stripping and polymethyl methacrylate interposed between fracture fragments. Histographic representation of absolute count rates along rabbit tibias followed a predictable pattern in the simple-fracture and delayed-union groups. They differed only in the time of appearance of phases. The non-union group demonstrated no recognizable sequential pattern. In this experimental model, serial bone scanning the quantitative data analysis has shown potential for indicating the course of healing in fractures and for serving as a guide to treatment.

  15. Improving Impact Strength Recovery of Fractured and Healed Rice Husks Fibre Reinforced Polypropylene Composites.

    Directory of Open Access Journals (Sweden)

    Odhong, O.V.E

    2016-10-01

    Full Text Available Rice husks fibre reinforced polypropylene composite (rhfrpc is a natural plant fibre reinforced polymer composite having advantages of high strength, light weight and affordability. They are commonly used for light load structural and non structural applications. They are mainly used as particle boards, for fencing post, roofing tiles, for interiors of car and aircrafts among other usages. This material once cracked by impact forces cannot be repaired using traditional repair methods for engineering materials such as metals or other composites that can be repaired by welding or by patch repair methods respectively, thus a method of repair of rice husks fibre reinforced polypropylene composites by refilling the damaged volume by injection of various healing agents has been investigated. The composite coupons were produced by injection moulding, cooled sufficiently and prepared for charpy impact tests. Test results for pristine coupons were a maximum of 48 J/mm2 . The destroyed coupons were then subjected to healing in a fabricated healing fixture. Healing agents such as epoxy resin, ethyl cyanoacrylate, and tannin gum have been investigated for their use as possible healing agents to fill the damaged volume and perform healing action at the fractured surfaces. The impact test results were recorded and compared with those of unhealed pristine coupons. The recovered strengths were a maximum of 60 J/mm2 translating into a 125% impact strength recovery, and this is good enough for the healed composites to be recommended for reuse in their second lives of their respective original functions.

  16. Tooth in the line of angle fractures: the impact in the healing process. A retrospective study of 112 patients.

    Science.gov (United States)

    Zanakis, Stylianos; Tasoulas, Jason; Angelidis, Ioannis; Dendrinos, Christos

    2015-01-01

    There is no consensus regarding the prophylactic removal of mandibular third molars (TM) in fracture lines to facilitate healing. Recent evidence suggests that poor healing is attributed to the limited use of antimicrobials, delayed care and semi-rigid fixation as a treatment method, favoring retention of TM. A retrospective cohort study of all patients presenting with mandibular angle fractures at the Hippokration General Hospital of Athens (2006-2011) was designed to examine the association between the presence versus absence of TMs in the line of mandibular fractures and the fracture healing process. Development of complications during the healing process was the outcome of interest. Additional factors considered were patient age, sex, and fracture etiology. Data were extracted from a retrospective chart review, including information from clinical and radiological examinations. The analytical sample included 112 patients with 121 angle fractures. Bivariate methods including Fisher's exact and chi-square tests were used to test the association between TM presence in the fracture line and healing complications. This study found no association between the presence of mandibular TM in the fracture line and postoperative complications and the healing process when combined with light intermaxillary fixation for 15 days. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Electromagnetic stimulation as coadjuvant in the healing of diaphyseal femoral fractures: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Alfredo Martinez Rondanelli

    2014-07-01

    Full Text Available Introduction: There is controversy in medical literature regarding the use of electromagnetic fields to promote bone healing.Methods: After designing and building devices capable of generating an electromagnetic field for this study, their safety was confirmed and the electromagnetic therapy was randomly allocated and compared to placebo in patients with fracture of the femoral diaphysis. Treatment began six weeks after the fracture and it was administered once a day, during 1 h, for eight consecutive weeks. Twenty devices were built, 10 of which were placebo-devices. Between June 2008 and October 2009, 64 patients were randomized in two different hospitals and were followed for 24 weeks. The mean age was 30 years (18-59 and 81% were males.Results: Healing observed at week 12 was 75% vs. 58% (p= 0.1; at week 18, it was 94% vs. 80% (p= 0.15; and at week 24, it was 94% vs. 87% (p= 0.43 for the device group and the placebo group, respectively.Discussion: This study suggests that an electromagnetic field stimulus can promote earlier bone healing compared to placebo in femoral diaphyseal fractures. Faster bone healing translates into sooner weight bearing, which – in turn – permits quicker return to normal daily activities.

  18. Determining the Role of Sost and Sostdc1 During Fracture Healing

    Energy Technology Data Exchange (ETDEWEB)

    Yee, Cristal Sook Ngei [Univ. of California, Merced, CA (United States)

    2016-01-01

    The bone is a dynamic organ, often changing throughout the course of the human lifespan with its continuous remodeling, laying down new bone and resorbing old bone. With age, the bone becomes increasingly porous and mechanically unstable, leading to the development of osteoporosis in some individuals. Elderly patients with osteoporosis are at an increased risk of fracturing their bones which contributes to a higher mortality rate. Recent studies have revealed that type 1 diabetic mellitus (T1DM) patients also have an osteoporotic bone phenotype and impaired fracture healing, independent of age. Currently, there is a lack of available treatments that can improve impaired healing and directly enhance bone formation. Therefore, there is a great need for developing new therapies that can not only aid type 1 diabetic patients with osteoporosis to improve bone phenotype, but that could also aid patients with difficult or impaired fracture healing. In this thesis, I will be discussing the role of Wnt signaling and Sclerostin, a Wnt antagonist that negatively regulates bone formation, in the content of fracture repair.

  19. Vitamin D in Foot and Ankle Fracture Healing: A Literature Review and Research Design.

    Science.gov (United States)

    Bernhard, Andrew; Matuk, Jorge

    2015-10-01

    Vitamin D is a generic name for a group of essential vitamins, or secosteroids, important in calcium homeostasis and bone metabolism. Specifically, efficacy of vitamin D with regard to bone healing is in question. A literature review was performed, finding mostly large studies involving vitamin D effects on prevention of fractures and randomized animal model studies consisting of controlled fractures with vitamin D interventions. The prevention articles generally focus on at-risk populations, including menopausal women and osteoporotic patients, and also most often include calcium in the treatment group. Few studies look at vitamin D specifically. The animal model studies often focus more on vitamin D supplementation; however the results are still largely inconclusive. While recent case reports appear promising, the ambiguity of results on the topic of fracture healing suggests a need for more, higher level research. A novel study design is proposed to help determine the efficacy on vitamin D in fracture healing. Therapeutic, Level IV: Systematic Review. © 2015 The Author(s).

  20. Cementless Titanium Mesh Fixation of Osteoporotic Burst Fractures of the Lumbar Spine Leads to Bony Healing: Results of an Experimental Sheep Model

    Directory of Open Access Journals (Sweden)

    Anica Eschler

    2016-01-01

    Full Text Available Introduction. Current treatment strategies for osteoporotic vertebral compression fractures (VCFs focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1 evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs and (2 demonstrate the healing capabilities in osteoporotic VCFs. Methods. Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1 were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1 or no augmentation was performed (G2, n=6 each. Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation. Results. Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%. Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing. Conclusions. Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications.

  1. Assessment and nutritional aspects of wound healing.

    Science.gov (United States)

    Campos, Antonio C L; Groth, Anne K; Branco, Alessandra B

    2008-05-01

    The aim of this study is to review the physiopathology and the nutritional aspects of wound healing. Wound healing consists of a perfect and coordinated cascade of events that result in tissue reconstitution. The healing process is common to all wounds, independent of the agent that has caused it. It is divided didactically into three phases: inflammation, proliferation, and remodeling or maturation. Collagen is the most abundant protein in the human body and is also the main component of the wound matrix. It is organized in a thick and dynamic net, resulting from constant collagen deposition and reabsorption. Wound scar is the result of the interaction between collagen synthesis, degradation, and remodeling. There are several ways to evaluate wound healing: tensiometry, collagen morphometry, immunohistochemistry, and, more recently, the dosage of growth factors. Malnutrition adversely affects wound healing. On the contrary, the healing process can be stimulated by preoperative feeding and by certain nutrients such as glutamine, arginine, butyrate, and antioxidants. Wound healing is a complex process that started to be fully understood only in recent years. Recent research has been directed to act in the nutrition modulation of the healing process.

  2. Stimulatory effect of zinc acexamate administration on fracture healing of the femoral-diaphyseal tissues in rats.

    Science.gov (United States)

    Igarashi, A; Yamaguchi, M

    1999-04-01

    The effect of zinc acexamate on fracture healing of the femoral-diaphyseal tissues in rats was investigated in vivo. Zinc acexamate (0.3 and 10.0 mg Zn/100 g body weight per day) was orally administered to rats (4 weeks old) surgically fractured the femoral diaphysis for 14 to 28 days. Calcium content and alkaline phosphatase activity in the femoral-diaphyseal tissues were significantly decreased in rats with fracture healing, while bone acid phosphatase activity and protein content were markedly increased. The administration of zinc acexamate (10.0 mg Zn/100 g) for 28 days caused a significant increase in calcium content, alkaline and acid phosphatases activities, protein and deoxyribonucleic acid (DNA) contents in the femoral-diaphyseal tissues of rats with fracture healing. With the lower dose (3.0 mg Zn/100 g), zinc compound had a partial effect on bone components. Femoral mineral density in rats with fracture healing was significantly increased by the administration of zinc acexamate (10.0 mg Zn/100 g) for 28 days. Femoral-diaphyseal zinc content was significantly decreased in rats with fracture healing. This decrease was completely restored by the administration of zinc acexamate (10.0 mg Zn/100 g) for 28 days. The present study suggests that the supplement of zinc compound stimulates fracture healing of the femoral-diaphyseal tissues in rats.

  3. Experimental study on healing process of rat mandibular bone fracture examined by radiological procedures

    Energy Technology Data Exchange (ETDEWEB)

    Iuchi, Yukio; Furumoto, Keiichi (Nippon Dental Univ., Tokyo (Japan))

    1994-06-01

    The healing process of rat mandibular fractures was stereoscopically observed daily, using plain roentgenography in the lateral-oblique and tooth axis directions and bone scintigraphy using 99m-Tc-methylene diphosphoric acid (Tc-99m-MDP). The findings were compared with microradiograms of regional polished specimens. X-ray findings included the following. Up to 3 days after bone fracture, the fracture mesiodistally showed distinct radiolucency, with sharp and irregular fracture stump. Radiopacity of the fracture site gradually increased 7 days or later, and bone trabecular formation by callus and stump bridging started to occur at 14 days. Findings similar to those in the control group were observed 49 days or later. The inside was difficult to differentiate, irrespective of the observation time. Bone scans in the mesiodistal and buccolingual planes revealed tracer uptake in the areas of mandibular and soft tissue damage one day after bone fracture. Tracer uptake began to be seen in the fracture site 3 days later, and became marked at 14 days. Then Tc-99m DMP began to be localized and returned to the findings similar to those at 49 days. Bone scanning tended to show wider areas earlier than roentgenography. Microradiographic mesiodistal examination revealed distinct radiopacy of the fracture line for 3 days after bone fracture. Seven days later, bone resorption cavity occurred in the cortical bone around the fracture stump, along with neogenesis of callus. Neogenesis and calcification began to occur gradually, and 14 days later, the fracture osteoremodeling of the internal bone trabeculae was observed. Bone trabecular formation within the bone, however, occurred later. (N.K.).

  4. Experimental Timescales of Fracture-Healing Rheological Behavior of Thermoreversible Gels

    Science.gov (United States)

    Thornell, Travis L.; Subramaniam, Krithika; Erk, Kendra A.

    Acrylic thermoreversible physical gels were used as a model soft material system to investigate fracture-healing behavior by shear rheometry. By using shear start-up experiments, gels at various concentrations and temperatures were measured to determine shear stress responses, and fracture was indicated by a decrease in shear stress (confirmed with rheophysical flow visualization experiments). Fractured gels were allowed to recover in the rheometer for set periods of time and were tested again using the same shear start-up procedure to evaluate the recovery kinetics of network strength. Relationships between the network recovery and the normalized ratio of the resting times and characteristic relaxation times of the gels were determined. It was found that resting times for fully healed networks needed to be 2 or 3 orders of magnitude greater than the relaxation times. The extent of fracture was also investigated. Gels that were deformed to smaller total strain magnitudes were suspected to have incomplete (or partial) fracture as results showed various responses for given resting times.

  5. Collagenases and gelatinases in bone healing. The focus on mandibular fractures

    Directory of Open Access Journals (Sweden)

    Kurzepa Jacek

    2014-06-01

    Full Text Available Due to high amount of collagen fibres in the structure of bone, the enzymes capable of collagen digestion play a key role in bone remodelling. Matrix metalloproteinases (MMPs, prevailing extracellular endopeptideses, can digest extracellularly located proteins, e.g. collagen, proteoglycans, elastin or fibronectin. Among MMPs, collagenases (MMP-1, MMP-8 and MMP-13 and gelatinases (MMP-2 and MMP-9 can cleave collagen particles to forms that are able to undergo further steps of catabolism intracellularly. In addition, activity of the gelatinases (as an activation of proinflammatory cytokines facilitates spreading inflammation that is necessary during the first stage of bone healing. Further studies related to the role of various MMPs in mandibular fractures should precisely explain their function in the bone healing and evaluate the influence of MMPs inhibitors on that process. This review provides the basic information about two groups among MMPs family, collagenases and gelatinases, and their role in repairing processes after mandibular fractures.

  6. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing.

    Science.gov (United States)

    Miller, Danielle L; Goswami, Tarun

    2007-12-01

    Metallic implants are often involved in the open reduction and internal fixation of fractures. Open reduction and internal fixation is commonly used in cases of trauma when the bone cannot be healed using external methods such as casting. The locking compression plate combines the conventional screw hole, which uses non-locking screws, with a locking screw hole, which uses locking head screws. This allows for more versatility in the application of the plate. There are many factors which affect the functionality of the plate (e.g., screw placement, screw choice, length of plate, distance from bone, etc.). This paper presents a review of the literature related to the biomechanics of locking compression plates and their use as internal fixators in fracture healing. Furthermore, this paper also addresses the materials used for locking compression plates and their mechanical behavior, parameters that control the overall success, as well as inherent bone quality results.

  7. Fracture assessment of magnetostrictive materials

    Directory of Open Access Journals (Sweden)

    M. Peron

    2017-10-01

    Full Text Available Giant magnetostrictive materials are gaining interest in the field of smart material, especially the commercially known Terfenol-D, that is an alloy made out of iron, terbium and dysprosium (Tb0.3Dy0.7Fe1.9. Since these smart materials are subjected to both mechanical loads and magnetic field during their industrial applications, an extensive characterization on the influence of a magnetic field and of defects on their fracture behavior is needed. Very few works can be found in literature about this topic and, thus, the purpose of this work is to partially fill this lack by means of three-point bending tests on single-edge pre-cracked Terfenol-D specimens. Failure loads have been measured at different loading rates and under magnetic fields of various intensities. Since giant magnetostrictive materials are very brittle, the strain energy density (SED approach has been exploited by means of couplefield finite element analyses. SED has revealed itself as a robust parameters in the assessment of the magnetic field and loading rate effects on fracture resistance, allowing also to propose a relationship between the radius of the control volume and the loading-rate

  8. To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2017-02-01

    Conclusion: PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing. However, PRP and matrix scaffold provided by fibrin membrane may provide an artificial hematoma effect in the initial phase of healing in open or failed closed intramedullary nailing.

  9. Effect of autocontrol micromotion intramedullary interlocking nail on fracture healing: an experimental study

    Institute of Scientific and Technical Information of China (English)

    XU Wei-zhou; GUO Xiao-dong; ZHAO Ju-cai; WANG Yi-jin

    2006-01-01

    Objective: To investigate the effect of autocontrol micromotion locking nail (AMLN) on experimental fracture healing and its mechanism.Methods: 16 goats undergoing both sides of transverse osteotomy of the femoral shafts were fixed intramedullary with AMLN and Gross-Kempf (GK) nail,respectively. The follow-up time was 7, 14, 28 and 56days. Roentgenographic, biomechanical, histological,scanning electromicroscopic and biochemical analyses were done.Results: ( 1 ) The strength of anticompression,antiflexion and antitorsion in the fractural end in the AMLN-fixed group was higher than that of GK nail-fixed group; whereas, the rate of stress shelter in the fractured end decreased significantly (P < 0.01 ). (2) The content of the total collagen, insoluble collagen, calcium and phosphate in the AMLN-fixed group was higher than that in the GK nail-fixed group ( P < 0.05 ). ( 3 ) Histological observation and quantitative analysis of calluses revealed that AMLN could promote the growth of bridge calluses and periosteum calluses. Hence the facture healing and remolding process achieved early, which was much better than traditional GK nail fixation. (P < 0.05). ( 4 ) 7-14days postoperation, the calluses of AMLN-fixed group was flourish and camellarly arranged and the collagen fibril formed constantly in the absorption lacuna of bone trabecula. 28-56 days postoperation, the collagen fibril was flourish around the absorption lacuna and was parallel to the bone's longitudinal axis. Active bony absorption and formation were seen, so was remolding and rebuilding.Haversian system was intact and the bony structural net was very tenacious because of the deposition of calcium salt.None of the above findings was observed in the GK nailfixed group.Conclusions: The design of AMLN accords well with the plastic fixation theory. As the geometry ametabolic system constituted by the intramedullary fixation instruments and the proximal and distal end of the fracture is very firm and stable

  10. Mechanics and mechano-biology of fracture healing in normal and osteoporotic bone.

    Science.gov (United States)

    Augat, Peter; Simon, Ulrich; Liedert, Astrid; Claes, Lutz

    2005-03-01

    Fracture repair, which aims at regaining the functional competence of a bone, is a complex and multifactorial process. For the success of fracture repair biology and mechanics are of immense importance. The biological and mechanical environments must be compatible with the processes of cell and tissue proliferation and differentiation. The biological environment is characterized by the vascular supply and by many biochemical components, the biochemical milieu. A good vascular supply is a prerequisite for the initiation of the fracture repair process. The biochemical milieu involves complex interactions among local and systemic regulatory factors such as growth factors or cytokines. The mechanical environment is determined by the local stress and strain within the fracture. However, the local stress and strain is not accessible, and the mechanical environment, therefore, is described by global mechanical factors, e.g., gap size or interfragmentary movement. The relationship between local stress and strain and the global mechanical factors can be obtained by numerical models (Finite Element Model). Moreover, there is considerable interaction between biological factors and mechanical factors, creating a biomechanical environment for the fracture healing process. The biomechanical environment is characterized by osteoblasts and osteocytes that sense the mechanical signal and express biological markers, which effect the repair process. This review will focus on the effects of biomechanical factors on fracture repair as well as the effects of age and osteoporosis.

  11. Osteoporosis influences the middle and late periods of fracture healing in a rat osteoporotic model

    Institute of Scientific and Technical Information of China (English)

    WANG Jian-wei; LI Wei; XU Shao-wen; YANG Di-sheng; WANG Yun; LIN Min; ZHAO Guang-feng

    2005-01-01

    Objective: To evaluate the influence of osteoporosis on the middle and late periods of fracture healing process through observing the histomorphological changes, bone mineral density and biomechanical properties in ovariectomized rats. Methods: Eighty-four female SD rats of 4 months old were randomly divided into osteoporosis group and sham operation group, 42 in each. Rats in osteoporosis group were performed ovariectomy operation while those in sham operation group were given sham operation. A midshaft tibia fracture model was established 10 weeks after ovariectomy. Tibias were harvested 2, 4, 6, 12, 18 weeks after fracture for bone mineral density, histomorphological and biomechanical evaluation. Results: Compared with the sham operation group, callus bone mineral density was 12.8%, 18.0%, 17.0% lower in osteoporosis group 6, 12, 18 weeks after fracture, respectively (P<0.05); callus failure load was 24.3%, 31.5%, 26.6%, 28.8% lower in osteoporosis group, and callus failure stress was 23.9%, 33.6%, 19.1%, 24.9% lower in osteoporosis group 4, 6, 12, 18 weeks after fracture, respectively (P<0.05). In osteoporosis group, endochondral bone formation was delayed, more osteoclast cells could be seen around the trabecula, and the new bone trabecula arranged loosely and irregularly. Conclusions: Osteoporosis influences the middle and late periods of fracture healing in the rat osteoporotic model. The impairment is considered to be the result of combined effects of prolonged endochondral calcification, high activated osteoclast cell and the deceleration of the increase in bone mineral density.

  12. Fracture risk assessed by Fracture Risk Assessment Tool (FRAX) compared with fracture risk derived from population fracture rates

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Abrahamsen, Bo; Hermann, Anne Pernille

    2011-01-01

    Purpose: To evaluate the performance of the Swedish version of Fracture Risk Assessment Tool (FRAX)) without bone mass density (BMD) in a Danish population to examine the possibility of applying this version to Danish women. METHODS: From the Danish National Register of social security numbers, we...... randomly selected 5000 women living in the region of Southern Denmark aged 40-90 years to receive a mailed questionnaire concerning risk factors for osteoporosis based on FRAX. The predicted 10-year probability of hip fractures was calculated for each woman returning a complete questionnaire using...... the Swedish version of FRAX. The observed 10-year hip fracture risk was also calculated for each woman using age-specific hip fracture rates from the National Hospital Discharge Register and National survival tables. RESULTS: A total of 4194 (84%) women responded to the questionnaire and 3636 (73%) gave...

  13. Effect of Absorbable Hydroxyapatite/Poly-DL-Lactide Rods on Experimental Fracture Healing

    Institute of Scientific and Technical Information of China (English)

    GUO Xiaodong; ZHENG Qixin; DU Jingyuan; LIU Yong

    2000-01-01

    In order to investigate the effect of a new institute-designed absorbable hydroxyapatite microparticles/poly-DL-lactide (HA/PDLLA) fracture fixation devices on experimental fracture healing, 25 rabbits with a transverse transcondylar osteotomy of the distal femur were fixed intramedullary by a HA/PDLLA rod (4.5 mm in diameter, 30-40 mm in length). The follow-up time lasted 1, 2, 4, 6 and 12 week(s). Roentgenographic, histological and ultrastructural analyses were conducted. The results showed that allosteotomies united within 6 weeks without delay.No accumulation of inflammatory cells was seen. Ultrastructural studies showed that polymorphonuclear neutrophils and macrophages were observed mainly at the 1st week, but only few were noted at the 2nd week. The inflammatory and debridement stages were not prolonged. Large amount of active fibroblasts and some chondroblasts were observed at the 2nd week, suggesting a fibrous callus stage. The main cellularity at 4th week was osteoblasts and osteocytes. Part of osteocytes had already entered the static stage at the 6th week. Our experiment showed that the HA/PDLLA had good biocompatibility, sufficient mechanical streugth and caused no delay to the fracture healing.

  14. Great increase in bone 66 kDa protein and osteocalcin at later stages with healing rat fractures: effect of zinc treatment.

    Science.gov (United States)

    Igarashi, Aki; Yamaguchi, Masayoshi

    2003-02-01

    Fracture healing has been demonstrated to increase production of bone growth factors, and this elevation has been shown to be enhanced by zinc treatment. Moreover, the effect of zinc treatment on production of bone osteocalcin, which is a kind of Ca2+-binding protein localized in bone matrix, at the later stages with bone fracture was investigated. Rats were sacrificed 7 (earlier stage) or 21 (later stage) days after fracture of femoral diaphysis. Femoral-diaphyseal tissues with fracture healing were cultured in a serum-free medium for 24 h. Many proteins in the bone tissues were released into the medium. Bone protein production was markedly elevated 21 days after bone fracture as compared with that of 7 days. A approximately 66 kDa protein molecule, a major protein component which was produced by the diaphyseal tissues during fracture healing, was predominantly increased at the later stages with fracture healing. Bone osteocalcin production was significantly increased during fracture healing. This increase was enhanced at the later stages with fracture healing. The presence of zinc acexamate (10(-4) M) in culture medium caused a significant increase in bone protein and osteocalcin production at 7 or 21 days after bone fracture. The effect of zinc acexamate in increasing bone total protein and osteocalcin production was remarkable at the later stages with fracture healing. Moreover, zinc treatment caused a significant increase in alkaline phosphatase activity, deoxyribonucleic acid (DNA) and calcium content in the femoral-diaphyseal tissues of the later stages with fracture healing in vitro. The present study demonstrates that bone protein production is markedly increased at the later stages with fracture healing, and that zinc treatment can enhance production of bone protein components including osteocalcin in vitro. Zinc treatment may stimulate the healing of femoral fracture at earlier and later stages.

  15. Enhancement of fracture healing by electrical stimulation in the comminuted intraarticular fracture of distal radius.

    Science.gov (United States)

    Kohata, Kazuhiro; Itoh, Soichiro; Takeda, Shu; Kanai, Misa; Yoshioka, Taro; Suzuki, Hiroyuki; Yamashita, Kimihiro

    2013-01-01

    Effectiveness of an alternating electric current (AC) stimulation in prevention of bone deformity for comminuted intraarticular fracture of distal radius were verified by comparing postoperative results treated with a wrist-bridging external fixator combined with or without an AC stimulator (EF and NEF, respectively), and a palmar locking plate (LP). This study evaluated 92 cases (mean age 67.9 ± 11.4 years) of type C2 and 60 cases (mean age 69.7 ± 9.5 years) of type C3 distal radius fractures, as classified by the Association for Osteosynthesis. In total, 55 and 24 cases were treated with EF and NEF, respectively; and 73 cases were treated with LP. Callus appeared 27.5 ± 4.6 days postoperatively and the external skeletal fixation period was significantly shorter in the EF group than in the NEF group. The decrease in radial length was significantly lower in the EF group when compared to the LP group. There were no significant differences among the groups for the other radiographic and functional parameters. AC stimulation combined to the external fixation may be a promising method to prevent postoperative deformity in the severely comminuted intraarticular fractures by accelerating callus maturation and facilitating new bone bridging across the gap of fracture site.

  16. Healing of delayed management of double traumatized incisors with complicated crown: Root fracture and apical pathosis

    Directory of Open Access Journals (Sweden)

    Abdullah M Alsaedan

    2017-01-01

    Full Text Available The present case report shows a 23-year-old male who was subjected to trauma in his maxillary right central and lateral incisors with crown and transverse apical third root fractures. Root canal therapy was started, but the patient did not complete it. After 6 years, the patient was subjected to another trauma on the same teeth and showed up after 3 weeks of the second trauma to continue his treatment. Clinical examination revealed that both incisors were sensitive to percussion and palpation with labial sinus tract and pus discharge through the open access cavity of the central incisor. Radiographic evaluation demonstrated root fracture of the central incisor with large radiolucency. Root canal treatment for both incisors and periradicular surgery was done. Histopathologic examination of the periapical lesion demonstrated tissue necrosis and fungal hyphae. Follow-up showed no symptoms with good healing. The treatment modality appears to be effective in dealing with delayed management of traumatized anterior teeth.

  17. Effects of recombinant human growth hormone (r-hGH) on experimental osteoporotic fracture healing

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To observe the effect of recombinant human growthhormone (r-hGH) on osteoporotic fracture healing in rats, and to provide an effective therapy for osteoporotic fracture.Methods: Thirty-six female 8-month-old SD rats were randomized into two groups: therapy group and control group. After the experimental model of osteoporotic fracture was established, the therapy group was treated with r-hGH of 2.7 mg/kg body weigh/day (1 mg=3 IU) for 10 days continuously by daily subcutaneous injection; whereas the control group was treated with equivalent saline. Plasma insulin-like growth factor I concentration was detected and bone mineral density (BMD) as well as biomechanical strength of callus were measured at 2, 4, 8 weeks.Results: Plasma insulin-like growth factor I concentration in the therapy group was higher than that in the control group (P<0.005) at 2nd week and began to decline at 4th week. At 8th week, there was no significant difference between the two groups. At 4th week, callus area and BMD in therapy group were higher than those in the control group, but at 8th week, they were lower and BMD had a significant difference between the two groups (P<0.001). Biomechanical testing of callus showed that torsional strength of the therapy group was higher than that of the control group at 4th or 8th week, meanwhile maximum torsional angle had a significant difference between the two groups (P<0.005).Conclusions: The results show that exogenous r-hGH can stimulate osteoporotic fracture healing in rats.

  18. Systemic inhibition of canonical Notch signaling results in sustained callus inflammation and alters multiple phases of fracture healing.

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    Michael I Dishowitz

    Full Text Available The Notch signaling pathway is an important regulator of embryological bone development, and many aspects of development are recapitulated during bone repair. We have previously reported that Notch signaling components are upregulated during bone fracture healing. However, the significance of the Notch pathway in bone regeneration has not been described. Therefore, the objective of this study was to determine the importance of Notch signaling in regulating bone fracture healing by using a temporally controlled inducible transgenic mouse model (Mx1-Cre;dnMAML(f/- to impair RBPjκ-mediated canonical Notch signaling. The Mx1 promoter was synthetically activated resulting in temporally regulated systemic dnMAML expression just prior to creation of bilateral tibial fractures. This allowed for mice to undergo unaltered embryological and post-natal skeletal development. Results showed that systemic Notch inhibition prolonged expression of inflammatory cytokines and neutrophil cell inflammation, and reduced the proportion of cartilage formation within the callus at 10 days-post-fracture (dpf Notch inhibition did not affect early bone formation at 10dpf, but significantly altered bone maturation and remodeling at 20dpf. Increased bone volume fraction in dnMAML fractures, which was due to a moderate decrease in callus size with no change in bone mass, coincided with increased trabecular thickness but decreased connectivity density, indicating that patterning of bone was altered. Notch inhibition decreased total osteogenic cell density, which was comprised of more osteocytes rather than osteoblasts. dnMAML also decreased osteoclast density, suggesting that osteoclast activity may also be important for altered fracture healing. It is likely that systemic Notch inhibition had both direct effects within cell types as well as indirect effects initiated by temporally upstream events in the fracture healing cascade. Surprisingly, Notch inhibition did not alter

  19. In vivo study of microarc oxidation coated biodegradable magnesium plate to heal bone fracture defect of 3mm width.

    Science.gov (United States)

    Wu, Y F; Wang, Y M; Jing, Y B; Zhuang, J P; Yan, J L; Shao, Z K; Jin, M S; Wu, C J; Zhou, Y

    2017-06-23

    Microarc oxidation (MAO) coated magnesium (Mg) with improved corrosion resistance appeal increasing interests as a revolutionary biodegradable metal for fractured bone fixing implants application. However, the in vivo corrosion degradation of the implants and bone healing response are not well understood, which is highly required in clinic. In the present work, 10μm and 20μm thick biocompatible MAO coatings mainly composed of MgO, Mg2SiO4, CaSiO3 and Mg3(PO4)2 phases were fabricated on AZ31 magnesium alloy. The electrochemical tests indicated an improved corrosion resistance of magnesium by the MAO coatings. The 10μm and 20μm coated and uncoated magnesium plates were separately implanted into the radius bone fracture site of adult New Zealand white rabbits using a 3mm width bone fracture defect model to investigate the magnesium implants degradation and uninhibited bone healing. Taking advantage of the good biocompatibility of the MAO coatings, no adverse effects were detected through the blood test and histological examination. The implantation groups of coated and uncoated magnesium plates were both observed the promoting effect of bone fracture healing compared with the simple fracture group without implant. The releasing Mg(2+) by the degradation of implants into the fracture site improved the bone fracture healing, which is attributed to the magnesium promoting CGRP-mediated osteogenic differentiation. Mg degradation and bone fracture healing promoting must be tailored by microarc oxidation coating with different thickness for potential clinic application. Copyright © 2017. Published by Elsevier B.V.

  20. Experimental studies of healing process of rat mandibular condylar fracture, using /sup 45/Ca as tracer

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Tatsuaki (Gifu Univ. (Japan). Faculty of Medicine)

    1982-09-01

    The cervical region of the mandibular condylus of young rats was fractured. The healing process was observed pathohistologically, autoradiographically using /sup 45/Ca as a tracer, and by ultra soft roentgenography. Condylectomy of the mandibular condylus was done at the same time and its regeneration observed. The results of the observation are as follows: The fractured portion is bonded with the soft tissue 1 - 2 weeks postoperatively. Histologically, new-blood vessels in the granulation tissue and the connective tissue's change into fibers are seen. On the second week chondrocytes appeared in the neck of the capitulum mandibulae and the stump of the ascending branch. On the 3rd postoperative week, the stump of the fracture of the bone is bonded with proliferated cartilaginous tissue and an osseous bond was seen in part by autoradiograph and ultra soft x-ray picture. New bone due to periosteal ossification is seen around the stump on the ascending branch side, and the bone reconstruction with osteoclasts was seen in the inside the trabeculae. On the 4th postoperative week, osseous concrescence is observed in the fractured portion. Regeneration of the capitulum mandibulae after extirpation of the capitulum mandibulae is seen in all the cases. On the postoperative 12th week, the macroscopic form of the degenerated capitulum mandibulae which seemed to be excessive becomes almost the same morphologically with that of the contralateral side and it was observed histologically that the construction of the capitulum mandibulae is completely restored.

  1. Study of stress adaptability of fracture healing%骨折愈合的应力适应性研究

    Institute of Scientific and Technical Information of China (English)

    董福慧; 关继超; 赵勇; 邹炳曾; 尚天裕

    2001-01-01

    目的 探讨骨折端受力、肌肉动力、骨痂密度与骨折愈合的关系。方法 通过传感器电测技术与X线灰度分析的方法,从三个方面对骨折愈合的应力适应性进行了研究:①分别对14只1岁龄山羊进行了断端受力与骨折愈合的关系的研究;②对10只健康成年家兔进行了肌肉动力与骨折愈合的关系的研究;③对56只健康成年家兔进行了骨痂密度与骨折愈合的关系的研究。结果与结论 ①理想的骨折愈合与最佳的应力状态相适应;②肌肉动力是应力适应的反馈调节因素;③骨痂密度是应力适应的反馈结果。%Objective To explore the relationship between local stress status,muscular motivation,callus density and fracture healing.Methods Stress adaptability of fracture healing was studied from three respects:1.the relationship between fracture local stress and fracture healing was studied in 14 one year old goats;2.the relationship between muscular motivation and fracture healing was studied in 10 health adult rabbits and 3.the relationship between callus density and fracture healing was studied in 56 healthy adult rabbits.Electric transducer technique and X-ray densitometry method were used in all the three groups of animals.Results and Conclusion 1.Ideal fracture healing should be adapted to the best stress status;2.Muscular motivation is the biofeedback regulation factor of stress adaptability of fracture healing;3.The density of callus is the result of biofeedback of stress adaptability of fracture healing.

  2. Effects of " vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Eftekhari

    2014-01-01

    Full Text Available Background: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. Material and Methods: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1 one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus plus 250 mg magnesium oxide (VAC + Mg group (n = 10, 2 one Agnugol tablet plus placebo (VAC group (n = 15, 3 placebo plus 250 mg magnesium oxide (Mg group (n = 12, or 4 placebo plus placebo (placebo group (n = 14 per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF were measured together with radiological bone assessment. Results: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05, administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05. Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39. No relevant side effect was observed in patients in each group. Conclusion : Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

  3. Effects of low-dose microwave on healing of fractures with titanium alloy internal fixation: an experimental study in a rabbit model.

    Directory of Open Access Journals (Sweden)

    Dongmei Ye

    Full Text Available BACKGROUND: Microwave is a method for improving fracture repair. However, one of the contraindications for microwave treatment listed in the literature is surgically implanted metal plates in the treatment field. The reason is that the reflection of electromagnetic waves and the eddy current stimulated by microwave would increase the temperature of magnetic implants and cause heat damage in tissues. Comparing with traditional medical stainless steel, titanium alloy is a kind of medical implants with low magnetic permeability and electric conductivity. But the effects of microwave treatment on fracture with titanium alloy internal fixation in vivo were not reported. The aim of this article was to evaluate the security and effects of microwave on healing of a fracture with titanium alloy internal fixation. METHODS: Titanium alloy internal fixation systems were implanted in New Zealand rabbits with a 3.0 mm bone defect in the middle of femur. We applied a 30-day microwave treatment (2,450MHz, 25W, 10 min per day to the fracture 3 days after operation. Temperature changes of muscle tissues around implants were measured during the irradiation. Normalized radiographic density of the fracture gap was measured on the 10th day and 30th day of the microwave treatment. All of the animals were killed after 10 and 30 days microwave treatment with histologic and histomorphometric examinations performed on the harvested tissues. FINDINGS: The temperatures did not increase significantly in animals with titanium alloy implants. The security of microwave treatment was also supported by histology of muscles, nerve and bone around the implants. Radiographic assessment, histologic and histomorphometric examinations revealed significant improvement in the healing bone. CONCLUSION: Our results suggest that, in the healing of fracture with titanium alloy internal fixation, a low dose of microwave treatment may be a promising method.

  4. Diabetes mellitus affects the biomechanical function of the callus and the expression of TGF-beta1 and BMP2 in an early stage of fracture healing

    Directory of Open Access Journals (Sweden)

    M.T. Xu

    2016-01-01

    Full Text Available Transforming growth factor beta 1 (TGF-β1 and bone morphogenetic protein-2 (BMP-2 are important regulators of bone repair and regeneration. In this study, we examined whether TGF-β1 and BMP-2 expressions were delayed during bone healing in type 1 diabetes mellitus. Tibial fractures were created in 95 diabetic and 95 control adult male Wistar rats of 10 weeks of age. At 1, 2, 3, 4, and 5 weeks after fracture induction, five rats were sacrificed from each group. The expressions of TGF-β1 and BMP2 in the fractured tibias were measured by immunohistochemistry and quantitative reverse-transcription polymerase chain reaction, weekly for the first 5 weeks post-fracture. Mechanical parameters (bending rigidity, torsional rigidity, destruction torque of the healing bones were also assessed at 3, 4, and 5 weeks post-fracture, after the rats were sacrificed. The bending rigidity, torsional rigidity and destruction torque of the two groups increased continuously during the healing process. The diabetes group had lower mean values for bending rigidity, torsional rigidity and destruction torque compared with the control group (P<0.05. TGF-β1 and BMP-2 expression were significantly lower (P<0.05 in the control group than in the diabetes group at postoperative weeks 1, 2, and 3. Peak levels of TGF-β1 and BMP-2 expression were delayed by 1 week in the diabetes group compared with the control group. Our results demonstrate that there was a delayed recovery in the biomechanical function of the fractured bones in diabetic rats. This delay may be associated with a delayed expression of the growth factors TGF-β1 and BMP-2.

  5. The Role of Radiographs and Office Visits in the Follow-Up of Healed Intertrochanteric Hip Fractures: An Economic Analysis.

    Science.gov (United States)

    Kempegowda, Harish; Richard, Raveesh; Borade, Amrut; Tawari, Akhil; Howenstein, Abby M; Kubiak, Erik N; Suk, Michael; Horwitz, Daniel S

    2016-12-01

    The purpose of this study was to evaluate the role and the necessity of radiographs and office visits obtained during follow-up of intertrochanteric hip injuries. Retrospective study. Two level I trauma centers. Four hundred sixty-five elderly patients who were surgically treated for an intertrochanteric fracture of the femur at 2 level I trauma centers between January 2009 and August 2014 were retrospectively identified from orthopaedic trauma databases. Analysis of all healed intertrochanteric hip fractures, including demographic characteristics, quality of reduction, time of healing, number of office visits, number of radiographs obtained, and each radiograph for fracture alignment, implant position or any pathological changes. The surgical fixation of 465 fractures included 155 short nails (33%), 232 long nails (50%), 69 sliding hip screw devices (15%), 7 trochanteric stabilizing plates (1.5%), and 2 proximal femur locking plates (0.5%). The average fracture healing time was 12.8 weeks and the average follow-up was 81.2 weeks. Radiographs of any patient obtained after the fracture had healed did not reveal any changes, including fracture alignment or implant position and hardware failure. In 9 patients, pathological changes, including arthritis (3), avascular necrosis (3), and ectopic ossification (3) were noted. The average number of elective office visits and radiographs obtained after the fracture had healed were 2.8 (range: 1-8) and 2.6 (range: 1-8), respectively. According to Medicare payments to the institution, these radiographs and office visits account for a direct cost of $360.81 and $192, respectively, per patient. The current study strongly suggests that there is a negligible role for radiographs and office visits during the follow-up of a well-healed hip fracture when there is documented evidence of radiographic and clinical healing with acceptable fracture alignment and implant position. Implementation of this simple measure will help in reducing

  6. Bone fractures: assessment and management.

    Science.gov (United States)

    Lim, L; Sirichai, P

    2016-03-01

    Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques. © 2016 Australian Dental Association.

  7. Healing

    Science.gov (United States)

    Ventres, William B.

    2016-01-01

    My personal ethos of healing is an expression of the belief that I can and do act to heal patients while I attend to the traditional goals of medicine. The 7 supporting principles that inform my ethos are dignity, authenticity, integrity, transparency, solidarity, generosity, and resiliency. I invite others, including medical students, residents, and practicing physicians, to reflect and discover their own ethos of healing and the principles that guide their professional growth. A short digital documentary accompanies this essay for use as a reflective prompt to encourage personal and professional development. PMID:26755787

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

    Science.gov (United States)

    Celestine, Asha-Dee N.

    of the crack tip. Control specimens in which the mechanophore is absent or tethered in positions in which no mechanochemical activation is expected are also tested and exhibit no change in color or fluorescence intensity with crack propagation. The relationship between fracture-induced mechanophore activation in rubber toughened SP-PMMA and the strain and stress ahead of the propagating crack is also studied. SP activation is again detected and quantified by in situ fluorescence imaging. Digital Image Correlation (DIC) is used to measure the strain ahead of the crack tip. The corresponding stress is generated through the use of the Hutchinson-Rice-Rosengren (HRR) singularity field equations. Mechanophore activation ahead of the crack tip is shown to follow a power law distribution that is closely aligned with strain. The potential of SP as a damage sensor is explored further by incorporating the spiropyran into the core of rubber nanoparticles. SP-linked rubber nanoparticles are synthesized using a seeded emulsion polymerization process and incorporated into cross-linked PMMA at a concentration of 5 wt%. Cylindrical specimens are torsion tested and the activation of the SP within the nanoparticles is monitored via full field fluorescence imaging. SP activation within the core is shown to increase with shear strain. Autonomous damage repair in PMMA is also investigated. The first demonstration of fully autonomous self-healing in PMMA is achieved through the use of solvent microcapsules. Solvent microcapsules with a PMMA-anisole liquid core are prepared and embedded within a linear PMMA matrix. Specimens of the microcapsule-loaded material are then fabricated for Double Cleavage Drilled Compression (DCDC) fracture testing. The DCDC specimens, containing increasing concentrations of solvent microcapsules, are tested and then allowed to heal for a fixed period of time before a second DCDC test. The healing efficiency of each material system is evaluated based on the

  9. Fragility fracture: recent developments in risk assessment.

    Science.gov (United States)

    Aspray, Terry J

    2015-02-01

    More than half of older women who sustain a fragility fracture do not have osteoporosis by World Health Organization (WHO) bone mineral density (BMD) criteria; and, while BMD has been used to assess fracture risk for over 30 years, a range of other skeletal and nonskeletal clinical risk factors (CRFs) for fracture have been recognized. More than 30 assessment tools using CRFs have been developed, some predicting fracture risk and others low BMD alone. Recent systematic reviews have reported that many tools have not been validated against fracture incidence, and that the complexity of tools and the number of CRFs included do not ensure best performance with poor assessment of (internal or comparative) validity. Internationally, FRAX® is the most commonly recommended tool, in addition to QFracture in the UK, The Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool in Canada and Garvan in Australia. All tools estimate standard 10-year risk of major osteoporotic and 10-year risk of hip fracture: FRAX® is able to estimate fracture risk either with or without BMD, but CAROC and Garvan both require BMD and QFracture does not. The best evidence for the utility of these tools is in case finding but there may be future prospects for the use of 10-year fracture risk as a common currency with reference to the benefits of treatment, whether pharmacological or lifestyle. The use of this metric is important in supporting health economic analyses. However, further calibration studies will be needed to prove that the tools are robust and that their estimates can be used in supporting treatment decisions, independent of BMD.

  10. Optimal Treatment of Malignant Long Bone Fracture: Influence of Method of Repair and External Beam Irradiation on the Pathway and Efficacy of Fracture Healing

    Science.gov (United States)

    2015-10-01

    Medical University of South Carolina Department of Orthopaedics 96 Jonathan Lucas Street Suite 708 MSC 622 8. PERFORMING ORGANIZATION REPORT NUMBER...analysis is completed in year 3. Nothing to report. Publications, Abstracts, and Presentations: Abstracts accepted for Orthopaedic Conferences: 1...Fracture Healing. The 32nd Annual Meeting of the Southern Orthopaedic Association, Asheville, NC. 2015. (Podium presentation) Abstract included in

  11. Characterization of the increase in bone 66 kDa protein component with healing rat fractures: stimulatory effect of zinc.

    Science.gov (United States)

    Igarashi, A; Yamaguchi, M

    2002-05-01

    The characterization of protein components produced from bone tissues with fracture healing was investigated. Weanling rats were sacrificed between 1 and 7 days after the femoral fracture. Protein content in the femoral-diaphyseal tissues was markedly elevated by fracture healing. Moreover, when the femoral-diaphyseal tissues with fracture healing were cultured for 24 h in a serum-free medium, many proteins in the bone tissues were released into the medium. Analysis with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed that many protein molecules were released from the diaphyseal tissues with fracture healing. Especially, a protein molecule of approximately 66 kDa was markedly increased by fracture healing. This protein molecule was significantly increased, when the diaphyseal tissues with fracture healing were cultured in the presence of zinc acexamate (10(-6)-10(-4) M). Zinc acexamate (10(-4) M)-induced increase in medium 66 kDa protein molecule was significantly inhibited in the presence of actinomycin D (10(-7) M) or cycloheximide (10(-6) M). The zinc effect was completely blocked in the presence of PD98059 (10(-5) M), an inhibitor of MAPK kinase, or staurosporine (10(-6) M), an inhibitor of protein kinase C. The medium 66 kDa protein molecule was significantly elevated in the presence of parathyroid hormone (1-34) (10(-7) M), insulin-like growth factor-I (10(-8) M) or transforming growth factor-beta (10(-11) M), while 17beta-estradiol (10(-9) M) did not have an effect. The effect of these bone-stimulating factors was equal to the zinc effect. Zinc did not significantly enhance the effect of insulin-like growth factor-I in increasing medium 66 kDa protein molecule. The present study demonstrates that fracture healing increases production of the approximately 66 kDa protein molecule which is a major component produced from femoral-diaphyseal tissues of weanling rats, and that this elevation is enhanced by zinc treatment.

  12. Effect of amino acids lysine and arginine on fracture healing in rabbits: A radiological and histomorphological analysis

    Directory of Open Access Journals (Sweden)

    Sinha Shivam

    2009-01-01

    Full Text Available Background: Amino acids like arginine and lysine have been suggested to hasten the process of fracture healing by improving the local blood supply, supplementing growth factors, and improving collagen synthesis. We studied the role of lysine and arginine in the fracture repair process with regard to the rate of healing, probable mechanisms involved in the process, and mutual synergism between these agents. Materials and Methods: In an experimental study, 40 rabbits were subjected to ulnar osteotomy. They were distributed in control (14 and test groups (26. Twenty-six animals in the test group were fed with a diet rich in lysine and arginine. Both the groups were followed radiologically and histologically till union. Results: There was better healing of osteotomy in terms of better vascularization, callus formation, and mineralization in the test group. The time of healing in the test group was reduced by a period of 2 weeks. Conclusion: We conclude that amino acids like arginine and lysine may hasten fracture healing.

  13. A Biomechanical Comparison of Two Intramedullary Implants for Subtrochanteric Fracture in Two Healing Stages: A Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Xinlei Wu

    2015-01-01

    Full Text Available Background. The biomechanical effect of two implants, namely, proximal femoral nail antirotation for Asia (PFNA-II and Expert Asian Femoral Nail (A2FN, for treating subtrochanteric fracture during healing stages, is still unclear. Methods. A 3D finite element model of an intact femur was constructed and validated. The fractured and postoperative models were accordingly produced. The postoperative models were loaded with the peak joint forces during gait for the soft and hard callus stages. The effects of stress distribution on the implants, femoral head and callus, and the deformation of the proximal femur were examined. Results. Both implants showed similar biomechanical effect in two healing stages. As the healing duration increased, the von Mises stress of two implants and the tensile stress of the femoral head decreased, whereas the compressive stress of the femoral head increased. However, the PFNA-II operation resulted in higher stress on the implant, lower stress on the proximal femur, and lower compressive stress and higher tensile stress on the callus than A2FN operation. Conclusions. The A2FN implant may provide a biomechanically superior construct for subtrochanteric fracture healing. However, the upper screw of the A2FN implant may be more likely to be loose in the healing process.

  14. Effect of bone marrow and low power lasers on fracture healing with destruction of both periosteum and endosteum in rabbits

    Directory of Open Access Journals (Sweden)

    M. G. Thanoon

    2010-01-01

    Full Text Available Ten mature rabbits of local breed were used in this study; weighing between 1.5 to 1.75 kg and aged about 1–2 years. These animals were divided into two equal groups; in group A destruction of both periosteum and endosteum was done one centimeter from each side of mid-shaft femoral bone fracture, then sufficient amount of autogenously bone marrow was injected directly at the fracture site after immobilization by intramedullary pin. In group B a similar procedure was achieved as in group A, but in additional to that He-Ne infrared laser therapy was used for several sessions. The result of radiological findings indicated that, the fracture healing occurred within group B at fifteen weeks, whereas in group A the healing occurred at eighteen weeks after operation. The implantation of autologous bone marrow enhanced the fracture healing, whereas using of combinations of autologous bone marrow and He-Ne infrared laser therapy hastened the healing.

  15. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing.

    Science.gov (United States)

    Dexel, Julian; Fritzsche, Hagen; Beyer, Franziska; Harman, Melinda K; Lützner, Jörg

    2017-03-01

    Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates. Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing. In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023). With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture. III.

  16. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation.

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-12-01

    Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group.

  17. Effect of 900MHz electromagnetic fields emitted from cellular phones on fracture healing: an experimental study on rats.

    Science.gov (United States)

    Aslan, Ahmet; Atay, Tolga; Gülle, Kanat; Kırdemir, Vecihi; Ozden, Ahmet; Çömlekçi, Selçuk; Aydoğan, Nevres Hürriyet

    2013-01-01

    The aim of this study was to investigate the effect of electromagnetic fields (EMFs) at 900 MHz frequencies on bone fracture healing. The study included 30 adult male Wistar albino rats (average weight: 256 g) divided into two equal groups. Transverse fracture was created manually by pressing a finger on the right tibias of all rats and fractures were fixed intramedullary using a K-wire. Rats in Group 1 were exposed to EMF at 900 MHz frequency 30 minutes a day, 5 days a week for 8 weeks. Group 2, the control group, was kept under the same experimental conditions without EMF exposure. Radiological, mechanical and histological examination of tibial fracture healing was performed. There was a significant difference between radiological, histological and manual biomechanical scores of the study and control groups (p=0.020, p=0.006 and p=0.032, respectively). All scores were lower in the study group than the control group. Results of this study demonstrate that EMF at 900 MHz of frequency emitted from cellular phones has a significantly negative effect on bone fracture healing in a rat tibia model.

  18. Effects of recombinant human basic fibroblast growth factor on cell proliferation during mandibular fracture healing in rabbits

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To investigate the effects of recombinant human basicfibroblast growth factor (rhbFGF) on the cell proliferation during mandibular fracture healing in rabbits.Methods: The complex of rhbFGF and bovine type I collagen was implanted into the mandibular fracture site under periosteum of the animal. The whole mandible was harvested at 7, 14, 28, 56 and 84 days respectively after operation. The expression of proliferating cell nuclear antigen (PCNA) in callus was examined with immunohistochemical staining.Results: PCNA-positive cells in callus in the rhbFGF-treated group on days 7 and 14 were more than that in the control group (P<0.01).Conclusions: It indicates that rhbFGF can stimulate cell proliferation during mandibular fracture healing in rabbits.

  19. Means of enhancing bone fracture healing : Optimal cell source, isolation methods and acoustic stimulation

    NARCIS (Netherlands)

    Ghebes, Corina Adriana; Braham, Maaike Vera Jasmijn; Zeegers, Adelgunde Veronica Clemens Maria; Renard, Auke Jan Sijbe; Fernandes, Hugo; Saris, Daniel B F

    2016-01-01

    Background: The human body has an extensive capacity to regenerate bone tissue after trauma. However large defects such as long bone fractures of the lower limbs cannot be restored without intervention and often lead to nonunion. Therefore, the aim of the present study was to assess the pool and

  20. Functional outcomes, morbidity, mortality, and fracture healing in 58 consecutive patients with geriatric odontoid fracture treated with cervical collar or posterior fusion.

    Science.gov (United States)

    Molinari, William J; Molinari, Robert W; Khera, Oner A; Gruhn, William L

    2013-03-01

    Controversy exists as to the most effective management option for elderly patients with type II odontoid fractures. The purpose of this study is to evaluate outcomes associated with rigid cervical collar and posterior fusion surgery. Patients with ≥ 50% odontoid displacement were treated with posterior fusion surgery including C1-2 (PSF group, n = 25, average age = 80 years). Patients with cervical collar for 12 weeks (collar group, n = 33, average age = 83 years). These inhomogeneous groups were followed for an average of 14 months. Fracture healing rates were higher in the operative group (28% versus 6%). Neck Disability Index scores were slightly lower in the nonoperative group (13 versus 18.3, p = 0.23). Analogue pain scores were also slightly lower in the nonoperative group (1.3 versus 1.9, p = 0.26). The mortality rate was 12.5% in the collar group and 20% in the operative group. Complications were higher in the operative group (24% versus 6%). Rates of type II odontoid facture healing and stability appear to be higher in geriatric patients treated with posterior fusion surgery. Fracture healing and stability did not correlate with improved outcomes with respect to levels of pain, function, and satisfaction. Mortality and complication rates are lower in those patients with lesser-displaced fractures who are treated with a cervical collar and early mobilization.

  1. The effects of pentoxifylline adminstration on fracture healing in a postmenopausal osteoporotic rat model

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Ahadi, Reza; Abdollahifar, Mohammadamin

    2017-01-01

    Previous studies report positive effects of pentoxifylline (PTX) alone or in combination with other drugs on some pathologic bone diseases as well as an ability to accelerate osteogensis and fracture healing in both animal models and human patients. The aim of this present study was to evaluate the effects of PTX administration on Hounsfield unit and bone strength at catabolic response (bone resorbing) of a fracture in an experimental rat model of ovariectomy induced osteoporosis (OVX-D). Thirty adult female rats were divided into groups as follows: 1 (OVX, control, no treatment); 2 (OVX, sham: daily distilled water); 3 (OVX, daily alendronate: 3 mg/kg); 4 (OVX, twice daily 100 mg/kg PTX) and 5 (OVX, PTX+alenderonate). OVX was induced by bilateral ovariectomy in all rats. A complete standardized osteotomy of the right femur was made after 3.5 months. PTX and alendronate treatments were performed for eight weeks. Then, rats were euthanized and had its right femur subjected to computerized tomography scanning for measuring Hounsfield unit; eventually, the samples were sent for a three point bending test for evaluation of the bone strength. Administration of PTX with 200 mg/kg and alendronate alone and in combination showed no significant alteration in Hounsfield unit and biomechanical properties of repairing callus of the complete osteotomy compared with the control group. Results showed increased bending stiffness and stress high load mean values of repairing complete osteotomy in PTX-treated rats compared to the control OVX-D.

  2. Bisphosphonates and the fracture healing and atypical fracture%双膦酸盐与骨折愈合和非典型性骨折

    Institute of Scientific and Technical Information of China (English)

    王雪鹏; 郝永强

    2011-01-01

    Fracture healing is typically characterized by four overlapping stages that include the hematoma and inflammatory response, initial fibrocartilage callus formation, hard callus formation and bone remodeling.The remodeling process is driven by a coupled process of bone resorption and bone formation.The soft callus remodeling and hard callus remodeling are of great importance to fracture healing.Bisphosphonates act to affect fracture healing by intervening callus remodelling, based on its pharmacological action of inhibiting the osteoclast activity and bone turnover level.Long-term use of bisphosphonates does not favor the fracture healing, and has been associated with the possibility of atypical fracture of the femur.%典型的骨折愈合过程包括血肿和炎症反应、原始软骨痂形成、成熟板层骨形成以及骨板重建和塑形等4个时期.骨重建包括骨吸收和骨形成两个方面.软骨痂和硬骨痂重建对骨折愈合具有重要意义.双膦酸盐类药理基础在于抑制破骨细胞活性和骨转化水平,通过干预骨重建对骨折愈合产生影响.长期使用双膦酸盐不利于骨折愈合,有引起股骨非典型性骨折发生的危险.

  3. The effect of bisphosphonates on fracture healing and atypical fracture%双膦酸盐与骨折愈合和非典型性骨折

    Institute of Scientific and Technical Information of China (English)

    王雪鹏; 郝永强

    2011-01-01

    Fracture healing is typically characterized by four overlapping stages, including the hematoma and inflammatory response, initial fibrocartilage callus formation, hard callus formation, and bone remodeling. The remodeling process is driven by a coupled process of orderly bone resorption followed by bone formation. The soft callus remodeling and hard callus remodeling are of great importance to fracture healing. Bisphosphonates act to affect fracture healing by intervening callus remodelling, based on its pharmacological action on inhibiting osteoclast activity and bone turnover levels. The long-term use of bisphosphonates seems to be turning against fracture healing, and has been associated with the possibility of atypical fractures of the femur.%典型的骨折愈合过程包括血肿和炎症反应、原始软骨痂形成、成熟板层骨形成以及骨板重建和塑形等四个时期。骨重建包括骨吸收和骨形成两个方面。软骨痂和硬骨痂重建对骨折愈合具有重要意义。双膦酸盐类药理基础在于抑制破骨细胞活性和骨转化水平,通过干预骨重建对骨折愈合产生影响。长期使用双膦酸盐不利于骨折愈合,有引起股骨非典型性骨折发生的危险。

  4. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts.

    Science.gov (United States)

    Kogan, Natalya M; Melamed, Eitan; Wasserman, Elad; Raphael, Bitya; Breuer, Aviva; Stok, Kathryn S; Sondergaard, Rachel; Escudero, Ana V Villarreal; Baraghithy, Saja; Attar-Namdar, Malka; Friedlander-Barenboim, Silvina; Mathavan, Neashan; Isaksson, Hanna; Mechoulam, Raphael; Müller, Ralph; Bajayo, Alon; Gabet, Yankel; Bab, Itai

    2015-10-01

    Cannabinoid ligands regulate bone mass, but skeletal effects of cannabis (marijuana and hashish) have not been reported. Bone fractures are highly prevalent, involving prolonged immobilization and discomfort. Here we report that the major non-psychoactive cannabis constituent, cannabidiol (CBD), enhances the biomechanical properties of healing rat mid-femoral fractures. The maximal load and work-to-failure, but not the stiffness, of femurs from rats given a mixture of CBD and Δ(9) -tetrahydrocannabinol (THC) for 8 weeks were markedly increased by CBD. This effect is not shared by THC (the psychoactive component of cannabis), but THC potentiates the CBD stimulated work-to-failure at 6 weeks postfracture followed by attenuation of the CBD effect at 8 weeks. Using micro-computed tomography (μCT), the fracture callus size was transiently reduced by either CBD or THC 4 weeks after fracture but reached control level after 6 and 8 weeks. The callus material density was unaffected by CBD and/or THC. By contrast, CBD stimulated mRNA expression of Plod1 in primary osteoblast cultures, encoding an enzyme that catalyzes lysine hydroxylation, which is in turn involved in collagen crosslinking and stabilization. Using Fourier transform infrared (FTIR) spectroscopy we confirmed the increase in collagen crosslink ratio by CBD, which is likely to contribute to the improved biomechanical properties of the fracture callus. Taken together, these data show that CBD leads to improvement in fracture healing and demonstrate the critical mechanical role of collagen crosslinking enzymes.

  5. Impaired angiogenesis during fracture healing in GPCR kinase 2 interacting protein-1 (GIT1 knock out mice.

    Directory of Open Access Journals (Sweden)

    Guoyong Yin

    Full Text Available G protein coupled receptor kinase 2 (GRK2 interacting protein-1 (GIT1, is a scaffold protein that plays an important role in angiogenesis and osteoclast activity. We have previously demonstrated that GIT1 knockout (GIT1 KO mice have impaired angiogenesis and dysregulated osteoclast podosome formation leading to a reduction in the bone resorbing ability of these cells. Since both angiogenesis and osteoclast-mediated bone remodeling are involved in the fracture healing process, we hypothesized that GIT1 participates in the normal progression of repair following bone injury. In the present study, comparison of fracture healing in wild type (WT and GIT1 KO mice revealed altered healing in mice with loss of GIT1 function. Alcian blue staining of fracture callus indicated a persistence of cartilagenous matrix in day 21 callus samples from GIT1 KO mice which was temporally correlated with increased type 2 collagen immunostaining. GIT1 KO mice also showed a decrease in chondrocyte proliferation and apoptosis at days 7 and 14, as determined by PCNA and TUNEL staining. Vascular microcomputed tomography analysis of callus samples at days 7, 14 and 21 revealed decreased blood vessel volume, number, and connection density in GIT1 KO mice compared to WT controls. Correlating with this, VEGF-A, phospho-VEGFR2 and PECAM1 (CD31 were decreased in GIT1 KO mice, indicating reduced angiogenesis with loss of GIT1. Finally, calluses from GIT1 KO mice displayed a reduced number of tartrate resistant acid phosphatase-positive osteoclasts at days 14 and 21. Collectively, these results indicate that GIT1 is an important signaling participant in fracture healing, with gene ablation leading to reduced callus vascularity and reduced osteoclast number in the healing callus.

  6. Effect of fluvastatin on vascular endothelial growth factor in rats with osteoporosis in process of fracture healing

    Institute of Scientific and Technical Information of China (English)

    YANG Mao-wei; ZHU Yue; TU Guan-jun; L(U) Gang

    2007-01-01

    Objective: To explore the effect of fluvastatin on vascular endothelial growth factor (VEGF) in rats with osteoporosis in the process of fracture healing.Methods: Fractures at the intermediate piece of the femur were made on 72 Sprague Dawley (SD) rats (weighing initially 290-340 g and aged 6 months ) with osteoporosis after ovariectomy for three months, then these rats were divided randomly into the medication administration group (the experimental group ) and the control group, 36 rats each. In the experimental group, the rats received fluvastatin lavage (10 mg/kg per day) since the next day of operation lasting for 6 weeks, and the rats in the control group received placebo. Then the expression of VEGF and VEGF mRNA in bony callus of the two groups was measured respectively with immunohistochemistry and in situ hybridization on days of 3rd, 7th, 14th, 21st, 28th, and 42nd, and image analysis was made with real-color image analysis machine.Results: No difference was found in the cellular localization of VEGF and VEGF mRNA gene expression between the experimental group and the control group in process of fracture healing and their expression modes were almost similar. On the 14th day postoperatively, the positive extent of positive cells in the experimental group was higher than that of the control group (P < 0.05).Conclusion: Fluvastatin can promote the VEGF level in rats with osteoporosis in process of fracture healing.

  7. Effect of Simvastatin on Fracture Healing in Osteoporotic Rats%辛伐他汀对大鼠骨质疏松性骨折愈合的影响

    Institute of Scientific and Technical Information of China (English)

    田发明; 张柳; 骆阳; 宋亚琪; 杨方

    2012-01-01

    treated with simvastatin( group E, 20 mg ? kg ' ? d~' ) or vehicle( group C,D) as control. Femurs from the A and B group rats sacrificed 4 weeks after ovariectomy operation were harvested for the bone mineral density assessment. The fractured rats were sacrificed 6 weeks after fracture. Radiographic evaluation( CR film) were taken to observe the fracture healing, a scoring system for CR film and bone mineral density were used to evaluate fracture healing quantitatively, and the femurs were then undecalcified for HE staining and subsequent histological observation. RESULTS Four weeks after the ovariectomy operation , the BMD of rats in group B were significantly lower than those of group A (P < 0. 05 ) ; In contrast to group C, a significant decreased BMD were observed in group D and E (P < 0. 05 ) ; the rats in group E and D showed more clear fracture gap by CR films in most examples, indicating a delayed fracture healing process compared to group C, in which the rats showed more progressed callus consolidation, accordingly, the scores for evaluation of fracture healing in group C was significantly higher than those of group E and D (P < 0. 05) ; the rats in group C showed more mature callus with partially lamellar bone formation, while a delayed fracture healing process was observed in group D and E characterized by more cartilage callus but no lamellar bone formation group. CONCLUSION Compared to normal rats, osteoporotic rats show a delayed process of fracture repair. Though simvastatin shows potential ability to prevent bone loss and thereby to promote fracture healing, the contribution is so limited that more study of simvastatin on osteoporotic fracture healing is required.OBJECTIVE To verify the delayed process of fracture healing in osteoporosis rats, as well as to investigate the effect of simvastatin on osteoprotic fracture healing. METHODS Fouty 12-week old female Sprague-Dawley rats were randomly divided into 5 groups with 8 animals in each group. All rats

  8. Spontaneous isolated midtrimester fracture of tibia and fibula in a normal fetus with in utero healing and good long-term outcome.

    Science.gov (United States)

    Scheier, M; Peter, M; Hager, C; Lang, T; Barvinek, A; Marth, C

    2010-01-01

    We report a case of spontaneous intrauterine fracture of the right tibia and fibula in an otherwise healthy fetus at 20 weeks of gestation. The fracture healed in utero in an abnormal position. Postnatal development of the baby was normal with spontaneous correction of the angulation, and no underlying disease could be discovered. Spontaneous isolated fetal fractures are rare and need to be differentiated from fractures that occur due to trauma or underlying skeletal diseases.

  9. A study of radiological features of healing in long bone fractures among infants less than a year

    Energy Technology Data Exchange (ETDEWEB)

    Warner, Christopher; Miller, Angie; Weinman, Jason; Fadell, Michael [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Maguire, Sabine; Trefan, Laszlo [Cardiff University, Institute of Primary Care and Child Health, Cardiff (United Kingdom)

    2017-03-15

    To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing. A retrospective cross-sectional time series of long bone fractures in infants aged less than 1 year was conducted from 2006 to 2013. After exclusion criteria were applied 59 digital image series were available for review from 40 infants. Utilizing published criteria for dating fractures, the presence or absence of four pre-defined features of healing was scored: periosteal reaction, callus, bridging, and remodeling. Three radiologists independently scored radiographs with a 3-point scale, marking each feature as present, absent, or equivocal. The times in days when features were first seen, peaked (feature agreed present in >40% of images), and last seen were noted. Statistical analysis using free marginal kappa was conducted. The level of agreement among the three radiologists was high (0.64-0.85). The sequence in which the features were seen was: periosteal reaction range 7-130 (present in the majority of cases between 9 and 49 days); callus range 9-130 (present in the majority of cases between days 9-26); bridging range 15-130 (seen in the majority of cases between 15 and 67 days); remodeling range 51-247 days. This study provides a timetable of radiological features of long bone healing among young infants for the first time. Dating of incomplete long bone fractures is challenging, beyond the presence of periosteal reaction, but a consistent sequence of changes is present in complete fractures. (orig.)

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

    Science.gov (United States)

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

    2016-09-01

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

  11. Fracture Toughness of Carbon Fiber Composites Containing Various Fiber Sizings and a Puncture Self-Healing Thermoplastic Matrix

    Science.gov (United States)

    Cano, Roberto J.; Grimsley, Brian W.; Ratcliffe, James G.; Gordon, Keith L.; Smith, Joseph G.; Siochi, Emilie J.

    2015-01-01

    Ongoing efforts at NASA Langley Research Center (LaRC) have resulted in the identification of several commercially available thermoplastic resin systems which self-heal after ballistic impact and through penetration. One of these resins, polybutylene graft copolymer (PBg), was selected as a matrix for processing with unsized carbon fibers to fabricate reinforced composites for further evaluation. During process development, data from thermo-physical analyses was utilized to determine a processing cycle to fabricate laminate panels, which were analyzed by photo microscopy and acid digestion. The process cycle was further optimized based on these results to fabricate panels for mechanical property characterization. The results of the processing development effort of this composite material, as well as the results of the mechanical property characterization, indicated that bonding between the fiber and PBg was not adequate. Therefore, three sizings were investigated in this work to assess their potential to improve fiber/matrix bonding compared to previously tested unsized IM7 fiber. Unidirectional prepreg was made at NASA LaRC from three sized carbon fibers and utilized to fabricate test coupons that were tested in double cantilever beam configurations to determine GIc fracture toughness.

  12. Assessment of burn depth and burn wound healing potential.

    Science.gov (United States)

    Monstrey, Stan; Hoeksema, Henk; Verbelen, Jos; Pirayesh, Ali; Blondeel, Phillip

    2008-09-01

    The depth of a burn wound and/or its healing potential are the most important determinants of the therapeutic management and of the residual morbidity or scarring. Traditionally, burn surgeons divide burns into superficial which heal by rapid re-epithelialization with minimal scarring and deep burns requiring surgical therapy. Clinical assessment remains the most frequent technique to measure the depth of a burn wound although this has been shown to be accurate in only 60-75% of the cases, even when carried out by an experienced burn surgeon. In this article we review all current modalities useful to provide an objective assessment of the burn wound depth, from simple clinical evaluation to biopsy and histology and to various perfusion measurement techniques such as thermography, vital dyes, video angiography, video microscopy, and laser Doppler techniques. The different needs according to the different diagnostic situations are considered. It is concluded that for the initial emergency assessment, the use of telemetry and simple burn photographs are the best option, that for research purposes a wide range of different techniques can be used but that, most importantly, for the actual treatment decisions, laser Doppler imaging is the only technique that has been shown to accurately predict wound outcome with a large weight of evidence. Moreover this technique has been approved for burn depth assessment by regulatory bodies including the FDA.

  13. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing

    Directory of Open Access Journals (Sweden)

    Yokoyama Kazuhiko

    2008-01-01

    Full Text Available Background: The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN by multivariate analysis. Materials and Methods: We examined 99 open tibial fractures (98 patients treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (≤6 h or> 6 h, method of soft-tissue management, skin closure time (≤1 week or> 1 week, existence of polytrauma (ISS< 18 or ISS≥18, existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Results: Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5 of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection ( P < 0.0001. In the immediate nailing group alone, the deep infection rate in type IIIB + IIIC was significantly higher than those in type I + II and IIIA ( P = 0.016. Nonunion occurred in 17 fractures (20.3%, 17/84. Multivariate analysis revealed that Gustilo type, skin closure time, and

  14. A cohesive elements based model to describe fracture and cohesive healing in elastomers

    NARCIS (Netherlands)

    Baldi, A.; Grande, A.M.; Bose, R.K.; Airoldi, A.; Garcia Espallargas, S.J.; Di Landro, L.; Van der Zwaag, S.

    2013-01-01

    Several polymeric systems with intrinsic Self-Healing (SH) capabilities have been reported in literature. Many of them showed healing upon contact across the crack interface. Different parameters such as contact time, temperature, pressure or chemical activity determine the degree of healing obtaine

  15. SDF-1/CXCR4 axis in Tie2-lineage cells including endothelial progenitor cells contributes to bone fracture healing.

    Science.gov (United States)

    Kawakami, Yohei; Ii, Masaaki; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Kuroda, Tomoya; Kwon, Sang-Mo; Kawamoto, Atsuhiko; Akimaru, Hiroshi; Mifune, Yutaka; Shoji, Taro; Fukui, Tomoaki; Kurosaka, Masahiro; Asahara, Takayuki

    2015-01-01

    CXC chemokine receptor 4 (CXCR4) is a specific receptor for stromal-derived-factor 1 (SDF-1). SDF-1/CXCR4 interaction is reported to play an important role in vascular development. On the other hand, the therapeutic potential of endothelial progenitor cells (EPCs) in fracture healing has been demonstrated with mechanistic insight of vasculogenesis/angiogenesis and osteogenesis enhancement at sites of fracture. The purpose of this study was to investigate the influence of the SDF-1/CXCR4 pathway in Tie2-lineage cells (including EPCs) in bone formation. We created CXCR4 gene conditional knockout mice using the Cre/loxP system and set two groups of mice: Tie2-Cre(ER) CXCR4 knockout mice (CXCR4(-/-) ) and wild-type mice (WT). We report here that in vitro, EPCs derived from of CXCR4(-/-) mouse bone marrow demonstrated severe reduction of migration activity and EPC colony-forming activity when compared with those derived from WT mouse bone marrow. In vivo, radiological and morphological examinations showed fracture healing delayed in the CXCR4(-/-) group and the relative callus area at weeks 2 and 3 was significantly smaller in CXCR4(-/-) group mice. Quantitative analysis of capillary density at perifracture sites also showed a significant decrease in the CXCR4(-/-) group. Especially, CXCR4(-/-) group mice demonstrated significant early reduction of blood flow recovery at fracture sites compared with the WT group in laser Doppler perfusion imaging analysis. Real-time RT-PCR analysis showed that the gene expressions of angiogenic markers (CD31, VE-cadherin, vascular endothelial growth factor [VEGF]) and osteogenic markers (osteocalcin, collagen 1A1, bone morphogenetic protein 2 [BMP2]) were lower in the CXCR4(-/-) group. In the gain-of-function study, the fracture in the SDF-1 intraperitoneally injected WT group healed significantly faster with enough callus formation compared with the SDF-1 injected CXCR4(-/-) group. We demonstrated that an EPC SDF-1/CXCR4 axis plays an

  16. Chondrocytes transdifferentiate into osteoblasts in endochondral bone during development, postnatal growth and fracture healing in mice.

    Science.gov (United States)

    Zhou, Xin; von der Mark, Klaus; Henry, Stephen; Norton, William; Adams, Henry; de Crombrugghe, Benoit

    2014-12-01

    One of the crucial steps in endochondral bone formation is the replacement of a cartilage matrix produced by chondrocytes with bone trabeculae made by osteoblasts. However, the precise sources of osteoblasts responsible for trabecular bone formation have not been fully defined. To investigate whether cells derived from hypertrophic chondrocytes contribute to the osteoblast pool in trabecular bones, we genetically labeled either hypertrophic chondrocytes by Col10a1-Cre or chondrocytes by tamoxifen-induced Agc1-CreERT2 using EGFP, LacZ or Tomato expression. Both Cre drivers were specifically active in chondrocytic cells and not in perichondrium, in periosteum or in any of the osteoblast lineage cells. These in vivo experiments allowed us to follow the fate of cells labeled in Col10a1-Cre or Agc1-CreERT2 -expressing chondrocytes. After the labeling of chondrocytes, both during prenatal development and after birth, abundant labeled non-chondrocytic cells were present in the primary spongiosa. These cells were distributed throughout trabeculae surfaces and later were present in the endosteum, and embedded within the bone matrix. Co-expression studies using osteoblast markers indicated that a proportion of the non-chondrocytic cells derived from chondrocytes labeled by Col10a1-Cre or by Agc1-CreERT2 were functional osteoblasts. Hence, our results show that both chondrocytes prior to initial ossification and growth plate chondrocytes before or after birth have the capacity to undergo transdifferentiation to become osteoblasts. The osteoblasts derived from Col10a1-expressing hypertrophic chondrocytes represent about sixty percent of all mature osteoblasts in endochondral bones of one month old mice. A similar process of chondrocyte to osteoblast transdifferentiation was involved during bone fracture healing in adult mice. Thus, in addition to cells in the periosteum chondrocytes represent a major source of osteoblasts contributing to endochondral bone formation in vivo.

  17. Time course of 25(OHD3 vitamin D3 as well as PTH (parathyroid hormone during fracture healing of patients with normal and low bone mineral density (BMD

    Directory of Open Access Journals (Sweden)

    Wöfl Christoph

    2013-01-01

    Full Text Available Abstract Background Until now the exact biochemical processes during healing of metaphyseal fractures of healthy and osteoporotic bone remain unclear. Especially the physiological time courses of 25(OHD3 (Vitamin D as well as PTH (Parathyroid Hormone the most important modulators of calcium and bone homeostasis are not yet examined sufficiently. The purpose of this study was to focus on the time course of these parameters during fracture healing. Methods In the presented study, we analyse the time course of 25(OHD3 and PTH during fracture healing of low BMD level fractures versus normal BMD level fractures in a matched pair analysis. Between March 2007 and February 2009 30 patients older than 50 years of age who had suffered a metaphyseal fracture of the proximal humerus, the distal radius or the proximal femur were included in our study. Osteoporosis was verified by DEXA measuring. The time courses of 25(OHD3 and PTH were examined over an eight week period. Friedmann test, the Wilcoxon signed rank test and the Mann-Withney U test were used as post-hoc tests. A p-value ≤ 0.05 was considered significant. Results Serum levels of 25(OHD3 showed no differences in both groups. In the first phase of fracture healing PTH levels in the low BMD level group remained below those of the normal BMD group in absolute figures. Over all no significant differences between low BMD level bone and normal BMD level bone could be detected in our study. Conclusions The time course of 25(OHD3 and PTH during fracture healing of patients with normal and low bone mineral density were examined for the first time in humans in this setting and allowing molecular biological insights into fracture healing in metaphyseal bones on a molecural level. There were no significant differences between patients with normal and low BMD levels. Hence further studies will be necessary to obtain more detailed insight into fracture healing in order to provide reliable decision criteria for

  18. An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS)

    Science.gov (United States)

    Sloan, Danetta Hendricks; BrintzenhofeSzoc, Karlynn; Kichline, Tiffany; Baker, Karen; Pinzon, Jean-Paul; Tafe, Christina; Li, Lingsheng; Cheng, M Jennifer; Berger, Ann

    2017-01-01

    Context Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS) assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho–social–spiritual homeostasis. Objective Preliminary examination of responses to items on the HEALS and examination of the factor structure. Method The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument. Results Outcome testing of sample adequacy using Kaiser–Meyer–Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach’s a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1) religion; 2) spirituality, demonstrated by a) interaction with a religious community and b) belief in higher power; 3) intrapersonal; and 4) interpersonal relationships expressed through psychological changes resulting in enhanced outlook and improvement in relationships with family and friends. Conclusion This study involved the initial step to commence the process of scale validation, with promising outcomes identifying

  19. Physician, Heal Thyself: Before You Assess Your Students, Assess Yourselves.

    Science.gov (United States)

    Kennedy, Mary Lynch

    1993-01-01

    Calls for consideration of the purposes for using student portfolios in writing classrooms. Argues that teachers refrain from using portfolios for assessing students and instead use them to assess teachers. Outlines how a portfolio approach centered on interpretive communities was used in the composition program and in academic departments at the…

  20. Interaction of age and mechanical stability on bone defect healing: an early transcriptional analysis of fracture hematoma in rat.

    Directory of Open Access Journals (Sweden)

    Andrea Ode

    Full Text Available Among other stressors, age and mechanical constraints significantly influence regeneration cascades in bone healing. Here, our aim was to identify genes and, through their functional annotation, related biological processes that are influenced by an interaction between the effects of mechanical fixation stability and age. Therefore, at day three post-osteotomy, chip-based whole-genome gene expression analyses of fracture hematoma tissue were performed for four groups of Sprague-Dawley rats with a 1.5-mm osteotomy gap in the femora with varying age (12 vs. 52 weeks - biologically challenging and external fixator stiffness (mechanically challenging. From 31099 analysed genes, 1103 genes were differentially expressed between the six possible combinations of the four groups and from those 144 genes were identified as statistically significantly influenced by the interaction between age and fixation stability. Functional annotation of these differentially expressed genes revealed an association with extracellular space, cell migration or vasculature development. The chip-based whole-genome gene expression data was validated by q-RT-PCR at days three and seven post-osteotomy for MMP-9 and MMP-13, members of the mechanosensitive matrix metalloproteinase family and key players in cell migration and angiogenesis. Furthermore, we observed an interaction of age and mechanical stimuli in vitro on cell migration of mesenchymal stromal cells. These cells are a subpopulation of the fracture hematoma and are known to be key players in bone regeneration. In summary, these data correspond to and might explain our previously described biomechanical healing outcome after six weeks in response to fixation stiffness variation. In conclusion, our data highlight the importance of analysing the influence of risk factors of fracture healing (e.g. advanced age, suboptimal fixator stability in combination rather than alone.

  1. Effect of safflower injection on lower limb fracture healing as well as blood viscosity and blood coagulation function

    Institute of Scientific and Technical Information of China (English)

    Ya-Zhong Wang; Yun Wen

    2016-01-01

    Objective:To analyze the effect of safflower injection on lower limb fracture healing as well as blood viscosity and blood coagulation function.Methods: A total of 118 patients with fracture of lower limb were randomly divided into observation group and control group (n=59), control group received conventional surgical treatment, observation group received surgery + postoperative safflower injection treatment, and then differences in serum content of bone turnover indexes and bone metabolism indexes as well as levels of thrombelastogram parameters and blood coagulation function indexes were compared between two groups after 1 month of treatment.Results:Bone turnover indexes sBAP, PINP and BGP content in serum of observation group after 1 month of treatment were higher than those of control group while sCTX, sTAP and TRAP-5b content were lower than those of control group; bone metabolism indexes Ca2+ and 25-OH-VitD content in serum were higher than those of control group while P, PTH andβ-CTX content were lower than those of control group; thrombelastogram parameters R time and K time were longer than those of control group while MA value, G value and angle level were lower than those of control group; blood coagulation function indexes PLT, FIB and D-D content in serum were lower than those of control group while PT, APTT and TT levels were higher than those of control group.Conclusions:Safflower injection can promote postoperative fracture end healing in patients with fracture of lower limb, and also plays a positive role in reducing blood viscosity and optimizing blood coagulation function.

  2. Assessment of Composite Delamination Self-Healing Via Micro-Encapsulation

    Science.gov (United States)

    O'Brien, T. Kevin; White, Scott R.

    2008-01-01

    Composite skin/stringer flange debond specimens manufactured from composite prepreg containing interleaf layers with a polymer based healing agent encapsulated in thin walled spheres were tested. As a crack develops and grows in the base polymer, the spheres fracture releasing the healing agent. The agent reacts with catalyst and polymerizes healing the crack. In addition, through-thickness reinforcement, in the form of pultruded carbon z-pins were included near the flange tips to improve the resistance to debonding. Specimens were manufactured with 14 plies in the skin and 10 plies in the stiffener flange. Three-point bend tests were performed to measure the skin/stiffener debonding strength and the recovered strength after healing. The first three tests performed indicated no healing following unloading and reloading. Micrographs showed that delaminations could migrate to the top of the interleaf layer due to the asymmetric loading, and hence, bypass most of the embedded capsules. For two subsequent tests, specimens were clamped in reverse bending before reloading. In one case, healing was observed as evidenced by healing agent that leaked to the specimen edge forming a visible "scar". The residual strength measured upon reloading was 96% of the original strength indicating healing had occurred. Hence, self-healing is possible in fiber reinforced composite material under controlled conditions, i.e., given enough time and contact with pressure on the crack surfaces. The micro-encapsulation technique may prove more robust when capsule sizes can be produced that are small enough to be embedded in the matrix resin without the need for using an interleaf layer. However, in either configuration, the amount of healing that can occur may be limited to the volume of healing agent available relative to the crack volume that must be filled.

  3. Limitations in assessment of mucosal healing in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Hugh; James; Freeman

    2010-01-01

    An emerging parameter to define the effectiveness of new therapeutic agents in clinical trials,and by extension,for use in day-to-day clinical practice has been labeled mucosal healing.It has been hypothesized that complete healing of the intestinal mucosa in inflammatory bowel diseases should result in reduced disease complications,reduced hospitalization and reduced surgical treatment.By implication,the natural history of inflammatory bowel disease might then be altered. Measurement of mucosal healing,how...

  4. Validity of bone mineral density and WHO fracture risk assessment thresholds in hip fractures.

    Science.gov (United States)

    Shahla, Ahmad

    2011-09-01

    Hip fractures are common and serious consequence of osteoporosis. Bone mineral density (BMD) measurement and the World Health Organization (WHO) fracture risk assessment tool are considered to predict the hip osteoporotic fractures. In this study, their sensitivities in hip fracture cases are evaluated. BMD and WHO probability of fracture risk were determined in 71 hip fractures ≥ 50 years of old. Totally, 65% of patients had ≤-2.5 BMD T score. 81% of patients had above the upper interventional threshold of WHO fracture risk probability model. Sensitivities were low in 50-59 year age group with progression in older age groups. Results of BMD T score and fracture risk probabilities were not significant between men and women. There were 23% and 49% sensitivities of less than or equal to -2.5 T score in the 50-59 and 60-69 year age groups with a 31% sensitivity of greater than 3% probability of hip fracture risk in the 50-59 year age group, both of which were not valid for predicting hip fracture risk.

  5. The use of wound healing assessment methods in psychological studies: a review and recommendations.

    Science.gov (United States)

    Koschwanez, Heidi E; Broadbent, Elizabeth

    2011-02-01

    To provide a critical review of methods used to assess human wound healing in psychological research and related disciplines, in order to guide future research into psychological influences on wound healing. Acute wound models (skin blister, tape stripping, skin biopsy, oral palate biopsy, expanded polytetrafluoroethylene tubing), surgical wound healing assessment methods (wound drains, wound scoring), and chronic wound assessment techniques (surface area, volumetric measurements, wound composition, and assessment tools/scoring systems) are summarized, including merits, limitations, and recommendations. Several dermal and mucosal tissue acute wound models have been established to assess the effects of psychological stress on the inflammatory, proliferative, and repair phases of wound healing in humans, including material-based models developed to evaluate factors influencing post-surgical recovery. There is a paucity of research published on psychological factors influencing chronic wound healing. There are many assessment techniques available to study the progression of chronic wound healing but many difficulties inherent to long-term clinical studies. Researchers need to consider several design-related issues when conducting studies into the effects of psychological stress on wound healing, including the study aims, type of wound, tissue type, setting, sample characteristics and accessibility, costs, timeframe, and facilities available. Researchers should consider combining multiple wound assessment methods to increase the reliability and validity of results and to further understand mechanisms that link stress and wound healing. ©2010 The British Psychological Society.

  6. [Advancement in methods of evaluation on bone fracture healing and its application in forensic medicine].

    Science.gov (United States)

    Li, Yu-fei

    2011-02-01

    It is frequently encountered to identify the time of bone fracture in forensic medicine. Hence it is important to develop the methods for evaluating the time of bone fracture. This article reviews the applications and values of the methods such as ultrasonic evaluation, impulse measurement, digital imaging technology and bone mineral density testing technology, etc. It is proposed that to use these methods jointly may provide more scientific evidence in determine the time of bone fracture.

  7. Demineralized Bone Matrix Add-On for Acceleration of Bone Healing in Atypical Subtrochanteric Femoral Fracture: A Consecutive Case-Control Study

    Directory of Open Access Journals (Sweden)

    Noratep Kulachote

    2016-01-01

    Full Text Available Background. Delayed union and nonunion are common complications in atypical femoral fractures (AFFs despite having good fracture fixation. Demineralized bone matrix (DBM is a successfully proven method for enhancing fracture healing of the long bone fracture and nonunion and should be used in AFFs. This study aimed to compare the outcome after subtrochanteric AFFs (ST-AFFs fixation with and without DBM. Materials and Methods. A prospective study was conducted on 9 ST-AFFs patients using DBM (DBM group during 2013-2014 and compared with a retrospective consecutive case series of ST-AFFs patients treated without DBM (2010–2012 (NDBM group, 9 patients. All patients were treated with the same standard guideline and followed up until fractures completely united. Postoperative outcomes were then compared. Results. DBM group showed a significant shorter healing time than NDBM group (28.1 ± 14.4 versus 57.9 ± 36.8 weeks, p=0.04. Delayed union was found in 4 patients (44% in DBM group compared with 7 patients (78% in NDBM group (p>0.05. No statistical difference of nonunion was demonstrated between both groups (DBM = 1 and NDBM = 2, p>0.05. Neither postoperative infection nor severe local tissue reaction was found. Conclusions. DBM is safe and effective for accelerating the fracture healing in ST-AFFx and possibly reduces nonunion after fracture fixation. Trial registration number is TCTR20151021001.

  8. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process.

    Science.gov (United States)

    Liu, Chng-Kui; Liu, Ping; Meng, Fan-Wen; Deng, Bang-Lian; Xue, Yang; Mao, Tian-Qiu; Hu, Kai-Jin

    2012-06-01

    The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

  9. Direct tensile test to assess healing in asphalt

    NARCIS (Netherlands)

    Leegwater, G.A.; Scarpas, T.; Erkens, S.

    2016-01-01

    Asphalt concrete has the advantageous ability to heal. During rest periods, damage present in the material is restored to a certain extent. Healing of the material can be observed in its regaining of strength and stiffness after rest periods. In this paper, a new test method is presented. It was

  10. An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS

    Directory of Open Access Journals (Sweden)

    Sloan DH

    2017-02-01

    Full Text Available Danetta Hendricks Sloan,1 Karlynn BrintzenhofeSzoc,2 Tiffany Kichline,1 Karen Baker,1 Jean-Paul Pinzon,1 Christina Tafe,1 Lingsheng Li,1 M Jennifer Cheng,1 Ann Berger1 1Pain and Palliative Care, National Institutes of Health, Clinical Center, Bethesda, MD, 2School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA Context: Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho–social–spiritual homeostasis.Objective: Preliminary examination of responses to items on the HEALS and examination of the factor structure.Method: The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument.Results: Outcome testing of sample adequacy using Kaiser–Meyer–Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach’s a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1 religion; 2 spirituality, demonstrated by a

  11. Genetic profiling and individualized assessment of fracture risk.

    Science.gov (United States)

    Nguyen, Tuan V; Eisman, John A

    2013-03-01

    Osteoporosis and its consequence of fragility fracture impose a considerable demand on health-care services because fracture is associated with a series of adverse events, including re-fracture and mortality. One of the major priorities in osteoporosis care is the development of predictive models to identify individuals at high risk of fracture for early intervention and management. Existing predictive models include clinical factors and anthropometric characteristics but have not considered genetic variants in the prediction. Genome-wide association studies conducted in the past decade have identified several genetic variants relevant to fracture risk. These genetic variants are common in frequency but have very modest effect sizes. A remaining challenge is to use these genetic data to individualize fracture risk assessment on the basis of an individual's genetic risk profile. Empirical and simulation studies have shown that the usefulness of a single genetic variant for fracture risk assessment is very limited, but a profile of 50 genetic variants, each with odds ratio ranging from 1.02 to 1.15, could improve the accuracy of fracture prediction beyond that obtained by use of existing clinical risk factors. Thus, genetic profiling when integrated with existing risk assessment models could inform a more accurate prediction of fracture risk in an individual.

  12. Research progress in mechanism of traumatic brain injury affecting speed of fracture healing

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xiao-gang; ZHAO Guang-feng; MA Yue-feng; JIANG Guan-yu

    2007-01-01

    @@ In patients who have sustained traumatic brain injury with associated extremity fracture, there is often a clinical perception that the rate of new bone formation around the fracture site increases. 1 An overgrowth of callus is observed and ectopic ossification even occurs in the muscle,2 but the mechanism remains unclear.

  13. Assessment of Composite Delamination Self-Healing Under Cyclic Loading

    Science.gov (United States)

    O'Brien, T. Kevin

    2009-01-01

    Recently, the promise of self-healing materials for enhanced autonomous durability has been introduced using a micro-encapsulation technique where a polymer based healing agent is encapsulated in thin walled spheres and embedded into a base polymer along with a catalyst phase. For this study, composite skin-stiffener flange debonding specimens were manufactured from composite prepreg containing interleaf layers with a polymer based healing agent encapsulated in thin-walled spheres. Constant amplitude fatigue tests in three-point bending showed the effect of self-healing on the fatigue response of the skin-stiffener flange coupons. After the cycling that created debonding, fatigue tests were held at the mean load for 24 hours. For roughly half the specimens tested, when the cyclic loading was resumed a decrease in compliance (increase in stiffness) was observed, indicating that some healing had occurred. However, with continued cycling, the specimen compliance eventually increased to the original level before the hold, indicating that the damage had returned to its original state. As was noted in a prevoius study conducted with specimens tested under monotonically increasing loads to failure, healing achieved via the micro-encapsulation technique may be limited to the volume of healing agent available relative to the crack volume.

  14. 失神经对大鼠胫骨骨折愈合影响作用的实验研究%Experimental Study of Denervation of Rat Tibial Fracture Healing Effect

    Institute of Scientific and Technical Information of China (English)

    王永红; 汪玉良; 吴卓; 康学文; 康鑫

    2015-01-01

    目的:通过观察失神经后大鼠胫骨骨折的愈合情况,探讨中枢神经系统影响失神经骨折愈合的作用机制。方法将64只 SD 成熟雌性大鼠随机分为失神经骨折组、单纯骨折组,每组各32只。分别于术后第7、14、21、28天进行 BBB 评分,观察骨折愈合情况,并行左下肢骨折部位 X 线检查、胫骨湿重称量、骨痂体积测量,进行相关统计学分析。结果 BBB 行为学评分提示两组大鼠在术后各时间点具有统计学意义(P <0.05)。通过比较失神经骨折组与单纯骨折组 BBB 评分结果,提示在术后各时间点,失神经骨折组大鼠运动功能恢复速度明显减慢。X 线片提示失神经骨折组大鼠骨折处有大量骨痂生成,且愈合速度明显加快。在术后7天,两组大鼠胫骨湿重称量、骨痂体积测量则无统计学意义(P >0.05),而在术后14至28天,失神经骨折组与单纯骨折组相比,胫骨湿重称量、骨痂体积测量分别具有统计学意义(P <0.05),提示在失神经骨折中晚期会生成过量骨痂。结论中枢神经系统在骨折愈合中起重要的调节作用,完整的神经支配是骨折愈合的必要条件。%Objective By observing the healing after denervation of rat tibial fractures to investigate the mechanism of the central nervous system denervation affect fracture healing.Methods The 64 mature female SD rats were randomly divided into 2 groups including denervation fractures and fracture group,32 in each group.7,14,21 and 28 days after surgery,re-spectively,to assess the BBB score,fracture healing was observed,and in the left lower limb fracture site X-ray examination, tibia wet weighing callus volume measurement,the related statistical analysis was carried.Results The BBB behavioral scores showed two groups of rats at various time points after surgery have statistically significant (P 0.05),and in 14 to 28 days after surgery

  15. Radiographic evaluation of fracture healing after rigid plate fixation. Experiments in the rabbit

    Energy Technology Data Exchange (ETDEWEB)

    Paavolainen, P.; Karaharju, E.; Slaetis, P.; Waris, P. (Helsinki Univ. Central Hospital (Finland). Meilahti Clinic)

    1981-01-01

    Experimental osteotomies were made in 35 rabbit tibio-fibular bones and fixed with rigid stainless steel osteosynthesis plates (DCP/ASIF). The radiographic and histopathologic appearances in the healing osteotomies and adjacent bone were analysed at intervals from 3 up to 24 weeks postoperatively. Radiologically the osteotomy had closed at 9 weeks and microscopically this could be confirmed as longitudinal orientation of the cutter heads across the osteotomy gap with longitudinal orientation of the bone structure. The healing of the osteotomy was accompanied by gross structural changes in the adjacent cortical bone with loss of intracortical and subendosteal osteons, cementing lines and intermediate tissue between the osteons. This was characterized by decreasing attenuation of the cortical bone after healing of the osteotomy and should clinically be regarded as an indication for removal of the implant.

  16. The effect of PTH(1-34) on fracture healing during different loading conditions

    DEFF Research Database (Denmark)

    Ellegaard, Maria; Kringelbach, Tina; Syberg, Susanne

    2013-01-01

    . Five days before fracture, half of the animals received Botulinum Toxin A injections in the muscles of the fractured leg to induce muscle paralysis (unloaded group), whereas the other half received saline injections (control group). For the following 8 weeks, half of the animals in each group received...... and control animals. PTH(1-34) treatment increased ultimate force of the fracture by 63% in both control and unloaded animals and no interaction of the two interventions could be detected. PTH(1-34) was able to stimulate bone formation in normally loaded as well as unloaded intact bone. In conclusion...

  17. Fracture healing and transport properties of wellbore cement in the presence of supercritical CO2

    NARCIS (Netherlands)

    Liteanu, E.; Spiers, C.J.

    2011-01-01

    This paper investigates the process and rate of carbonation reaction of Class A wellbore cement exposed to CO2-saturated solution at confined conditions similar to those employed in geological storage of CO2. The main goal was to investigate whether reaction improves or degrades the sealing/healing

  18. Pharmacological agents and impairment of fracture healing: what is the evidence?

    NARCIS (Netherlands)

    Pountos, I.; Georgouli, T.; Blokhuis, T.J.; Pape, H.C.; Giannoudis, P.V.

    2008-01-01

    Bone healing is an extremely complex process which depends on the coordinated action of several cell lineages on a cascade of biological events, and has always been a major medical concern. The use of several drugs such as corticosteroids, chemotherapeutic agents, non-steroidal anti-inflammatory dru

  19. Dynamic Loading Assessment at the Fifth Metatarsal in Elite Athletes with a history of Jones Fracture

    Science.gov (United States)

    Hunt, Kenneth; Goeb, Yannick

    2016-01-01

    Objectives: Fractures of the proximal metaphysis of the fifth metatarsal (i.e., Jones fractures) are common in the athletic population and frequently require surgical fixation to optimize healing rates and return to sport. Subtle hindfoot varus alignment, which likely results in greater forces at the fifth metatarsal, has been associated with increased risk of Jones fractures due to presumed increase in forces on the lateral foot. The goal of the present study was to dynamically assess plantar pressure loads at the fifth metatarsal in elite athletes with a history of Jones fracture. We hypothesize that athletes who have suffered Jones fractures will apply significantly higher loads at the fifth metatarsal base during athletic activities compared to matched uninjured athletes. Methods: Sixteen elite, competitive athletes were recruited to participate. Eight athletes had a history of Jones fracture and eight age, gender and position-matched athletes without a history of foot injury were recruited as controls. While wearing calibrated, wireless pressure mapping insoles, all athletes performed a standardized series of athletic movements including walking, running and cutting. Tests were repeated with the patient’s standard corrective insole. Peak pressure, mean pressure, maximum force, and force-time integral (i.e., impulse) were recorded for each activity. Comparison between groups was performed using a paired Wilcoxon Sign Rank test. Results: Athletes with a history of Jones fracture showed a significantly increased peak pressure (183 ±23 kPA vs. 138±7 kPA), mean pressure (124±14 kPA vs. 95±4 kPA), and maximum force (15±1.2%BW vs. 12±1.2%BW) at the fifth metatarsal base during walking and running compared to uninjured matched controls (all Pinsole did not significantly reduce peak or mean pressure, maximum force, or impulse at the fifth metatarsal base during running or cutting. Conclusion: Athletes with a history of Jones fracture exert significantly

  20. Quantitative assessment of wound healing using high-frequency ultrasound image analysis.

    Science.gov (United States)

    Mohafez, H; Ahmad, S A; Hadizadeh, M; Moghimi, S; Roohi, S A; Marhaban, M H; Saripan, M I; Rampal, S

    2017-05-29

    We aimed to develop a method for quantitative assessment of wound healing in ulcerated diabetic feet. High-frequency ultrasound (HFU) images of 30 wounds were acquired in a controlled environment on post-debridement days 7, 14, 21, and 28. Meaningful features portraying changes in structure and intensity of echoes during healing were extracted from the images, their relevance and discriminatory power being verified by analysis of variance. Relative analysis of tissue healing was conducted by developing a features-based healing function, optimised using the pattern-search method. Its performance was investigated through leave-one-out cross-validation technique and reconfirmed using principal component analysis. The constructed healing function could depict tissue changes during healing with 87.8% accuracy. The first principal component derived from the extracted features demonstrated similar pattern to the constructed healing function, accounting for 86.3% of the data variance. The developed wound analysis technique could be a viable tool in quantitative assessment of diabetic foot ulcers during healing. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. The impact of low-magnitude high-frequency vibration on fracture healing is profoundly influenced by the oestrogen status in mice

    Directory of Open Access Journals (Sweden)

    Esther Wehrle

    2015-01-01

    Full Text Available Fracture healing is impaired in aged and osteoporotic individuals. Because adequate mechanical stimuli are able to increase bone formation, one therapeutical approach to treat poorly healing fractures could be the application of whole-body vibration, including low-magnitude high-frequency vibration (LMHFV. We investigated the effects of LMHFV on fracture healing in aged osteoporotic mice. Female C57BL/6NCrl mice (n=96 were either ovariectomised (OVX or sham operated (non-OVX at age 41 weeks. When aged to 49 weeks, all mice received a femur osteotomy that was stabilised using an external fixator. The mice received whole-body vibrations (20 minutes/day with 0.3 g peak-to-peak acceleration and a frequency of 45 Hz. After 10 and 21 days, the osteotomised femurs and intact bones (contra-lateral femurs, lumbar spine were evaluated using bending-testing, micro-computed tomography (μCT, histology and gene expression analyses. LMHFV disturbed fracture healing in aged non-OVX mice, with significantly reduced flexural rigidity (−81% and bone formation (−80% in the callus. Gene expression analyses demonstrated increased oestrogen receptor β (ERβ, encoded by Esr2 and Sost expression in the callus of the vibrated animals, but decreased β-catenin, suggesting that ERβ might mediate these negative effects through inhibition of osteoanabolic Wnt/β-catenin signalling. In contrast, in OVX mice, LMHFV significantly improved callus properties, with increased flexural rigidity (+1398% and bone formation (+637%, which could be abolished by subcutaneous oestrogen application (0.025 mg oestrogen administered in a 90-day-release pellet. On a molecular level, we found an upregulation of ERα in the callus of the vibrated OVX mice, whereas ERβ was unaffected, indicating that ERα might mediate the osteoanabolic response. Our results indicate a major role for oestrogen in the mechanostimulation of fracture healing and imply that LMHFV might only be safe and

  2. BMP-7 stimulates early diaphyseal fracture healing in estrogen deficient rats

    NARCIS (Netherlands)

    Blokhuis, T.J.; Buma, P.; Verdonschot, N.J.J.; Gotthardt, M.; Hendriks, T.

    2012-01-01

    Estrogen deficiency causes postmenopausal osteoporosis. The relationship between estrogen deficiency and the high failure rate after osteoporotic fracture treatment is unclear, as is the effect of possible interventions, either with anti-resorptive agents or with anabolic agents such as bone morphog

  3. BMP-7 stimulates early diaphyseal fracture healing in estrogen deficient rats.

    NARCIS (Netherlands)

    Blokhuis, T.J.; Buma, P.; Verdonschot, N.J.; Gotthardt, M.; Hendriks, T.

    2012-01-01

    Estrogen deficiency causes postmenopausal osteoporosis. The relationship between estrogen deficiency and the high failure rate after osteoporotic fracture treatment is unclear, as is the effect of possible interventions, either with anti-resorptive agents or with anabolic agents such as bone morphog

  4. New unified fracture toughness estimation scheme for structural integrity assessment

    Energy Technology Data Exchange (ETDEWEB)

    Wallin, K.; Nevasmaa, P. [VTT, Espoo (Finland); Bannister, A. [Research and Development, British Steel plc., Swinden Technology Centre Rotherham (United Kingdom)

    1998-12-31

    At present, treatment of fracture toughness data varies depending on the type of data (K{sub IC}, J, CTOD) that are available for fracture mechanics analysis. This complicates structural integrity assessment and makes it difficult to apply any single, unified procedure. Within the Brite-Euram project `SINTAP` a fracture toughness estimation scheme has been developed for the unified treatment of data for use in structural integrity assessment. As a procedure, it can be applied to Charpy data, as well as to fracture toughness data, and is suitable for the treatment of data at both single and different temperatures. The data sets may contain results from both homogeneous and inhomogeneous material, making the procedure applicable also to welded joints. The procedure allows fracture toughness assessment with quantified probability and confidence levels. Irrespective of the type of the original data, one material-specific K{sub mat} value representing a conservative estimate of the mean fracture toughness is obtained (with its probability distribution). This information can then be applied to structural integrity assessment. (orig.) 4 refs.

  5. Observations concerning different patterns of bone healing using the Point Contact Fixator (PC-Fix) as a new technique for fracture fixation.

    Science.gov (United States)

    Hofer, H P; Wildburger, R; Szyszkowitz, R

    2001-09-01

    The recent trend in all surgical disciplines has been the development of techniques in minimally invasive surgery and the optimal maintenance of the blood supply to the bone fragments during osteosynthesis. Currently, the Point Contact Fixator (PC-Fix) has been introduced as a new implant for the stabilization of forearm bones. This plate-like splint and screw fixation system, which actually acts as an internal fixator, is characterized by minimized isolated contacts to the bone and proven angular stability of the monocortically locked screws. By using the PC-Fix, a further reduction of damage to the blood supply to the bone is achieved. Since 1994, 38 patients have been treated with this new device; we have reviewed the radiographs of 52 consolidated forearm fractures/osteotomies in accordance with the patterns of bone healing associated with the different methods of implant application according to the fracture type. In the groups in which traditionally precise reduction, interfragmentary compression and stable fixation was achieved (N=31), we found in 71% an absence of periosteal callus (direct bone healing). In the groups in which compression and adaptation were combined, or even main fragments adapted without compression, with wedges remaining unreduced in soft tissue connection (N=21), we found a visible external callus in 81% (indirect healing) (P = 0.002). Indirect healing after internal fixation is no longer regarded as a disturbance to healing, but is a goal in itself. The appearance of callus is a welcome sign indicating a prompt and positive reaction in the course of bone union which will lead to progressive fracture immobilization. When using the PC-Fix in a "biological way", callus formation and solid union take place earlier than in conventional plating. The new internal fixator offers substantial technical and mechanical advantages in fracture treatment. Therefore, it is an ideal implant to satisfy the requirements of modern biological

  6. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    revascularization process and better healing of fractures. Patients with these fractures should be on longer non-weight bearing ambulation than other patients. To conclude, the dynamic MRI seems to be reliable, non-invasive, sensitive, specific and accurate method of assessing the femoral head vascularity after intracapsular femoral neck fractures as early as 48 h of injury and to predict the outcome of fractures and may be used as a guideline for management of intracapsular femoral neck fractures.

  7. Quality of Bone Healing: Perspectives and Assessment Techniques

    Science.gov (United States)

    2014-01-01

    from nails and screws to dental prostheses and total joint replacements. Direct mechanical testing The true efficacy of bone regeneration can be...method of choice to image bone fluid flow and permeability in vivo61 which is a strong indicator of a successful bone healing response. MRI is also...Bone permeability Fluid transport within bone is not usually estimated in a clinical setting. Recent advances in MRI and positron emis- sion

  8. Bone stimulation for fracture healing: What′s all the fuss?

    Directory of Open Access Journals (Sweden)

    Victoria Galkowski

    2009-01-01

    Full Text Available Approximately 10% of the 7.9 million annual fracture patients in the United States experience nonunion and/or delayed unions, which have a substantial economic and quality of life impact. A variety of devices are being marketed under the name of "bone growth stimulators." This article provides an overview of electrical and electromagnetic stimulation, ultrasound, and extracorporeal shock waves. More research is needed for knowledge of appropriate device configurations, advancement in the field, and encouragement in the initiation of new trials, particularly large multicenter trials and randomized control trials that have standardized device and protocol methods.

  9. Melt fracturing and healing: A mechanism for degassing and origin of silicic obsidian

    Science.gov (United States)

    Cabrera, A.; Weinberg, R.F.; Wright, H.M.N.; Zlotnik, S.; Cas, Ray A.F.

    2011-01-01

    We present water content transects across a healed fault in pyroclastic obsidian from Lami pumice cone, Lipari, Italy, using synchrotron Fourier transform infrared spectroscopy. Results indicate that rhyolite melt degassed through the fault surface. Transects define a trough of low water content coincident with the fault trace, surrounded on either side by high-water-content plateaus. Plateaus indicate that obsidian on either side of the fault equilibrated at different pressure-temperature (P-T) conditions before being juxtaposed. The curves into the troughs indicate disequilibrium and water loss through diffusion. If we assume constant T, melt equilibrated at pressures differing by 0.74 MPa before juxtaposition, and the fault acted as a low-P permeable path for H2O that diffused from the glass within time scales of 10 and 30 min. Assuming constant P instead, melt on either side could have equilibrated at temperatures differing by as much as 100 ??C, before being brought together. Water content on the fault trace is particularly sensitive to post-healing diffusion. Its preserved value indicates either higher temperature or lower pressure than the surroundings, indicative of shear heating and dynamic decompression. Our results reveal that water contents of obsidian on either side of the faults equilibrated under different P-T conditions and were out of equilibrium with each other when they were juxtaposed due to faulting immediately before the system was quenched. Degassing due to faulting could be linked to cyclical seismic activity and general degassing during silicic volcanic activity, and could be an efficient mechanism of producing low-water-content obsidian. ?? 2011 Geological Society of America.

  10. Clinical assessment tools identify functional deficits in fragility fracture patients

    Directory of Open Access Journals (Sweden)

    Ames TD

    2016-05-01

    Full Text Available Tyler D Ames,1 Corinne E Wee,1 Khoi M Le,1 Tiffany L Wang,1 Julie Y Bishop,2 Laura S Phieffer,2 Carmen E Quatman2 1The Ohio State University College of Medicine, 2Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA Purpose: To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.Patients and methods: Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB, handgrip strength (handheld dynamometer, and lumbopelvic control (iPod Touch Level Belt, which were compared between fragility fracture patients and healthy controls.Results: Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042 and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026 when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020 and total components (P=0.010 of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003.Conclusion: The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls. Keywords: fall risk, geriatric fracture, Nintendo Wii Balance Board, Level Belt, fragility fracture

  11. A novel coupled system of non-local integro-differential equations modelling Young's modulus evolution, nutrients' supply and consumption during bone fracture healing

    Science.gov (United States)

    Lu, Yanfei; Lekszycki, Tomasz

    2016-10-01

    During fracture healing, a series of complex coupled biological and mechanical phenomena occurs. They include: (i) growth and remodelling of bone, whose Young's modulus varies in space and time; (ii) nutrients' diffusion and consumption by living cells. In this paper, we newly propose to model these evolution phenomena. The considered features include: (i) a new constitutive equation for growth simulation involving the number of sensor cells; (ii) an improved equation for nutrient concentration accounting for the switch between Michaelis-Menten kinetics and linear consumption regime; (iii) a new constitutive equation for Young's modulus evolution accounting for its dependence on nutrient concentration and variable number of active cells. The effectiveness of the model and its predictive capability are qualitatively verified by numerical simulations (using COMSOL) describing the healing of bone in the presence of damaged tissue between fractured parts.

  12. Risk Assessment in Fractured Clayey Tills - Which Modeling Tools?

    DEFF Research Database (Denmark)

    Chambon, Julie Claire Claudia; Bjerg, Poul Løgstrup; Binning, Philip John

    2012-01-01

    assessment is challenging and the inclusion of the relevant processes is difficult. Furthermore the lack of long-term monitoring data prevents from verifying the accuracy of the different conceptual models. Further investigations based on long-term data and numerical modeling are needed to accurately......The article presents different tools available for risk assessment in fractured clayey tills and their advantages and limitations are discussed. Because of the complex processes occurring during contaminant transport through fractured media, the development of simple practical tools for risk...

  13. Quantitative NDI integration with probabilistic fracture mechanics for the assessment of fracture risk in pipelines

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, Jochen H.; Cioclov, Dragos; Dobmann, Gerd; Boiler, Christian [Fraunhofer Inst. fuer Zerstoerungsfreie Pruefverfahren (IZFP), Saarbruecken (Germany)

    2009-07-01

    In the context of probabilistic paradigm of fracture risk assessment in structural components a computer simulation rationale is presented which has at the base the integration of Quantitative Non-destructive Inspection and Probabilistic Fracture Mechanics. In this study the static failure under static loading is assessed in the format known as Failure Assessment Diagram (FAD). The key concept in the analysis is the stress intensity factor (SIF) which accounts on the geometry of the component and the size of a pre-existent defect of a crack nature. FAD assessments can be made in deterministic sense, which yields the end result in dual terms of fail/not-fail. The fracture risk is evaluated in probabilistic terms. The superposed probabilistic pattern over the deterministic one (in mean sense) is implemented via Monte-Carlo sampling. The probabilistic fracture simulation yields a more informative analysis in terms of probability of failure. An important feature of the PVrisk software is the ability to simulate the influence of the quality and reliability of non-destructive inspection (NDI). It is achieved by integrating, algorithmically. probabilistic FAD analysis and the Probability of Detection (POD). The POD information can only be applied in a probabilistic analysis and leads to a refinement of the assessment. By this means, it can be ascertained the decrease of probability of failure (increase of reliability) when POD-characterized NDI is applied. Therefore, this procedure can be used as a tool for inspection based life time conceptions. In this paper results of sensitivity analyses of the fracture toughness are presented with the aim to outline, in terms of non-failure probabilities, the benefits of applying NDI, in various qualities, in comparison with the situation when NDI is lacking. (orig.)

  14. The 9/11 Decade: Social Imaginary and Healing Virtual Community Fracture

    Directory of Open Access Journals (Sweden)

    Charles A. Hays

    2011-01-01

    Full Text Available The initial events of 9/11 broke upon the awareness of people who turned first to traditional media for information, then to their networks of distant others when traditional media could not meet their needs. This study looks at two online community groups on Usenet. Though other technologies have supplanted Usenet to some degree, it provided a vibrant means of asynchronously connecting people interested in online discussion. As community members expressed their shock and horror, they also acted out the process of repairing the radical fracture to their virtual communal identity. The process by which they enacted this repair embodies a social imaginary, and is generally called “community repair”. This study finds that the process of community repair is very much driven by the culture inherent in the sodality represented by the participants to each newsgroup, reflecting the values that participants have communally agreed to hold valuable.

  15. Low-intensity pulsed ultrasound increases bone volume, osteoid thickness and mineral apposition rate in the area of fracture healing in patients with a delayed union of the osteotomized fibula

    NARCIS (Netherlands)

    Rutten, S.; Nolte, P.A.; Korstjens, C.M.; van Duin, M.A.; Klein-Nulend, J.

    2008-01-01

    Introduction Low-intensity pulsed ultrasound (LIPUS) accelerates impaired fracture healing, but the exact mechanism is unknown. The aim of this study was to investigate how LIPUS affects bone healing at the tissue level in patients with a delayed union of the osteotomized fibula, by using histology

  16. The use of MTA/blood mixture to induce hard tissue healing in a root fractured maxillary central incisor. Case report and treatment considerations.

    Science.gov (United States)

    Chaniotis, A

    2014-10-01

    To report the use of MTA/blood mixture for the induction of hard tissue healing of multiple horizontal root fractures in a maxillary incisor. An 18-year-old male patient was referred after suffering trauma to the anterior maxilla. Radiographic evaluation revealed multiple horizontal fractures in the middle and cervical third of his maxillary right central incisor. Clinical evaluation revealed third grade mobility of the coronal segment. The patient's accompanying radiographs revealed that root canal treatment of all segments had been previously initiated and both segments had been rendered pulpless. The coronal segment was repositioned and stabilized. A bi-antibiotic mixture, containing equal parts of ciprofloxacin and metronidazole, was used for the disinfection of the root canal segments. A blood clot was induced from the periapical area and MTA powder was mixed with the blood creating a bioceramic mixture covering all the fractures. Thick MTA was placed as a coronal barrier and the tooth was restored. Recall examination after 24 months revealed healing of the horizontal fractures. The MTA mixed with the blood lost its radio-opacity over time. Tooth mobility returned to normal limits. A low range of 5-25% of all horizontally root fractured cases develop pulp necrosis, confined in the coronal segment, leaving the apical segment with vital tissue. In the unfortunate situation that the pulp of both segments becomes necrotic or the entire pulp tissue is removed, the use of MTA/blood mixture may be beneficial for the induction of hard tissue healing. MTA when mixed with blood seems to lose its radio-opacity over time. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  17. Fracture Assessment of Strengthened Cracked Metallic Components Using FRP Stiffeners

    Science.gov (United States)

    Ahmed, W. K.; Mourad, A.-H. I.

    2015-07-01

    The present study focuses on applying the fracture mechanics approach to the fracture assessment of a cracked member/component strengthened with fiber-reinforced polymer composite stiffeners. The parameters of linear elastic fracture mechanics (LEFM) — the stress intensity factor and the crack opening displacement — are estimated using a finite-element analysis. A metallic plate with an edge crack repaired with fiber-reinforced polymer composite stiffeners is considered in the study. The effects of crack length, debonding length, and adhesive stiffness on the LEFM parameters are examined. Two different loading conditions are considered — axial tension and bending. The results obtained show that fiber-reinforced polymer composite stiffeners are very useful in repairing cracked metallic components.

  18. EXPERIMENTAL ANALYSIS OF THE HEALING PROCESS IN THE AREA OF TIBIAL BONE FRACTURE

    Directory of Open Access Journals (Sweden)

    I. F. Аkhtyamov

    2016-01-01

    Full Text Available Purpose. To quantify the density of the cortical bone of the tibia in the area of reparative regeneration and the state of the vascular bed (hemodynamics of the operated limb under intramedullary osteosynthesis using pins coated with titanium and hafnium nitrides. Materials and methods. In the experiment, changes in the bone density and the characteristics of the local blood supply were studied on 40 outbred rabbits which underwent intramedullary osteosynthesis by the use of pins with a nanocoating based on superhard compounds which consist of titanium and hafnium nitrides and pins without a coating. Using color Doppler mode helped to evaluate the condition of the vascular bed proximally to the fracture site. Results. It is noted that the use of pins with the described coating above did not violate the osteoregeneration staging. The density of the cortical bone in the test group exceeded that of the comparison group by an average of 30%. Bone remodeling processes in the test group completed at an earlier date, as determined by the higher rates of its density. In the study of the vascular bed of the operated limb, it was found that on the 10th day of the experiment, an increase in the maximal velocity of the blood flow was recorded (TAMAX. In animals of the test group this index approached preoperative values on the 30th day, while in animals of the comparison group this index approached the initial values only by the 60th day. Conclusion. The use of implants coated with titanium and hafnium nitrides which are characterized by high strength, thermal and chemical stability is accompanied by the formation of a cortical bone in the area of osteotomy with higher density characteristics. The changes which are typical of the vasodilatation in the area of injury in the early postoperative period can be regarded as a positive factor in the formation of primary bone union. In the group where implants coated with titanium and hafnium nitrides were used

  19. [The Helkimo index for assessing treatment results after mandibular fractures].

    Science.gov (United States)

    Härtel, J; Hellmuth, M; Hellmuth, K O

    1991-01-01

    Based on the Helkimo index we assessed the success of conservative and conservative-surgical forms of treatment for mandibular fractures in a total of 166 patients. The control group consisted of 50 probands. The Helkimo dysfunction index, which is based on various criteria, showed dysfunction in 81.9% of the patients with only slight functional impairment in 57.2% of these cases. 18.1% of the patients were clinically symptom-free. A comparison with the probands revealed no major differences in dysfunction between the two groups. Significant differences were observed only in the case of 2 isolated criteria (maximum mandibular protrusion, muscle pain). Severe dysfunction, however, was more common in the fracture patients. Based on the Helkimo occlusion index disorder were noted in 91.7% of the patients, while severe occlusion disorder were observed particularly in patients with combined mandibular body and condyle fractures (40.0%). In the control group a more favorable occlusion index was found to be due mainly to the greater number of present and/or occluding teeth. The Helkimo index, particularly the dysfunctionindex, is a very useful instrument for assessing the success of treatment measures in mandibular fracture cases. It should be more commonly used to improve the possibilites of objective comparisons between patients from different hospitals.

  20. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

    Halliday, K.E., E-mail: kath.halliday@nuh.nhs.uk [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Broderick, N.J.; Somers, J.M. [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Hawkes, R. [Department of Radiology, Paul O' Gorman Building, Bristol (United Kingdom)

    2011-11-15

    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  1. Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws.

    Directory of Open Access Journals (Sweden)

    Anica Eschler

    Full Text Available There is a high incidence of vertebral burst fractures following low velocity trauma in the elderly. Treatment of unstable vertebral burst fractures using the same principles like in stable vertebral burst fractures may show less favourable results in terms of fracture reduction, maintenance of reduction and cement leakage. In order to address these shortcomings this study introduces cementless fixation of unstable vertebral burst fractures using internal fixators and expandable intravertebral titanium mesh cages in a one-stage procedure via minimum-invasive techniques.A total of 16 consecutive patients (median age 76 years, range 58-94 with unstable thoracolumbar burst fractures and concomitant osteoporosis were treated by an internal fixator inserted via minimum invasive technique one level above and below the fractured vertebra. Fracture reduction was achieved and maintained by transpedicular placement of two titanium mesh cages into the fractured vertebral body during the same procedure. Intra- and postoperative safety of the procedure as well as analysis of reduction quality was analysed by 3D C-arm imaging or CT, respectively. Clinical and radiographic follow-up averaged 10.4 months (range 4.5-24.5.Stabilization of the collapsed vertebral body was achieved in all 16 cases without any intraoperative complication. Surgical time averaged 102 ± 6.6 minutes (71-194. The postoperative kyphotic angle (KA and Cobb angle revealed significant improvements (KA 13.7° to 7.4°, p < 0.001; Cobb 9.6° to 6.0°, p < 0.002 with partial loss of reduction at final follow-up (KA 8.3°, Cobb 8.7°. VAS (Visual Analogue Scale improved from 7.6 to 2.6 (p < 0.001. Adjacent fractures were not observed. One minor (malposition of pedicle screw complication was encountered.Cementless fixation of osteoporotic burst fractures revealed substantial pain relief, adequate maintenance of reduction and a low complication rate. Bony healing after unstable osteoporotic burst

  2. The fracture risk assessment tool (FRAX® score in subclinical hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Polovina Snežana

    2015-01-01

    Full Text Available Background/Aim. The Fracture Risk Assessment Tool (FRAX® score is the 10-year estimated risk calculation tool for bone fracture that includes clinical data and hip bone mineral density measured by dual-energy x-ray absorptiometry (DXA. The aim of this cross-sectional study was to elucidate the ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and post-menopausal women with subclinical hyperthyroidism. Methods. The bone mineral density (by DXA, thyroid stimulating hormone (TSH level, free thyroxine (fT4 level, thyroid peroxidase antibodies (TPOAb titre, osteocalcin and beta-cross-laps were measured in 27 pre- and post-menopausal women with newly discovered subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI 27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause onset in 48.53 ± 4.58 years. The etiology of subclinical hyperthyroisims was autoimmune thyroid disease or toxic goiter. FRAX® score calculation was performed in both groups. Results. In the group with subclinical hyperthyroidism the main FRAX® score was significantly higher than in the controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015. The FRAX® score for hip was also higher in the evaluated group than in the controls (1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022. There was no correlations between low TSH and fracture risk (p > 0.05. The ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and postmenopausal female subjects (p < 0.001 is presented by the area under the curve (AUC plotted via ROC analysis. The determined FRAX score cut-off value by this analysis was 6%, with estimated sensitivity and specificity of 95% and 75.9%, respectively. Conclusion. Pre- and postmenopausal women with subclinical hyperthyroidism have higher FRAX® scores and thus

  3. Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability1

    Science.gov (United States)

    Alvarenga, Marina Barreto; Francisco, Adriana Amorim; de Oliveira, Sonia Maria Junqueira Vasconcellos; da Silva, Flora Maria Barbosa; Shimoda, Gilcéria Tochika; Damiani, Lucas Petri

    2015-01-01

    OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy. METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale. RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators. CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process. PMID:25806645

  4. Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA scale reliability

    Directory of Open Access Journals (Sweden)

    Marina Barreto Alvarenga

    2015-02-01

    Full Text Available OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy.METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale.RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88, marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46, marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42 and good agreement regarding redness (0.46< Kappa ≥0.66. For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators.CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.

  5. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study

    DEFF Research Database (Denmark)

    Doetsch, A M; Faber, J; Lynnerup, N

    2004-01-01

    scan, WHO criteria), and not taking any drugs related to bone formation, including calcium or vitamin D supplementation, were randomly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo, in a double-blind prospective study. We measured biochemical, radiographic, and bone mineral......The purpose of this study was to (1) quantify the healing process of the human osteoporotic proximal humerus fracture (PHF) expressed in terms of callus formation over the fracture region using BMD scanning, and (2) quantify the impact of medical intervention with vitamin D3 and calcium......, with peak levels in week 6. By week 6 BMD levels were higher in the active group (0.623 g/cm2) compared with the placebo group (0.570 g/cm2, P = 0.006). Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l, indicative of mild vitamin D insufficiency. In conclusion, we have...

  6. Comparative analysis of deterministic and probabilistic fracture mechanical assessment tools

    Energy Technology Data Exchange (ETDEWEB)

    Heckmann, Klaus [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) gGmbH, Koeln (Germany); Saifi, Qais [VTT Technical Research Centre of Finland, Espoo (Finland)

    2016-11-15

    Uncertainties in material properties, manufacturing processes, loading conditions and damage mechanisms complicate the quantification of structural reliability. Probabilistic structure mechanical computing codes serve as tools for assessing leak- and break probabilities of nuclear piping components. Probabilistic fracture mechanical tools were compared in different benchmark activities, usually revealing minor, but systematic discrepancies between results of different codes. In this joint paper, probabilistic fracture mechanical codes are compared. Crack initiation, crack growth and the influence of in-service inspections are analyzed. Example cases for stress corrosion cracking and fatigue in LWR conditions are analyzed. The evolution of annual failure probabilities during simulated operation time is investigated, in order to identify the reasons for differences in the results of different codes. The comparison of the tools is used for further improvements of the codes applied by the partners.

  7. Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications.

    NARCIS (Netherlands)

    Link, T.M.; Guglielmi, G.; Kuijk, C. van; Adams, J.E.

    2005-01-01

    As populations age osteoporosis becomes an increasingly important public health issue. Among osteoporotic fractures vertebral fractures are of particular relevance: they are the most common fractures, frequently are asymptomatic but have an important influence on prognosis and morbidity in the

  8. An X-ray template assessment for distal radial fractures

    Science.gov (United States)

    Lindeboom, R.; Oosterkamp, A. E.; Goslings, J. C.

    2007-01-01

    Background The current method for radiological measurements on plain X-rays of distal radius fractures is unreliable. We examined the reproducibility of a new X-ray assessment technique—where the uninjured side is used as a template for the injured side—compared to the conventional assessment technique. Methods X-rays of 30 patients with a unilateral distal radial fracture were included reflecting the prevalence of AO fracture types in clinical practice. Eight experienced observers assessed these X-rays on two separated occasions (2-month interval) using the traditional measurement technique and the template technique. Reproducibility of the X-ray assessments was quantified by intraclass correlations and weighted kappa coefficients. Results The reproducibility of the radial length measurement did not improve nor did the volar angulation measurement. However, marked improvement in reproducibility was observed for the radial inclination measurement, the kappa increased from 0.36 (95 % CI; 0.30–0.41) to 0.49 (95 % CI; 0.43–0.55) in the template technique. As a result, the classification of the reduction results (Lidström score) greatly improved. The overall kappa for the Lidström score improved from 0.37 (95 % CI; 0.31/0.43) to 0.59 (0.52/0.63). Conclusion The assessment technique using the uninjured side as a template for the injured side resulted only in an improved reproducibility of the radial inclination measurement which in turn resulted in an improved classification reproducibility of the reduction results. PMID:17622544

  9. Utility of Computed Tomographic Enteroclysis/Enterography for the Assessment of Mucosal Healing in Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Shinichi Hashimoto

    2013-01-01

    Full Text Available Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE. Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens. Results. According to the CTE findings, patients were determined to be in the active CD group (n=31 or inactive CD group (n=8. The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P<0.0001, whereas mucosal healing was found in 62.5% of inactive group patients but in only 3.2% of active group patients (P<0.0001. Conclusion. CTE appeared to be a useful diagnostic method for assessment of mucosal healing in Crohn's disease.

  10. A new self-healing epoxy with tungsten (VI) chloride catalyst.

    Science.gov (United States)

    Kamphaus, Jason M; Rule, Joseph D; Moore, Jeffrey S; Sottos, Nancy R; White, Scott R

    2008-01-06

    Using self-healing materials in commercial applications requires healing chemistry that is cost-effective, widely available and tolerant of moderate temperature excursions. We investigate the use of tungsten (VI) chloride as a catalyst precursor for the ring-opening metathesis polymerization of exo-dicyclopentadiene (exo-DCPD) in self-healing applications as a means to achieve these goals. The environmental stability of WCl6 using three different delivery methods was evaluated and the associated healing performance was assessed following fracture toughness recovery protocols. Both as-received and recrystallized forms of the WCl6 resulted in nearly complete fracture recovery in self-activated tests, where healing agent is manually injected into the crack plane, at 12wt% WCl6 loading. In situ healing using 15wt% microcapsules of the exo-DCPD produced healing efficiencies of approximately 20%.

  11. Non-contact hematoma damage and healing assessment using reflectance photoplethysmographic imaging

    Science.gov (United States)

    Amelard, Robert; Pfisterer, Kaylen J.; Clausi, David A.; Wong, Alexander

    2016-03-01

    Impact trauma may cause a hematoma, which is the leakage of venous blood into surrounding tissues. Large hematomas can be dangerous as they may inhibit local blood ow. Hematomas are often diagnosed visually, which may be problematic if the hematoma leaks deeper than the visible penetration depth. Furthermore, vascular wound healing is often monitored at home without the aid of a clinician. We therefore investigated the use of near infrared (NIR) re ectance photoplethysmographic imaging (PPGI) to assess vascular damage resulting from a hematoma, and monitor the healing process. In this case study, the participant experienced internal vascular damage in the form of a hematoma. Using a PPGI system with dual-mode temporally coded illumination for ambient-agnostic data acquisition and mounted optical elements, the tissue was illuminated with a spatially uniform irradiance pattern of 850 nm wavelength light for increased tissue penetration and high oxy-to-deoxyhemoglobin absorption ratio. Initial and follow-up PPGI data collection was performed to assess vascular damage and healing. The tissue PPGI sequences were spectrally analyzed, producing spectral maps of the tissue area. Experimental results show that spatial differences in spectral information can be observed around the damaged area. In particular, the damaged site exhibited lower pulsatility than the surrounding healthy tissue. This pulsatility was largely restored in the follow-up data, suggesting that the tissue had undergone vascular healing. These results indicate that hematomas can be assessed and monitored in a non-contact visual manner, and suggests that PPGI can be used for tissue health assessment, with potential extensions to peripheral vascular disease.

  12. Analysis Strategy for Fracture Assessment of Defects in Ductile Materials

    Energy Technology Data Exchange (ETDEWEB)

    Dillstroem, Peter; Andersson, Magnus; Sattari-Far, Iradj; Weilin Zang (Inspecta Technology AB, Stockholm (Sweden))

    2009-06-15

    The main purpose of this work is to investigate the significance of the residual stresses for defects (cracks) in ductile materials with nuclear applications, when the applied primary (mechanical) loads are high. The treatment of weld-induced stresses as expressed in the SACC/ProSACC handbook and other fracture assessment procedures such as the ASME XI code and the R6-method is believed to be conservative for ductile materials. This is because of the general approach not to account for the improved fracture resistance caused by ductile tearing. Furthermore, there is experimental evidence that the contribution of residual stresses to fracture diminishes as the degree of yielding increases to a high level. However, neglecting weld-induced stresses in general, though, is doubtful for loads that are mostly secondary (e.g. thermal shocks) and for materials which are not ductile enough to be limit load controlled. Both thin-walled and thick-walled pipes containing surface cracks are studied here. This is done by calculating the relative contribution from the weld residual stresses to CTOD and the J-integral. Both circumferential and axial cracks are analysed. Three different crack geometries are studied here by using the finite element method (FEM). (i) 2D axisymmetric modelling of a V-joint weld in a thin-walled pipe. (ii) 2D axisymmetric modelling of a V-joint weld in a thick-walled pipe. (iii) 3D modelling of a X-joint weld in a thick-walled pipe. t. Each crack configuration is analysed for two load cases; (1) Only primary (mechanical) loading is applied to the model, (2) Both secondary stresses and primary loading are applied to the model. Also presented in this report are some published experimental investigations conducted on cracked components of ductile materials subjected to both primary and secondary stresses. Based on the outcome of this study, an analysis strategy for fracture assessment of defects in ductile materials of nuclear components is proposed. A new

  13. Quantitative assessment of bone defect healing by multidetector CT in a pig model

    Energy Technology Data Exchange (ETDEWEB)

    Riegger, Carolin; Kroepil, Patric; Lanzman, Rotem S.; Miese, Falk R.; Antoch, Gerald; Scherer, Axel [University Duesseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Duesseldorf (Germany); Jungbluth, Pascal; Hakimi, Mohssen; Wild, Michael [University Duesseldorf, Medical Faculty, Department of Traumatology and Hand Surgery, Duesseldorf (Germany); Hakimi, Ahmad R. [Universtity Duesseldorf, Medical Faculty, Department of Oral Surgery, Duesseldorf (Germany)

    2012-05-15

    To evaluate multidetector CT volumetry in the assessment of bone defect healing in comparison to histopathological findings in an animal model. In 16 mini-pigs, a circumscribed tibial bone defect was created. Multidetector CT (MDCT) of the tibia was performed on a 64-row scanner 42 days after the operation. The extent of bone healing was estimated quantitatively by MDCT volumetry using a commercially available software programme (syngo Volume, Siemens, Germany).The volume of the entire defect (including all pixels from -100 to 3,000 HU), the nonconsolidated areas (-100 to 500 HU), and areas of osseous consolidation (500 to 3,000 HU) were assessed and the extent of consolidation was calculated. Histomorphometry served as the reference standard. The extent of osseous consolidation in MDCT volumetry ranged from 19 to 92% (mean 65.4 {+-} 18.5%). There was a significant correlation between histologically visible newly formed bone and the extent of osseous consolidation on MDCT volumetry (r = 0.82, P < 0.0001). A significant negative correlation was detected between osseous consolidation on MDCT and histological areas of persisting defect (r = -0.9, P < 0.0001). MDCT volumetry is a promising tool for noninvasive monitoring of bone healing, showing excellent correlation with histomorphometry. (orig.)

  14. Quantitative assessment of pressure sore generation and healing through numerical analysis of high-frequency ultrasound images

    Directory of Open Access Journals (Sweden)

    Sahar Moghimi, MS

    2010-04-01

    Full Text Available This article focuses on the development of a method to quantitatively assess the healing process of artificially induced pressure sores using high-frequency (20 MHz ultrasound images. We induced sores in guinea pigs and monitored predefined regions on days 3, 7, 14, and 21 after sore generation. We extracted relevant parameters regarding the tissue echographic structure and attenuation properties. We examined tissue healing by defining a healing function that used the extracted parameters. We verified the significance of the extracted features by using analysis of variance and multiple comparison tests. The features displayed ascending/descending behavior during wound generation and reverse behavior during healing. We optimized the parameters of our healing function by using a pattern search method. We tested the efficiency of the optimized values by calculating the healing function value on assessment days and then comparing these results with the expected pattern of changes in the tissue conditions after removing the applied pressure. The results of this study suggest that the methodology developed may be a viable tool for quantitative assessment of pressure sores during their early generation as well as during healing stages.

  15. Quantitative assessment of pressure sore generation and healing through numerical analysis of high-frequency ultrasound images.

    Science.gov (United States)

    Moghimi, Sahar; Miran Baygi, Mohammad Hossein; Torkaman, Giti; Mahloojifar, Ali

    2010-01-01

    Abstract-This article focuses on the development of a method to quantitatively assess the healing process of artificially induced pressure sores using high-frequency (20 MHz) ultrasound images. We induced sores in guinea pigs and monitored predefined regions on days 3, 7, 14, and 21 after sore generation. We extracted relevant parameters regarding the tissue echographic structure and attenuation properties. We examined tissue healing by defining a healing function that used the extracted parameters. We verified the significance of the extracted features by using analysis of variance and multiple comparison tests. The features displayed ascending/descending behavior during wound generation and reverse behavior during healing. We optimized the parameters of our healing function by using a pattern search method. We tested the efficiency of the optimized values by calculating the healing function value on assessment days and then comparing these results with the expected pattern of changes in the tissue conditions after removing the applied pressure. The results of this study suggest that the methodology developed may be a viable tool for quantitative assessment of pressure sores during their early generation as well as during healing stages.

  16. 胫骨骨折不愈合28例临床分析%Analyses of 28 tibia fracture cases not healed

    Institute of Scientific and Technical Information of China (English)

    张庆凯

    2014-01-01

    目的:通过对28例胫骨骨折不愈合患者的临床治疗研究,分析造成其不愈合的原因。方法:收集我院自2005年6月至2013年5月8年间所收治的胫骨骨折不愈合患者28例,其中,男性16例,女性12例,年龄从12岁到73岁,平均38.7岁。交通事故所致17例,重物砸伤所致6例,摔伤所致4例,被别人打伤1例。闭合性骨折9例,开放性骨折19例。患者从首次治疗出院到再次入院时间在0.6—2年,均进行2次手术治疗,术后随访,并根据其症状、体征及影像学资料进行评估分析。结果:术后随访3-24个月,平均14个月,患者切口愈合良好,无感染,无皮肤坏死。全部患者未见骨不愈合、感染、畸形及再骨折发生。结论:胫骨骨折不愈合可以有胫骨本身解剖及生理特点,外伤程度及部位,手术治疗及术后功能锻炼等几个方面原因。%Objective:Through the clinic analyses of 20 cases of tibia fracture, found the reasons which caused the tibia fracture not healed Method:From Jane 2005 to May 2013, In the 8 Months, 28 cases with tibia fracture not healed were col ected. Including 16 males and 12 females , with an average of 38.7 years old .(range,12 to 73 years old).17 cases were caused by the traffic accident ,6 cases were caused by heavy parts ,4 cases were caused by fal damage,1 case was caused by a fight;9 closed fractures ,19 open fractures .It was about 0.6-2 years from the time that the patients left hospital after first treated to the time that the patients returned .Through the second operations, al the patients was fol owed up, According to the symptoms、signs and images, we carried a evaluate and analyses .Result:Al the cases were fol owed up for an average of 14 months (range, 3 to 24 months). The fractures of al the cases were recovered .There were no complications such as infection of wound , skin necrosis , yet infection of bone didn't healed, deformity and broken

  17. Implicit fracture modelling in FLAC3D: Assessing the behaviour of fractured shales, carbonates and other fractured rock types

    NARCIS (Netherlands)

    Osinga, S.; Pizzocolo, F.; Veer, E.F. van der; Heege, J.H. ter

    2016-01-01

    Fractured rocks play an important role in many types of petroleum and geo-energy operations. From fractured limestone reservoirs to unconventionals, understanding the geomechanical behaviour and the dynamically coupled (dual) permeability system is paramount for optimal development of these systems.

  18. Assessment of circular wound healing in rats after exposure to 808-nm laser pulses during specific healing phases.

    Science.gov (United States)

    Tabakoglu, Hasim O; Sani, Musbahu M; Uba, Abdullahi I; Abdullahi, Umar A

    2016-04-01

    Low-level laser therapy (LLLT), is an important application modality for the advancement of wound healing processes. In this study, histological and morphometric analyses have been made to understand and compare effects of high-power 808-nm pulses on circular skin wounds among groups irradiated immediately after wounding and groups irradiated at specific stages of the healing period. Experimental groups were as follows: Laser Therapy (LT) was received as three sessions of laser irradiation (6.38 J/cm2, 1.276 W/cm2, 808 nm) immediately after wounding (Inflammatory group, n = 12), 24 hours post-wounding (Proliferative group, n = 12), and 72 hours post-wounding (Remodeling group, n = 12); the Control group (n = 12) received no irradiation. Histological analyses were performed on the 3rd, 7th, and 14th days post-wounding. Mean wound diameters were 5 mm for all groups. On Day 7, wound diameters were measured as 2.99 ± 0.17, 2.95 ± 0.3, 2.52 ± 0.11, and 2.41 ± 0.34 mm for the Control, Inflammatory, Proliferative, and Remodeling groups, respectively. At 2 weeks post-wounding, dermal tissue in the Inflammatory and Proliferative groups closed superficially, while 1.30 ± 0.1 mm and 1.30 ± 0.06 mm openings remained in the Control and Remodeling groups, respectively. Mean wound healing rates (WHR) for all treatment groups were found to differ significantly from the control group (P wounding (late inflammatory, early proliferative stage) as demonstrated by increases in granulation tissue, fibroblasts and collagen deposition, which lead to faster rates of wound contraction and thus accelerated healing. © 2015 Wiley Periodicals, Inc.

  19. Parathyroid hormone and bone healing

    DEFF Research Database (Denmark)

    Ellegaard, M; Jørgensen, N R; Schwarz, P

    2010-01-01

    , no pharmacological treatments are available. There is therefore an unmet need for medications that can stimulate bone healing. Parathyroid hormone (PTH) is the first bone anabolic drug approved for the treatment of osteoporosis, and intriguingly a number of animal studies suggest that PTH could be beneficial...... in the treatment of fractures and could thus be a potentially new treatment option for induction of fracture healing in humans. Furthermore, fractures in animals with experimental conditions of impaired healing such as aging, estrogen withdrawal, and malnutrition can heal in an expedited manner after PTH treatment...

  20. Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

    Energy Technology Data Exchange (ETDEWEB)

    Jagt-Willems, H.C. van der, E-mail: Hvanderjagt@spaarneziekenhuis.nl [Department of Geriatrics, Slotervaart Hospital, Amsterdam (Netherlands); Department of Internal Medicine, Spaarne Hospital, Hoofddorp (Netherlands); Munster, B.C. van [Department of Internal Medicine, Academic Medical Center, Amsterdam (Netherlands); Department of Geriatrics, Gelre Hospitals, Apeldoorn (Netherlands); Leeflang, M. [Department of Geriatrics, Gelre Hospitals, Apeldoorn (Netherlands); Beuerle, E. [Department of Radiology, Slotervaart Hospital, Amsterdam (Netherlands); Tulner, C.R. [Department of Geriatrics, Slotervaart Hospital, Amsterdam (Netherlands); Lems, W.F. [Department of Rheumatology, VU Medical Center, Amsterdam (Netherlands)

    2014-12-15

    Highlights: • (Lateral) chest X-ray's are often performed in older individuals for various reasons. • Vertebral fractures are visualized on lateral chest X-ray, but the diagnosis of vertebral fractures is until now only validated on (lateral) spine X-ray's. • This study shows that a (lateral) chest X-ray is sufficient for the diagnosis of vertebral fractures. • Older individuals with a vertebral fracture on a (lateral) chest X-ray do not need further radiography with thoracic spine X-ray or vertebral fracture assessment with DXA. - Abstract: Background: In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays. Methods: To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately, blinded and in different time periods. Agreement and Cohens’ kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures. Results: 109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95–98% for the two levels of fracturing, with a Cohen's kappa of 0.88–0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81–0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001). Conclusion: The results show good agreement and intraobserver reliability on

  1. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-01-01

    for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. RESULTS: Immature: No severe complications (PN.......3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. CONCLUSION: Teeth involved in alveolar process fractures appear......AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify...

  2. The potential role of original fracture hematoma in fracture healing%骨折愈合过程中原始骨折血肿的潜在作用

    Institute of Scientific and Technical Information of China (English)

    林梁; 唐亚辉; 吾路汗; 谢增如

    2015-01-01

    BACKGROUND:In closed fractures, the initial hematoma that is inclined to remove is seldom considered as the important reasons for bone healing. OBJECTIVE:To observe the mechanism and potential role of original fracture hematoma in fracture healing. METHODS:Ninety-six patients with closed fractures of the long bones undergoing open reduction and internal fixation were randomly divided into experimental group (n=48) and control group (n=48). In the experimental group, original fracture hematoma, 1.0-2.0 mL, was first taken out during the internal fixation and placed into a special sterile plastic bag; then, 3-4 pieces of hematomas were filed into the fracture site and sutured layer by layer. On the contrary, original fracture hematomas from the control group were discarded. Blood samples were extracted to detect the biochemical indicators at 1 month after internal fixation. X-ray examination was done at 1, 3, 6 months after internal fixation for observation of fracture healing. RESULTS AND CONCLUSION: X-ray films showed that the healing rate at 3 months after operation was 95% in the experimental group and 78% in the control group, and there was a significant difference between the two groups (P < 0.05). Levels of bone glaprotein, I-type precolagen carboxy terminus peptide and serum bone alkaline phosphatase were significantly higher in the experimental group than the control group (P < 0.01 orP < 0.05). These findings indicate that the original fracture hematoma can accelerate calus formation, promote bone induction, provide nutrition to the fracture site, and participate in revascularization. Therefore, the original fracture hematomas is one of the effectively therapeutic methods for union and nonunion of fractures.%背景:临床实践中闭合性骨折内固定过程中,骨折原始血肿很少视为骨折愈合的重要因素,常被有意清除,非常可惜。目的:对比分析骨折血肿在骨折愈合过程中所发挥的机制及作用。方

  3. CT VIRTUAL ENDOSCOPY IN ASSESSING OSSICULAR CHAIN DISRUPTION CSUSED BY TEMPORAL BONE FRACTURE AND EAR TRAUMA

    Institute of Scientific and Technical Information of China (English)

    JIANG Lixin; XIAO Zhiwen

    2013-01-01

    Objective To explore the value of computed tomography virtual endoscopy (VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography (CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed us-ing a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain sublux-ation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evalu-ation; those with facial paralysis underwent surgery if no recovery after 4-8 weeks of conservative treat-ment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial pa-ralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Re-sults Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3 recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and House-Brackmann (HB) grade I facial function from HB grade II ,4 showed facial function recovery to HB grade I (n=2) or II (n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to

  4. In Vivo Assessment of Protease Dynamics in Cutaneous Wound Healing by Degradomics Analysis of Porcine Wound Exudates*

    Science.gov (United States)

    Sabino, Fabio; Hermes, Olivia; Egli, Fabian E.; Kockmann, Tobias; Schlage, Pascal; Croizat, Pierre; Kizhakkedathu, Jayachandran N.; Smola, Hans; auf dem Keller, Ulrich

    2015-01-01

    Proteases control complex tissue responses by modulating inflammation, cell proliferation and migration, and matrix remodeling. All these processes are orchestrated in cutaneous wound healing to restore the skin's barrier function upon injury. Altered protease activity has been implicated in the pathogenesis of healing impairments, and proteases are important targets in diagnosis and therapy of this pathology. Global assessment of proteolysis at critical turning points after injury will define crucial events in acute healing that might be disturbed in healing disorders. As optimal biospecimens, wound exudates contain an ideal proteome to detect extracellular proteolytic events, are noninvasively accessible, and can be collected at multiple time points along the healing process from the same wound in the clinics. In this study, we applied multiplexed Terminal Amine Isotopic Labeling of Substrates (TAILS) to globally assess proteolysis in early phases of cutaneous wound healing. By quantitative analysis of proteins and protein N termini in wound fluids from a clinically relevant pig wound model, we identified more than 650 proteins and discerned major healing phases through distinctive abundance clustering of markers of inflammation, granulation tissue formation, and re-epithelialization. TAILS revealed a high degree of proteolysis at all time points after injury by detecting almost 1300 N-terminal peptides in ∼450 proteins. Quantitative positional proteomics mapped pivotal interdependent processing events in the blood coagulation and complement cascades, temporally discerned clotting and fibrinolysis during the healing process, and detected processing of complement C3 at distinct time points after wounding and by different proteases. Exploiting data on primary cleavage specificities, we related candidate proteases to cleavage events and revealed processing of the integrin adapter protein kindlin-3 by caspase-3, generating new hypotheses for protease

  5. In vivo assessment of protease dynamics in cutaneous wound healing by degradomics analysis of porcine wound exudates.

    Science.gov (United States)

    Sabino, Fabio; Hermes, Olivia; Egli, Fabian E; Kockmann, Tobias; Schlage, Pascal; Croizat, Pierre; Kizhakkedathu, Jayachandran N; Smola, Hans; auf dem Keller, Ulrich

    2015-02-01

    Proteases control complex tissue responses by modulating inflammation, cell proliferation and migration, and matrix remodeling. All these processes are orchestrated in cutaneous wound healing to restore the skin's barrier function upon injury. Altered protease activity has been implicated in the pathogenesis of healing impairments, and proteases are important targets in diagnosis and therapy of this pathology. Global assessment of proteolysis at critical turning points after injury will define crucial events in acute healing that might be disturbed in healing disorders. As optimal biospecimens, wound exudates contain an ideal proteome to detect extracellular proteolytic events, are noninvasively accessible, and can be collected at multiple time points along the healing process from the same wound in the clinics. In this study, we applied multiplexed Terminal Amine Isotopic Labeling of Substrates (TAILS) to globally assess proteolysis in early phases of cutaneous wound healing. By quantitative analysis of proteins and protein N termini in wound fluids from a clinically relevant pig wound model, we identified more than 650 proteins and discerned major healing phases through distinctive abundance clustering of markers of inflammation, granulation tissue formation, and re-epithelialization. TAILS revealed a high degree of proteolysis at all time points after injury by detecting almost 1300 N-terminal peptides in ∼450 proteins. Quantitative positional proteomics mapped pivotal interdependent processing events in the blood coagulation and complement cascades, temporally discerned clotting and fibrinolysis during the healing process, and detected processing of complement C3 at distinct time points after wounding and by different proteases. Exploiting data on primary cleavage specificities, we related candidate proteases to cleavage events and revealed processing of the integrin adapter protein kindlin-3 by caspase-3, generating new hypotheses for protease

  6. Rectal prolapse associated with a healed pelvic fracture in a pregnant free-ranging African black rhinoceros (Diceros bicornis. Part 2 : surgery and necropsy : case report

    Directory of Open Access Journals (Sweden)

    A. Olivier

    2001-07-01

    Full Text Available The oedematous and traumatised protruding section of the rectal tissue of an adult free-ranging female African black rhinoceros (Diceros bicornis was surgically amputated. Immediately before completion of surgery, the rhinoceros died of anaesthetic-related cardiac arrest. At necropsy a deformed pelvis and sacrum associated with a healed fracture of the left ileal wing were noted. New bone formation in and around the left ventral sacral foramina may have resulted in neuropathy of particularly the 3rd and 4th left ventral sacral nerves, which (in the horse supply the majority of the nerve fibres innervating the caudal rectum and anus. The cause of the injury is not known, although back injuries, presumably sustained during mating by bulls, have been recorded in white rhinoceros. An encounter with elephants could also have been responsible for the injury in this case.

  7. The accuracy of the imaging reformation of cone beam computed tomography for the assessment of bone defect healing

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ho Duk; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Kyung Hee Univ., Seoul (Korea, Republic of)

    2007-06-15

    To evaluate the accuracy of the imaging reformation of cone beam computed tomography for the assessment of bone defect healing in rat model. Sprague-Dawely strain rats weighing about 350 gms were selected. Then critical size bone defects were done at parietal bone with implantation of collagen sponge. The rats were divided into seven groups of 3 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, and 8 weeks. The healing of surgical defect was assessed by multiplanar reconstruction (MPR) images and three-dimensional (3-D) images of cone beam computed tomography, compared with soft X-ray radiograph and histopathologic examination. MPR images and 3-D images showed similar reformation of the healing amount at 3 days, 1 week, 2 weeks, and 8 weeks, however, lower reformation at 3 weeks, 4 weeks, and 6 weeks. According to imaging-based methodologies, MPR images revealed similar reformation of the healing mount than 3-D images compare with soft X-ray image. Among the four threshold values for 3-D images, 400-500 HU revealed similar reformation of the healing amount. Histopathologic examination confirmed the newly formed trabeculation correspond with imaging-based mythologies. MPR images revealed higher accuracy of the imaging reformation of cone beam computed tomography and cone beam computed tomography is a clinically useful diagnostic tool for the assessment of bone defect healing.

  8. Ductile fracture assessment using parameters from small specimens

    Energy Technology Data Exchange (ETDEWEB)

    Talja, H. [VTT Manufacturing Technology, Espoo (Finland)

    1998-12-31

    The topic of this thesis is the computational aspects in the assessment of ductile failure in metals. The first part briefly describes the micromechanics of ductile crack growth and methods for assessing it. The `classic` approach to describe material behaviour using fracture mechanics is summarised. The limitations of the one parameter approach based on the stress intensity factor K or the J- integral are described. Attempts to extend the application field of fracture mechanics parameters by introducing triaxility or constraint parameters are also presented. Different local approach methodologies are summarised. Special attention is paid to the modified Gurson model, which is based on micro-mechanical studies of void initiation, growth and coalescence. The main part of the work consists of numerical analyses with the modified Gurson model. The parameters of the model are first determined by matching tensile test results by finite element analysis, and then applied to J-R curve prediction. This methodology is applied to several reactor pressure vessel materials: A533B, 20 MnMoNi 5 5 and austenitic VVER 440 cladding. As a result, the applicability of different specimen types for the parameter determination of the modified Gurson model has been evaluated. Because a combination of experimental and numerical work is needed, it proved to be most feasible to use specimens which can be simulated with two-dimensional or axisymmetric finite element models. Further, a practical way to treat anisotropic material behaviour using the modified Gurson model by using separate parameter sets for different orientations has been proposed and verified. The correspondence between the observed scatters in tensile and fracture mechanical test results has been examined. Best agreement was obtained fitting the scatter of tensile tests by varying the values of initial parameters. Reasons for apparently higher ductility measured from sub-sized than standard size tensile specimens were

  9. Early changes of fracture healing on MRI%骨折愈合早期磁共振成像的实验研究

    Institute of Scientific and Technical Information of China (English)

    殷耀斌; 张力丹; 腾星; 程晓光; 王满宜

    2010-01-01

    Objective To observe MRI presentations of fracture healing process in the early stage.Methods Six New Zealand rabbits were used in the experiment. A union model of long oblique fracture of 1 mm in bone defect and 10 mm in vertical length was created on the right radius. A model of 10 mm bone defect was created on the left radius. X-ray and MRI examinations were performed in 1 w, 2 w, 4 w, 6 w, 8 w, 12 wafter the surgery and CT examination was performed in 4 w, 12 w after the surgery. The imaging presentations at the fracture sites were observed on T1, T2, FS-T2, PD, FS-PD sequences. Results The soft tissue around the fracture site presented high signals on T2, FS-T2, PD, FS-PD sequences in the early stage of fracture healing. The signals decreased as time went on, but turned intermediate at 6 w after surgery. The signals of bone marrow turned from high to intermediate on T1, T2 and PD sequences early after the surgery,but turned high again with the healing of medullary cavity. On FS-T2 and FS-PD sequences, bone marrow presented intermediate signals mixed with high signals, but the high signals subsided as time went by. Early changes of callus formation could be observed by MRI. Callus formation at the site of fracture showed intermediate signals in FS-T2 and FS-PD images obtained at 2 w after the surgery in the fracture union model. The changes above could not be observed in the bone defect model. Conclusions Callus formation may be predicted earlier by MRI than by X ray, especially on FS-T2 and FS-PD sequences. The MRI presentations of early fracture healing are to be confirmed by pathological examinations.%目的 探讨骨折愈合过程中磁共振成像(MRI)的表现及变化规律.方法 6只新西兰白兔右侧桡骨中段制造垂直长度为10 mm、断端间隙为1 mm的长斜形骨折愈合模型.左侧桡骨中段制造10 mm骨质缺损模型.于术后1、2、4、6、8、12周对动物模型行X线及MRI扫描,于术后4 周及12周行螺旋CT扫描,

  10. A Biomechanical Approach to Assessing Hip Fracture Risk

    Science.gov (United States)

    Ellman, Rachel

    2009-01-01

    Bone loss in microgravity is well documented, but it is difficult to quantify how declines in bone mineral density (BMD) contribute to an astronaut's overall risk of fracture upon return. This study uses a biomechanical approach to assessing hip fracture risk, or Factor of Risk (Phi), which is defined as the ratio of applied load to bone strength. All long-duration NASA astronauts from Expeditions 1-18 were included in this study (n=25), while crewmembers who flew twice (n=2) were treated as separate subjects. Bone strength was estimated based on an empirical relationship between areal BMD at the hip, as measured by DXA, and failure load, as determined by mechanical testing of cadaver femora. Fall load during a sideways fall was calculated from a previously developed biomechanical model, which takes into account body weight, height, gender, and soft tissue thickness overlying the lateral aspect of the hip that serves to attenuate the impact force. While no statistical analyses have been performed yet, preliminary results show that males in this population have a higher FOR than females, with a post- flight Phi of 0.87 and 0.36, respectively. FOR increases 5.1% from preflight to postflight, while only one subject crossed the fracture "threshold" of Phi = 1, for a total of 2 subjects with a postflight Phi > 1. These results suggest that men may be at greater risk for hip fracture due largely in part to their relatively thin soft tissue padding as compared to women, since soft tissue thickness has the highest correlation (R(exp 2)= .53) with FOR of all subject-specific parameters. Future work will investigate changes in FOR during recovery to see if baseline risk levels are restored upon return to 1-g activity. While dual x-ray absorptiometry (DXA) is the most commonly used clinical measure of bone health, it fails to provide compartment-specific information that is useful in assessing changes to bone quality as a result of microgravity exposure. Peripheral

  11. A Biomechanical Approach to Assessing Hip Fracture Risk

    Science.gov (United States)

    Ellman, Rachel

    2009-01-01

    Bone loss in microgravity is well documented, but it is difficult to quantify how declines in bone mineral density (BMD) contribute to an astronaut's overall risk of fracture upon return. This study uses a biomechanical approach to assessing hip fracture risk, or Factor of Risk (Phi), which is defined as the ratio of applied load to bone strength. All long-duration NASA astronauts from Expeditions 1-18 were included in this study (n=25), while crewmembers who flew twice (n=2) were treated as separate subjects. Bone strength was estimated based on an empirical relationship between areal BMD at the hip, as measured by DXA, and failure load, as determined by mechanical testing of cadaver femora. Fall load during a sideways fall was calculated from a previously developed biomechanical model, which takes into account body weight, height, gender, and soft tissue thickness overlying the lateral aspect of the hip that serves to attenuate the impact force. While no statistical analyses have been performed yet, preliminary results show that males in this population have a higher FOR than females, with a post- flight Phi of 0.87 and 0.36, respectively. FOR increases 5.1% from preflight to postflight, while only one subject crossed the fracture "threshold" of Phi = 1, for a total of 2 subjects with a postflight Phi > 1. These results suggest that men may be at greater risk for hip fracture due largely in part to their relatively thin soft tissue padding as compared to women, since soft tissue thickness has the highest correlation (R(exp 2)= .53) with FOR of all subject-specific parameters. Future work will investigate changes in FOR during recovery to see if baseline risk levels are restored upon return to 1-g activity. While dual x-ray absorptiometry (DXA) is the most commonly used clinical measure of bone health, it fails to provide compartment-specific information that is useful in assessing changes to bone quality as a result of microgravity exposure. Peripheral

  12. Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction

    Directory of Open Access Journals (Sweden)

    Sathya Kumar Devireddy

    2014-01-01

    Full Text Available Objective: The aim was to assess the accuracy of three-dimensional anatomical reductions achieved by open method of treatment in cases of displaced unilateral mandibular subcondylar fractures using preoperative (pre op and postoperative (post op computed tomography (CT scans. Materials and Methods: In this prospective study, 10 patients with unilateral sub condylar fractures confirmed by an orthopantomogram were included. A pre op and post op CT after 1 week of surgical procedure was taken in axial, coronal and sagittal plane along with three-dimensional reconstruction. Standard anatomical parameters, which undergo changes due to fractures of the mandibular condyle were measured in pre and post op CT scans in three planes and statistically analysed for the accuracy of the reduction comparing the following variables: (a Pre op fractured and nonfractured side (b post op fractured and nonfractured side (c pre op fractured and post op fractured side. P < 0.05 was considered as significant. Results: Three-dimensional anatomical reduction was possible in 9 out of 10 cases (90%. The statistical analysis of each parameter in three variables revealed (P < 0.05 that there was a gross change in the dimensions of the parameters obtained in pre op fractured and nonfractured side. When these parameters were assessed in post op CT for the three variables there was no statistical difference between the post op fractured side and non fractured side. The same parameters were analysed for the three variables in pre op fractured and post op fractured side and found significant statistical difference suggesting a considerable change in the dimensions of the fractured side post operatively. Conclusion: The statistical and clinical results in our study emphasised that it is possible to fix the condyle in three-dimensional anatomical positions with open method of treatment and avoid post op degenerative joint changes. CT is the ideal imaging tool and should be used on

  13. Constraint corrected fracture mechanics in structural integrity assessment

    Energy Technology Data Exchange (ETDEWEB)

    Laukkanen, A.; Wallin, K. [VTT Industrial Systems, Espoo (Finland)

    2004-07-01

    Specimen size, crack depth and loading conditions may affect the materials fracture toughness. In order to safeguard against these geometry effects, fracture toughness testing standards prescribe the use of highly constrained deep cracked bend specimens having a sufficient size to guarantee conservative fracture toughness values. One of the more advanced testing standards, for brittle fracture, is the Master Curve standard ASTM E1921, which is based on technology developed at VTT Industrial Systems. When applied to a structure with low constraint geometry, the standard fracture toughness estimates may lead to strongly over-conservative estimate of structural performance. In some cases this may lead to unnecessary repairs or even to an early 'retirement' of the structure. In the case of brittle fracture, essentially three different methods to quantify constraint have been proposed, J-small scale yielding correction (SSYC), Q-parameter and the T{sub stress}. (orig.)

  14. EPA Releases Draft Assessment on the Potential Impacts to Drinking Water Resources from Hydraulic Fracturing Activities

    Science.gov (United States)

    WASHINGTON-The Environmental Protection Agency (EPA) is releasing a draft assessment today on the potential impacts of hydraulic fracturing activities on drinking water resources in the United States. The assessment, done at the request of Congress, shows

  15. Local transplantation of ex vivo expanded bone marrow-derived CD34-positive cells accelerates fracture healing.

    Science.gov (United States)

    Kawakami, Yohei; Ii, Masaaki; Alev, Cantas; Kawamoto, Atsuhiko; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Shoji, Taro; Fukui, Tomoaki; Masuda, Haruchika; Akimaru, Hiroshi; Mifune, Yutaka; Kuroda, Tomoya; Horii, Miki; Yokoyama, Ayumi; Kurosaka, Masahiro; Asahara, Takayuki

    2012-01-01

    Transplantation of bone marrow (BM) CD34(+) cells, an endothelial/hematopoietic progenitor-enriched cell population, has shown therapeutic efficiency in the treatment of ischemic diseases enhancing neovascularization. However, the number of CD34(+) cells obtained from bone marrow is not sufficient for routine clinical application. To overcome this issue, we developed a more efficient and clinically applicable CD34(+) cell expansion method. Seven-day ex vivo expansion culture of BM CD34(+) cells with a cocktail of five growth factors containing VEGF, SCF, IL-6, Flt-3 ligand, and TPO resulted in reproducible more than 20-fold increase in cell number. The favorable effect of the local transplantation of culture expanded (cEx)-BM CD34(+) cells on rat unhealing fractures was equivalent or higher than that of nonexpanded (fresh) BM CD34(+) cells exhibiting sufficient therapeutic outcome with frequent vasculogenic/osteogenic differentiation of transplanted cEx-BM CD34(+) cells and fresh BM CD34(+) cells as well as intrinsic enhancement of angiogenesis/osteogenesis at the treated fracture sites. Specifically, cEx-BM CD34(+) cell treatment demonstrated the best blood flow recovery at fracture sites compared with the nonexpanded BM CD34(+) cells. In vitro, cEx-BM CD34(+) cells showed higher colony/tube-forming capacity than nonexpanded BM CD34(+) cells. Both cells demonstrated differentiation potential into osteoblasts. Since fresh BM CD34(+) cells can be easily collected from fracture sites at the time of primary operation and stored for future use, autologous cEx-BM CD34(+) cell transplantation would be not only a simple but also a promising therapeutic strategy for unhealing fractures in the field of orthopedic trauma surgery.

  16. Multi-factors analysis on the healing of open fracture of tibia and fibula%影响胫腓骨开放性骨折愈合的多因素分析

    Institute of Scientific and Technical Information of China (English)

    赵国平; 苏伟; 赵劲民; 唐建东; 秦汉兴

    2012-01-01

    [Objective] To discuss the main factors affecting the healing of open fracture of tibia and fibula. [ Method ] Retrospective analysis of our hospital from May 2005 to February 201031 cases of treated open fractures of tibia and fibula information were gathered. Univariate logistic regression analysis were used including patients age,sex,cause of injury,associated injuries, fractures of other limbs,fracture type,the time from injury to debridement,fixation,the timing of the soft tissue closure, and the application of VSD etc. Above 10 factors were analyzed on the relationship to the healing rate. The binary logistic regression analysis of multiple factors was carried out. [ Result ] Univariate logistic regression revealed that causes of injury, fracture type, the time from injury to debridement, and the timing of the soft tissue closure were correlated with the healing rate of open fracture of tibia and fibula. Logistic regression analysis of multiple factors revealed that causes of injury, fracture type and the timing of the soft tissue closure were associated independently with the healing of open fracture of tibia and fibula, while the other factors were not statistically significant. [ Conclusion ] High-energy injuries is the risk factor of affecting healing of open fracture of tibia and fibula. There is a connection between the type and severity of fracture to the healing rate of open fractures of tibia and fibula. Early repair of soft tissue does have a benefit in the healing of open fractures of tibia and fibula.%[目的]探讨影响胫腓骨开放性骨折愈合的主要因素.[方法]回顾性分析本院从2005年5月~2010年2月5年间收治的81例胫腓骨开放性骨折的病历资料.采用单因素分析患者年龄、性别、致伤原因、合并伤、骨折肢别、骨折分型、从受伤至开始清创的时间、固定方式、软组织修复时机、VSD的应用等10项因素与骨折愈合率的关系,对以上有意义的因素进行二

  17. Development of an Injectable Salmon Fibrinogen-Thrombin Matrix to Enhance Healing of Compound Fractures of Extremities

    Science.gov (United States)

    2012-09-01

    protein for tooth enamel . Teeth and bones are related structures but have distinct components and cellular components Surgical results- animal...A fibrin adhesive seal for the repair of osteochondral fracture fragments. Clin Orthop Relat Res, 1984(182): p. 258-63. 33. Kim, S.S. and B.S. Kim...needle, and held in place while the needle was 158 retracted. The catheter was secured in place using tissue adhesive and transparent adhesive 159

  18. Assessment of laser photobiomodulation and polarized light on the healing of cutaneous wounds on euthyroid and hypothyroid induced rats

    Science.gov (United States)

    Ramalho, Luciana Maria Pedreira; Weyll, Barbara Mayoral Pedroso; da Costa Lino, Maíra Dória M.; Ramalho, Maria Jose Pedreira; Barbosa Pinheiro, Antonio Luis

    2010-02-01

    The aim of this study was to assess the influence of low-level laser therapy (LLLT) or polarized light (PL) in cutaneous wound healing of hypothyroid rats at dosages of 20 or 40J/cm2. Bioestimulatory effects of Laser radiation and Polarized light are recognized alternative therapies to improve healing on systemic disease patients, but their usefulness in the improvement of hypothyroidism healing impairment is uncertain till date. Forty Wistar rats were used in this study. Hypothyroidism was propylthiouracil- induced. Standard excisional cutaneous wounds were created without suturing and LLLT (λ660nm, 30mW, φ 3mm) or PL (λ 400-2000nm, 40mW, φ 10mm) was applied every 48 hours up to seven days on experimental groups. The rats were killed on the eighth day when wound contraction was assessed. The healing features were evaluated by light microscopy (H/E and Sirius Red). The cutaneous wounds of hypothyroid rats showed delayed healing process characterized by reduced thickness of epithelial layers, incipient formation of disorganized collagen fibers and wound contraction to a lesser extent (FISHER, p=0.0276), when compared to the euthyroid group. The use of both the Laser and Polarized Light on hypothyroid rats increased the amount of fibroblasts and the thickness of collagen fibers, especially on the L 20J/cm2 group. Euthyroid rats have still demonstrated more regular collagen fibers pattern than hypothyroid rats. It was therefore concluded that hypothyroidism delays wound healing and both Laser photobiomodulation and Polarized Light at 20j/cm2 dosages had improved the healing process in hypothyroid rats.

  19. Does sitting versus standing radiographic assessment of odontoid fractures matter? A case report.

    Science.gov (United States)

    Aleem, Ilyas S; Gussous, Yazeed; King, Michael; Fogelson, Jeremy; Nassr, Ahmad; Currier, Bradford L

    2017-06-01

    Fractures of the odontoid are the most common cervical spine injury in the geriatric population. The relationship between odontoid fracture displacement and postural change has not been previously described. We present the first described case of an elderly female patient with thoracic kyphosis and a type II odontoid fracture demonstrating significant fracture displacement with a postural change from sitting to standing. Various radiographic parameters are assessed and discussed in an attempt to characterize and explain this finding. We highlight the importance of regional and global spinal alignment and quantify physiologic odontoid fracture behavior with postural changes in this growing demographic. Upright radiographs in both sitting and standing positions may be considered when concern for odontoid fracture stability is questioned.

  20. Assessment of Regional Bone Density in Fractured Vertebrae Using Quantitative Computed Tomography

    Science.gov (United States)

    Soliman, Hany A.G.; Mac-Thiong, Jean-Marc; Levasseur, Annie; Parent, Stefan

    2017-01-01

    Study Design Cohort study. Purpose The aim of this study is to propose and evaluate a new technique to assess bone mineral density of fractured vertebrae using quantitative computed tomography (QCT). Overview of Literature There is no available technique to estimate bone mineral density (BMD) at the fractured vertebra because of the alterations in bony structures at the fracture site. Methods Forty patients with isolated fracture from T10 to L2 were analyzed from the vertebrae above and below the fracture level. Apparent density (AD) was measured based on the relationship between QCT images attenuation coefficients and the density of calibration objects. AD of 8 independent regions of interest (ROI) within the vertebral body and 2 ROI within the pedicles of vertebrae above and below the fractured vertebra were measured. At the level of the fractured vertebra, AD was measured at the pedicles, which are typically intact. AD of the fractured vertebral body was linearly interpolated, based on the assumption that AD at the fractured vertebra is equivalent to the average AD measured in vertebrae adjacent to the fracture. Estimated and measured AD of the pedicles at the fractured level were compared to verify our assumption of linear interpolation from adjacent vertebrae. Results The difference between the measured and the interpolated density of the pedicles at the fractured vertebra was 0.006 and 0.003 g/cm3 for right and left pedicle respectively. The highest mean AD located at the pedicles and the lowest mean AD was found at the anterior ROI of the vertebral body. Significant negative correlation exist between age and AD of ROI in the vertebral body. Conclusions This study suggests that the proposed technique is adequate to estimate the AD of a fractured vertebra from the density of adjacent vertebrae. PMID:28243370

  1. Coupled phenomenological and fracture mechanics approach to assess the fracture behaviour of TWC piping component

    Energy Technology Data Exchange (ETDEWEB)

    Saxena, Sanjeev, E-mail: san_bpl@yahoo.co [Advanced Materials and Processes Research Institute (AMPRI), CSIR Concern, Hoshangabad Road, Bhopal 462026 (India); Ramakrishnan, N. [Advanced Materials and Processes Research Institute (AMPRI), CSIR Concern, Hoshangabad Road, Bhopal 462026 (India); Chouhan, J.S. [Civil Engineering Department, Samrat Ashok Technological Institute, Vidisha (India)

    2010-04-15

    The present study demonstrates the numerical prediction of experimental specimen J-R curve using Gurson-Tvergaard-Needleman phenomenologically based material model. The predicted specimen J-R curve is used to determine the geometric independent initiation fracture toughness (J{sub SZWc}) value that compares well with experimental result. Using the experimentally determined and numerically predicted J{sub SZWc} values and specimen J-R curves, the accuracy of predicting the fracture behaviour of the cracked component is judged. Thus the present study proposed a coupled phenomenological and fracture mechanics approach to predict the crack initiation and instability stages in cracked piping components using numerically predicted specimen J-R curve obtained from tensile specimens testing data.

  2. Bone healing in 2016

    Science.gov (United States)

    Buza, John A.; Einhorn, Thomas

    2016-01-01

    Summary Delayed fracture healing and nonunion occurs in up to 5–10% of all fractures, and can present a challenging clinical scenario for the treating physician. Methods for the enhancement of skeletal repair may benefit patients that are at risk of, or have experienced, delayed healing or nonunion. These methods can be categorized into either physical stimulation therapies or biological therapies. Physical stimulation therapies include electrical stimulation, low-intensity pulsed ultrasonography, or extracorporeal shock wave therapy. Biological therapies can be further classified into local or systemic therapy based on the method of delivery. Local methods include autologous bone marrow, autologous bone graft, fibroblast growth factor-2, platelet-rich plasma, platelet-derived growth factor, and bone morphogenetic proteins. Systemic therapies include parathyroid hormone and bisphosphonates. This article reviews the current applications and supporting evidence for the use of these therapies in the enhancement of fracture healing. PMID:27920804

  3. Reprint of: The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide.

    Science.gov (United States)

    Curtis, Elizabeth M; Moon, Rebecca J; Harvey, Nicholas C; Cooper, Cyrus

    2017-08-01

    Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority amongst health measures considered by policy makers. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX(®). Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such

  4. Assessment of microcapsule—catalyst particles healing system in high performance fibre reinforced polymer composite

    Science.gov (United States)

    Bolimowski, P. A.; Wass, D. F.; Bond, I. P.

    2016-08-01

    Autonomous self-healing in carbon fibre reinforced polymer (CFRP) is demonstrated using epoxy resin filled microcapsules and a solid-state catalyst. Microcapsules filled with oligomeric epoxy resin (20-450 μm) and particles of Sc(OTf)3 are embedded in an interleave region of a unidirectional CFRP laminate and tested under mode I loading. Double cantilever beam (DCB) test specimens containing variable concentrations of microcapsules and catalyst were prepared, tested and compared to those healed by manual injection with corresponding healing resin formulation. The healing efficiency was evaluated by comparing the maximum peak load recorded on load-displacement curves for pristine and healed specimens. A 44% maximum recovery was observed for specimens containing 10 wt% of solid phase catalyst and 11 wt% of epoxy microcapsules. However, a significant (80%) decrease in initial strain energy release rate (G IC) was observed for specimens with the embedded healing chemistries.

  5. Multi-hazard risk assessment applied to hydraulic fracturing operations

    Science.gov (United States)

    Garcia-Aristizabal, Alexander; Gasparini, Paolo; Russo, Raffaella; Capuano, Paolo

    2017-04-01

    Without exception, the exploitation of any energy resource produces impacts and intrinsically bears risks. Therefore, to make sound decisions about future energy resource exploitation, it is important to clearly understand the potential environmental impacts in the full life-cycle of an energy development project, distinguishing between the specific impacts intrinsically related to exploiting a given energy resource and those shared with the exploitation of other energy resources. Technological advances as directional drilling and hydraulic fracturing have led to a rapid expansion of unconventional resources (UR) exploration and exploitation; as a consequence, both public health and environmental concerns have risen. The main objective of a multi-hazard risk assessment applied to the development of UR is to assess the rate (or the likelihood) of occurrence of incidents and the relative potential impacts on surrounding environment, considering different hazards and their interactions. Such analyses have to be performed considering the different stages of development of a project; however, the discussion in this paper is mainly focused on the analysis applied to the hydraulic fracturing stage of a UR development project. The multi-hazard risk assessment applied to the development of UR poses a number of challenges, making of this one a particularly complex problem. First, a number of external hazards might be considered as potential triggering mechanisms. Such hazards can be either of natural origin or anthropogenic events caused by the same industrial activities. Second, failures might propagate through the industrial elements, leading to complex scenarios according to the layout of the industrial site. Third, there is a number of potential risk receptors, ranging from environmental elements (as the air, soil, surface water, or groundwater) to local communities and ecosystems. The multi-hazard risk approach for this problem is set by considering multiple hazards

  6. Monitoring healing of pressure ulcers : a review of assessment instruments for use in the spinal cord unit

    NARCIS (Netherlands)

    van Lis, M. S.; van Asbeck, F. W. A.; Post, M. W. M.

    2010-01-01

    Study design: Review. Objectives: To identify the pressure ulcer healing assessment instrument that is the best choice for use in spinal cord injury rehabilitation. Methods: Articles were retrieved from PubMed. Inclusion criteria were written in English, published up to December 2008 and describing

  7. Perfusion of burn wounds assessed by Laser Doppler Imaging is related to burn depth and healing time

    NARCIS (Netherlands)

    Kloppenberg, FWH; Beerthuizen, GIJM; ten Duis, HJ

    Average perfusion in various burn wounds was assessed using Laser Doppler Imaging (LDI). The time necessary for a complete healing of the wound was compared to the results of the LDI measurements. A certain depth of burn was associated with a typical pattern of perfusion in the course of time. There

  8. Perfusion of burn wounds assessed by Laser Doppler Imaging is related to burn depth and healing time

    NARCIS (Netherlands)

    Kloppenberg, FWH; Beerthuizen, GIJM; ten Duis, HJ

    2001-01-01

    Average perfusion in various burn wounds was assessed using Laser Doppler Imaging (LDI). The time necessary for a complete healing of the wound was compared to the results of the LDI measurements. A certain depth of burn was associated with a typical pattern of perfusion in the course of time. There

  9. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Storgård Jensen, Simon; Kofod, Thomas

    2008-01-01

    The clinical outcome of closed vs open reduction and rigid fixation was compared based on a systematic review of the literature. Ten non-randomized retrospective studies were found. In six of these ten studies, the complication rate was significantly increased when open reduction and plating...... or wires. Nerve injuries were slightly increased when open reduction was found (although not significant). With regard to occlusal disturbances, no difference was found in the open and closed reduction group. Concerning overall complication problems, six of seven studies showed more problems after open...... in case of more complicated fractures cannot be excluded, which might explain the differences found between the two procedures. Prospective, randomized clinical trials are needed to illuminate this problem....

  10. Assessment of the effects of laser or LED photobiomodulation on hypothyroid rats of cutaneous wound healing: A morphometric study.

    Science.gov (United States)

    De Castro, Isabele Cardoso Vieira; Paraguassú, Gardênia Matos; dod Reis Júnior, João Alves; Xavier, Flávia Caló Aquino; Rodriguez, Tânia Tavares; Ramalho, Maria José Pedreira; Pinheiro, Antônio L. B.; Ramalho, Luciana Maria Pedreira

    2012-09-01

    Hypothyroid has been associated to a disruption of the body's metabolism, including the healing process. Laser and LED have been shown to be effective on improving healing in many situations, but their benefit in the improvement of healing on hypothyroidism remains unknown. The aim of this study was to assess, morphometrically, the influence of Laser (λ660nm, 24 J/cm2, 40mW, CW, spot output= 4mm2;) and LED (λ630nm ± 20, 24 J/cm2, 150mW, CW, spot output= 0.5 cm2) on the wound healing of rats with Hypothyroid. Under general anesthesia, a standard surgical wound (1cm2) was created on the dorsum of 72 male Wistar rats divided into 6 groups of 12 animals each: G1: Euthyroid; G2: Euthyroid + Laser; G3: Euthyroid + LED; G4: Hypothyroid; G5: Hypothyroid + Laser and G6: Hypothyroid + LED. Hypothyroidism was induced in rats with propylthiouracil (0.05g/100mL) administered orally for 4 weeks and maintained until the end of the experiment. Rats were irradiated after surgery each 48h then killed after 7 and 14 days. Statistical analysis was performed using ANOVA and Tukey's test. Hypothyroid rats with phototherapy laser or LED showed significant less wound contraction than euthyroid's rats at the 7th day (pphotobiomodulation using 24 J/cm2 per session improved cutaneous wound healing in hypothyroid rats.

  11. A National Assessment of the Potential Impacts of Hydraulic Fracturing Activities on Drinking Water Resources

    Science.gov (United States)

    Ridley, C.; Burden, S.; Fleming, M. M.; Knightes, C. D.; Koplos, J.; LeDuc, S. D.; Ring, S.; Stanek, J.; Tuccillo, M. E.; Weaver, J.; Frithsen, J.

    2015-12-01

    The U.S. Environmental Protection Agency recently released a draft assessment of the potential impacts of hydraulic fracturing on drinking water resources. As part of the draft assessment, we reviewed, analyzed, and synthesized information from over 950 sources and concluded that there are above and below ground mechanisms by which hydraulic fracturing activities have the potential to impact drinking water resources. These mechanisms include: Water withdrawals in times of, or in areas with, low water availability; Spills of hydraulic fracturing fluids and produced water; Fracturing directly into underground drinking water resources; Below ground migration of liquids and gases; and Inadequate treatment and discharge of wastewater. Of the potential mechanisms identified in this report, we found specific instances where one or more mechanisms led to impacts on drinking water resources, including contamination of drinking water wells. The number of identified cases, however, was small compared to the number of hydraulically fractured wells. This finding could reflect a rarity of effects on drinking water resources, but may also be due to other limiting factors. These factors include: insufficient pre- and post-fracturing data on the quality of drinking water resources; the paucity of long-term systematic studies; the presence of other sources of contamination precluding a definitive link between hydraulic fracturing activities and an impact; and the inaccessibility of some information on hydraulic fracturing activities and potential impacts. Disclaimer: The views expressed are those of the authors and do not necessarily reflect the views or polices of the EPA.

  12. Fracture mechanics safety assessment based on mechanics of materials

    Energy Technology Data Exchange (ETDEWEB)

    Roos, E.; Demler, T.; Eisele, U.; Gillot, R. (Stuttgart Univ. (Germany, F.R.). Staatliche Materialpruefungsanstalt)

    1990-01-01

    In order to determine the influence of the test temperature on the fracture mechanics characteristics for static and dynamic initiation, crack growth, and arrest, investigations were carried out on pressure vessel and piping steels of different toughness and strength (22 NiMoCr 37; 15 NiCuMoNb 5; 20 MnMoNi 55; 15 MnNi 63). The selected temperature range allowed both linear-elastic and elastic-plastic material behaviour to be examined. In the regime of linear-elastic fracture mechanics (LEFM) the conservatism of the reference curves of American and German guidelines could be demonstrated. In the upper shelf, where elastic-plastic, fracture mechanics (EPFM) parameters have to be applied, toughness-dependent overestimations of the real material properties result from the application of the reference curves. (orig./MM).

  13. Potential impact of enhanced fracture-toughness data on fracture mechanics assessment of PWR vessel integrity for pressurized thermal shock

    Energy Technology Data Exchange (ETDEWEB)

    Dickson, T.L.; Theiss, T.J.

    1991-01-01

    The Heavy Section Steel Technology (HSST) Program is involved with the generation of enhanced fracture-initiation toughness and fracture-arrest toughness data of prototypic nuclear reactor vessel steels. These two sets of data are enhanced because they have distinguishing characteristics that could potentially impact PWR pressure vessel integrity assessments for the pressurized-thermal shock (PTS) loading condition which is a major plant-life extension issue to be confronted in the 1990's. A series of large-scale fracture-mechanics experiments have produced crack-arrest (K{sub Ia}) data with the distinguishing characteristic that the values are considerably above 220 MPA {center dot} {radical}m. The implicit limit of the ASME Code and the limit used in the Integrated Pressurized Thermal Shock (IPTS) studies. Currently, the HSST Program is planning experiments to verify and quantify for A533B steel the distinguishing characteristic of elevated the distinguishing characteristic of elevated initiation-fracture toughness for shallow flaws which has been observed for other steels. The results of the analyses indicated that application of the enhanced K{sub Ia} data does reduce the conditional probability of failure P(F{vert bar}E); however, it does not appear to have the potential to significantly impact the results of PTS analyses. The application of enhanced fracture-initiation-toughness data for shallow flaws also reduces P(F{vert bar}E), and does appear to have a potential for significantly affecting the results of PTS analyses. 19 refs., 11 figs., 1 tab.

  14. Fracture assessment for a dissimilar metal weld of low alloy steel and Ni-base alloy

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Takuya, E-mail: takuya4.ogawa@toshiba.co.jp [Toshiba Corporation Power Systems Company, Power and Industrial Systems Research and Development Center, 8, Shinsugita-cho, Isogo-ku, Yokohama 235-8523 (Japan); Itatani, Masao; Saito, Toshiyuki; Hayashi, Takahiro; Narazaki, Chihiro; Tsuchihashi, Kentaro [Toshiba Corporation Power Systems Company, Power and Industrial Systems Research and Development Center, 8, Shinsugita-cho, Isogo-ku, Yokohama 235-8523 (Japan)

    2012-02-15

    Recently, instances of SCC in Ni-base alloy weld metal of light water reactor components have been reported. Despite the possibility of propagation of SCC crack to the fusion line between low alloy steel (LAS) of pressure vessel and Ni-base alloy of internal structure, a fracture assessment method of dissimilar metal welded joint has not been established. The objective of this study is to investigate a fracture mode of dissimilar metal weld of LAS and Ni-base alloy for development of a fracture assessment method for dissimilar metal weld. Fracture tests were conducted using two types of dissimilar metal weld test plates with semi-elliptical surface crack. In one of the test plates, the fusion line lies around the surface points of the surface crack and the crack tips at the surface points have intruded into LAS. Material ahead of the crack tip at the deepest point is Ni-base alloy. In the other, the fusion line lies around the deepest point of the surface crack and the crack tip at the deepest point has intruded into LAS. Material ahead of the crack tip at the deepest point is LAS. The results of fracture tests using the former type of test plate reveal that the collapse load considering the proportion of ligament area of each material gives a good estimation for fracture load. That is, fracture assessment based on plastic collapse mode is applicable to the former type of test plate. It is also understood that a fracture assessment method based on the elastic-plastic fracture mode is suitable for the latter type of test plate.

  15. 促进跟骨骨折内固定术后切口愈合的护理对策%Nursing Strategy of Promoting Incision Healing After Internal Fixation of Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    吴惠冰; 杜雪莲

    2014-01-01

    Objective To investigate nursing strategy of promoting incision healing after internal fixation of calcaneal fractures. Methods 121 patients with internal fixation of calcaneal fractures were divided into two groups. 60 cases of control group received routine nursing, while 61 cases of observation group received swelling care, pain care and wound care on the basis of routine nursing. The clinical outcomes were compared. Results Among 61 cases of observation group, there were 56 cases of incision healing within 14 days, 4 cases of poor partial involution (healing after one month of treatment) and one case of unhealed incision (caused by allograft rejection). Among 60 cases of control group, there were 39 cases of incision healing within 14 days, 15 cases of poor partial involution (healed after one month of treatment) and 6 cases of necrosis of local skin of incision (healing at 2 months after treatment). Conclusions Nursing intervention can promote the incision healing of calcaneal fractures surgery.%目的:探讨促进跟骨骨折内固定术后切口愈合的护理对策。方法将121例跟骨骨折内固定手术患者分为观察组及对照组,观察组在常规护理基础上,加强肿胀护理、疼痛护理、伤口护理,对照组予常规护理,比较两组的临床效果。结果观察组61例患者有56例切口14天愈合,4例切口局部对合差,经治疗1月内愈合,1例伤口不愈,为异体骨排斥引起;对照组60例患者有39例切口14天愈合,15例患者切口局部对合差,经治疗1月内愈合,6例患者伤口局部皮肤坏死,术后2个月愈合。结论护理干预可以促进跟骨骨折术后切口的愈合。

  16. Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

    Directory of Open Access Journals (Sweden)

    Al. Șerban

    2014-02-01

    Full Text Available Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68. The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks. All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

  17. A fracture risk assessment model of the femur in children with osteogenesis imperfecta (OI) during gait.

    Science.gov (United States)

    Fritz, Jessica M; Guan, Yabo; Wang, Mei; Smith, Peter A; Harris, Gerald F

    2009-11-01

    Osteogenesis imperfecta (OI) is a heritable bone fragility disorder characterized by skeletal deformities and increased bone fragility. There is currently no established clinical method for quantifying fracture risk in OI patients. This study begins the development of a patient-specific model for femur fracture risk assessment and prediction based on individuals' gait analysis data, bone geometry from imaging and material properties from nanoindentation (Young's modulus=19 GPa, Poisson's ratio=0.3). Finite element models of the femur were developed to assess fracture risk of the femur in a pediatric patient with OI type I. Kinetic data from clinical gait analysis was used to prescribe loading conditions on the femoral head and condyles along with muscle forces on the bone's surface. von Mises stresses were analyzed against a fracture strength of 115 MPa. The patient with OI whose femur was modeled showed no risk of femoral fracture during normal gait. The highest stress levels occurred during the mid-stance and loading responses phases of gait. The location of high stress migrated throughout the femoral diaphysis across the gait cycle. Maximum femoral stress levels occurred during the gait cycle phases associated with the highest loading. The fracture risk (fracture strength/von Mises stress), however, was low. This study provides a relevant method for combining functional activity, material property and analytical methods to improve patient monitoring.

  18. The Effects of One Chinese Herbal Medicine on Fracture Healing of Rabbits%一剂复方中药对家兔骨骼愈合的影响

    Institute of Scientific and Technical Information of China (English)

    曲伟杰; 李进军; 王生奎

    2011-01-01

    The pathways of Chinese herbal medicine in fracture healing are not very well understood. Therefore, the objective of the present study was to evaluate the effects of one compound Chinese herbal medicine on rabbits radius fracture healing using indexes(such as the serum Ca. P, serum ALP, and X-ray of bone fracture). 48 healthy mature rabbits were selected to build standard defect models, and randomly divided into experimental groups and control groups. The control rabbits were given standard diet. Experimental rabbits were fed with standard diet plus Chinese herbal medicine (2. 5 g/kg) every day. The detection was performed on the 2,4,6 and 8 weeks after operation. The results of the study showed that the level of serum Ca, P, the activity of AKP and X-ray appearances for taking Chinese herbal medicine after fracture were significantly higher than that of the control. In conclusion, composite Chinese herbs might shorten the time to union, improve the quality of fracture healing and be beneficial to the fracture healing.%复方中药对骨折愈合的作用机制目前尚不明确,本试验通过观察复方中药对家兔桡骨骨折后血清钙、磷、碱性磷酸酶和X线影像学等指标的影响,分析该中药促骨愈合的效能及其可能作用机理.试验选用48只成年家兔,制成骨缺损标准模型,随机分为试验组和空白对照组,试验组每日在饲料中添加复方中药2.5 g/kg饲喂,对照组给予普通饲料.分别于术后2、4、6、8周进行生化指标和X线影像学检测.试验结果表明,试验组血清钙、血清磷、血清碱性磷酸酶及X线片评分骨折后明显高于对照组.该复方中药能缩短骨折愈合过程所需时间,提高骨折愈合质量,有利于骨折愈合.

  19. Iloprost inhibits fracture repair in rats.

    Science.gov (United States)

    Doğan, Ali; Duygun, Fatih; Kalender, A Murat; Bayram, Irfan; Sungur, Ibrahim

    2014-01-01

    Previous studies have shown that prostaglandins (PGs) dramatically stimulate healing processes in bone. However, the effect of prostaglandin I2 (PGI2) on fracture healing remains unclear. To investigate the effect of PGI2, a study on fracture healing process in closed tibia fractures was designed. Thirty-six Sprague-Dawley male rats were randomized into two groups. On the first day, their right tibias were fractured by three-point bending technique. The study group (n = 18) received a single injection of 10 µg/kg iloprost for 5 days, while the control group (n = 18) received saline solution in the same way. On the 7th, 14th and 28th days following the fracture, six rats were sacrificed and their right legs were harvested in each group. The progression of fracture healing was assessed for each specimen by the scores of radiography (by Lane-Sandhu) and histology (by Huo et al). On the 7th day, the radiographic and histologic scores were equal. On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group, whereas radiographic total score was 11 and histologic total score was 33 in the control group. On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group (P iloprost group, whereas radiographic total score was 15 and histologic total score was 40 in the control group. On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group, it was not statistically significant (P > 0.05). Iloprost delays fracture healing in early stage in rats.

  20. Iloprost inhibits fracture repair in rats

    Institute of Scientific and Technical Information of China (English)

    Ali Do(g)an; Fatih Duygun; A.Murat Kalender; Irfan Bayram; Ibrahim Sungur

    2014-01-01

    Background Previous studies have shown that prostaglandins (PGs) dramatically stimulate healing processes in bone.However,the effect of prostaglandin l2 (PGI2) on fracture healing remains unclear.To investigate the effect of PGI2,a study on fracture healing process in closed tibia fractures was designed.Methods Thirty-six Sprague-Dawley male rats were randomized into two groups.On the first day,their right tibias were fractured by three-point bending technique.The study group (n=18) received a single injection of 10 μg/kg iloprost for 5 days,while the control group (n=18) received saline solution in the same way.On the 7th,14th and 28th days following the fracture,six rats were sacrificed and their right legs were harvested in each group.The progression of fracture healing was assessed for each specimen by the scores of radiography (by Lane-Sandhu) and histology (by Huo et al).Results On the 7th day,the radiographic and histologic scores were equal.On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group,whereas radiographic total score was 11 and histologic total score was 33 in the control group.On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group (P <0.05).On the 28th day radiographic total score was 12 and histologic total score was 37 in the iloprost group,whereas radiographic total score was 15 and histologic total score was 40 in the control group.On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group,it was not statistically significant (P >0.05).Conclusion Iloprost delays fracture healing in early stage in rats.

  1. Assessment of solvent capsule-based healing for woven E-glass fibre-reinforced polymers

    Science.gov (United States)

    Manfredi, Erica; Cohades, Amaël; Richard, Inès; Michaud, Véronique

    2015-01-01

    Vacuum Assisted Resin Infusion Molding (VARIM) with low vacuum pressure difference was used to manufacture woven glass fibre-reinforced epoxy resin plates, with a fibre volume fraction of approx. 50 vol% and containing ethyl phenylacetate (EPA)-filled capsules for self-healing purposes. Capsules were introduced by functionalising the fabrics through manual dispersion. We investigated the capability of autonomously healing delaminations induced by static loading in Mode I and II. Healing did not take place for composite samples; this was attributed to the presence of bare fibres on the crack plane and to the reduction of EPA diffusion into the matrix in the presence of fibres both of which hinder the swelling mechanism responsible for healing the cracks.

  2. Randomised trial assessing the impact of framing of fracture risk and osteoporosis treatment benefits in patients undergoing bone densitometry

    Science.gov (United States)

    Kalluru, Rama; Petrie, Keith J; Grey, Andrew; Nisa, Zaynah; Horne, Anne M; Gamble, Greg D; Bolland, Mark J

    2017-01-01

    Objectives The accuracy of patients' perception of risk is important for decisions about treatment in many diseases. We framed the risk of fracture and benefits of treatment in different ways and assessed the impact on patients' perception of fracture risk and intentions to take medication. Design Randomised trial of 4 different presentations of fracture risk and likely benefits from osteoporosis treatment. Setting Academic centre. Participants 200 patients undergoing bone densitometry. Intervention Presentation that framed the patient's absolute fracture risk either as the chance of having or not having an event, with their likely benefits from osteoporosis treatment in natural frequencies or numbers needed to treat. Outcomes Participants' views about their fracture risk and the need for osteoporosis treatment. Results The median 5-year fracture risk threshold participants regarded as high enough to consider preventative medication was 50–60%, and did not change substantially after the presentation. The median (Q1, Q3) 5-year risk initially estimated by participants was 20% (10, 50) for any fracture and 19% (10, 40) for hip fracture. 61% considered their fracture risk was low or very low, and 59–67% considered their fracture risk was lower than average. These participant estimates were 2–3 times higher than Garvan calculator estimates for any fracture, and 10–20 times higher for hip fracture. Participant estimates of fracture risk halved after the presentation, but remained higher than the Garvan estimates (1.5–2 times for any fracture, 5–10 times for hip fracture). There was no difference in these outcomes between the randomised groups. Participants' intentions about taking medication to prevent fractures were not substantially affected by receiving information about fracture risk and treatment benefits. Conclusions Altering the framing of estimated fracture risks and treatment benefits had little effect on participants' perception of the need to take

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

    Science.gov (United States)

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

    2015-11-15

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

  4. Study of the impact of PDLLA in fracture healing%PDLLA可吸收材料髓内固定对骨折愈合的影响

    Institute of Scientific and Technical Information of China (English)

    凌卓彦; 史高龙; 陈礼; 董启榕

    2015-01-01

    Objective To compare the different effect of PDLLA absorbable materials and traditional metal fixation products for post-traumatic bone healing and osteogenesis/osteoclast.Methods The project will establish an open osteotomy model of SD rats using traditional metal internal fixation products (Kirschner) and PDLLA absorbable intramedullary rod fixation.We compared the osteoblasts/osteoclasts effects of the two materials by dynamic monitoring of relevant indicators of bone repair in wound healing process.Furthermore, wehaveanalyzed the signaling pathways and transcription factor expression levels of osteoblast/osteoclast differentiation and maturation in healing process.We thoroughly studied the differenceof the cellular and molecular mechanisms in the treatment of traumatic fractures by PDLLA intramedullary rod fixation and traditional metal products.We measured the soluble receptor activateor of nuclear factors-κB ligand (sRANKL), osteoprotegerin (OPG), RANKL, OPG by the enzyme linked immunosorbent assay (ELISA) to evaluate the fracture healing.We compared the osteoblasts/osteoclasts effects of the two materials by X-ray and MicroCT.We observed the protein of Wnt OPG and RANKL by histology method.Compared the expression of mRNA of Wnt OPG and RANKL by real-time quantitative polymerase chain reaction (Real-time PCR).Results At 4 and 6 weeks after surgery, compared to that of metal intramedullary fixation products, after using the PDLLA absorbable material for intramedullary fixation, the growth of trabecula in callus was significantly promoted [4 W: (0.522 ± 0.06) 1/mm;6 W: (0.709 ±0.06) 1/mm];The serum concentrations of sRANKL [4 W: (132.66 ± 2.87) ng/L;6 W: (131.08 ±2.09) ng/L], OPG [4W: (42.68 ± 3.99) ng/L;6 W: (44.88 ± 3.90) ng/L], and the ratio of OPG/sRANKL (4 W:0.34 ±0.06;6W:0.34 ±0.08) were significantly increased;The serum concentrations of TRACP-5b[4 W:(86.48 ±5.11) ng/L;6 W:(90.05 ±5.13) ng/L]was decreased(P <0.05).At 4 and 6 weeks after

  5. Ultrasound stimulation of maxillofacial bone healing

    NARCIS (Netherlands)

    Schortinghuis, J; Stegenga, B; Raghoebar, GM; de Bont, LGM

    2003-01-01

    A substantial part of the maxillofacial surgery practice deals with maxillofacial bone healing. In the past decades, low-intensity ultrasound treatment has been shown to reduce the healing time of fresh fractures of the extremities up to 38%, and to heal delayed and non-unions up to 90% and 83%, res

  6. Fracture risk assessment in Latin America: is Frax an adaptable instrument for the region?

    Science.gov (United States)

    Morales-Torres, Jorge; Clark, Patricia; Delezé-Hinojosa, Margarita; Cons-Molina, Fidencio; Messina, Osvaldo Daniel; Hernández, Jaime; Jaller-Raad, Juan José; Quevedo-Solidoro, Héctor; Radominski, Sebastiao Cezar

    2010-10-01

    Osteoporosis is a generalized disease of bone that increases fracture risk. Multiple factors influence this risk, besides low bone mass. To decrease osteoporotic fractures, those patients who require preventive management should be readily identified. This paper aims to review current information on the use of the fracture risk assessment tool (FRAX) in Latin America. Bone mineral density measurement is currently the method of reference for evaluating the fracture risk and opting for treatment; but, it misses a notable proportion of individuals who have clinical risk factors for osteoporosis and fractures. FRAX was designed to predict the 10-year absolute risk of sustaining a major osteoporotic fracture or a hip fracture. Although data is available for several countries, from Latin America, only Argentina appears in the current version of the tool. Its present use in other Latin American countries is possible with some adaptations based in similarities of epidemiological information of each country with some of the existing databases. The cutoff value beyond which treatment should be initiated needs to be determined, based not only on clinical criteria, but also on economic considerations.

  7. The Biological Metallic versus Metallic Solution in Treating Periprosthetic Femoral Fractures: Outcome Assessment

    Directory of Open Access Journals (Sweden)

    Serafino Carta

    2016-01-01

    Full Text Available Introduction. The periprosthetic fracture of the femur is, in order of frequency, the fourth leading cause (5.9% of surgical revision. Our study aims to demonstrate how the grafting of bone splint betters the outcomes. Materials. We treated 15 periprosthetic femoral fractures divided into two groups: PS composed of 8 patients treated with plates and splints and PSS involving 7 patients treated only with plates. The evaluation criteria for the two groups during the clinical and radiological follow-up were the quality of life measured by the Short Form (36 Health Survey (SF-36, Harris Hip Score (HHS, Modified Cincinnati Rating System Questionnaire (MCRSQ, bone healing measured by the Radiographic Union Score (RUS, postoperative complications, and mortality. The evaluation endpoint was set at 24 months for both groups (p<0.05. Results. The surgery lasted an average of 124.5 minutes for the PS group and 112.6 minutes for the PSS. At 24 months all clinical and radiographic scores were p<0.05 for the PS group. During follow-up 4 patients (2 in each group died of causes not related to surgery. Conclusions. The use of the metal plate as opposed to cortical allogenic splint should be taken into consideration as a noteworthy point for periprosthetic femoral fractures.

  8. Distribution of Risks for Major Osteoporotic Fracture Based on Fracture Risk Assessment Tool in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

    Directory of Open Access Journals (Sweden)

    Nik Fatin Farhana Binti Mohd Rahhim

    2015-09-01

    Full Text Available Background: Osteoporosis has become a growing public health problem in Indonesia. A definite estimation of osteoporosis prevalence in Indonesia is not available due to the limited access of dual energy X ray absorptiometry (DXA facilities. In 2008, the World Health Organization has developed a tool called Fracture Risk Assessment Tool to identify fracture risk based on the clinical risk factors. The study aimed to identify the risk factors of osteoporotic fracture using Fracture Risk Assessment Tool in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Methods: This descriptive study was conducted from June–December 2013 in Orthopedic & Traumatology, Internal Medicine, Geriatric and Surgery polyclinics Dr. Hasan Sadikin General Hospital, Bandung to 77 respondents, aged 40–90 years, using the random sampling method. Fracture risks were calculated online, and the data obtained were analyzed and presented using frequency distribution in tables. Results: Most of the respondents had low risk for osteoporotic fracture, and only 5.19% of them had moderate risk. The main risk factors were rheumatoid arthritis (57.14%, followed by current smoking (27.27% and prolonged glucocorticoids consumption (25.98%. The moderate risk group was females, above 60 years old and with normal BMI or underweight with risks of previous fracture, parent’s previous hip fracture, rheumatoid arthritis and prolonged glucocorticoids exposure. Conclusions: Majority of the respondents have low risk for osteoporotic fracture. It must be taken into consideration that increasing age, rheumatoid arthritis, current smoking, prolonged glucocorticoids consumption, previous fracture and parent’s previous hip fracture can cause increased risk.

  9. Assessment and management of rib fracture pain in geriatric population: an ode to old age.

    Science.gov (United States)

    Wardhan, Richa

    2013-10-01

    Pain management for traumatic rib fractures has been described in literature, but there is paucity of data when it comes to acute pain management in the elderly, let alone pain resulting from traumatic rib fractures. This article focuses on challenges of assessment of pain in elderly patients and the various options available for pain management including utilization of nerve blocks. Nerve blocks are instrumental in treating rib fracture pain along with utilization of opioids and nonopioids thus formulating a multimodal approach to pain management. The goal is to devise a proper pain management regimen for geriatric patients with rib fractures to decrease the morbidity and mortality associated with it. Developing institutional protocols is one step forward towards quality care for such patients.

  10. Comprehensive assessment on dynamic roof instability under fractured rock mass conditions in the excavation disturbed zone

    Institute of Scientific and Technical Information of China (English)

    Xing-ping Lai; Fen-hua Ren; Yong-ping Wu; Mei-feng Cai

    2009-01-01

    The damage process of fractured rock mass showed that the fracture in rocks induced roof collapse in Yangchangwan Coal Mine,China.The rock mass was particularly weak and fractured.There occurred 6 large-scale dynamical roof falls in the excavation disturbed zone (EDZ) with the collapsing volume of 216 m3.First,the field detailed geological environment,regional seismic dy-namics,and dynamic instability of roadways were generally investigated.Second,the field multiple-index monitoring measurements for detecting the deep delamination of the roof,convergence deformation,bolt-cable load,acoustic emission (AE) characteristic pa-rameters,total AE events,AE energy-releasing rate,rock mass fracture,and damage were arranged.Finally,according to the time-space-strength relations,a quantitative assessment of the influence of rock-mass damage on the dynamic roof instability was accomplished.

  11. Thrombin related peptide TP508 promoted fracture repair in a mouse high energy fracture model

    Directory of Open Access Journals (Sweden)

    Pan Xiao-Hua

    2009-01-01

    Full Text Available Abstract Background Thrombin related peptide (TP508 is a 23 amino-acid synthetic peptide that represents a portion of the receptor-binding domain of thrombin molecule. Previous studies have shown that TP508 can accelerate musculoskeletal tissue repair including fracture healing. Objectives The aim of this study was to investigate the effect of TP508 on fracture healing in a murine fracture model representing high energy fracture situation. Methods Eighty CD 1 mice underwent controlled quadriceps muscle crush and open transverse mid diaphyseal femoral fracture that was then fixed with an external fixator. Animals were randomised into four groups to receive an intra-operative dose of either 100 μg TP508 into the fracture gap; 100 μg TP508 into the surrounding damaged muscle tissues; 10 μg TP508 into the fracture gap, or control equal amount of saline into the fracture gap. Radiographic assessment was performed weekly for 5 weeks; histological analysis was at 3 and 5 weeks post fracture and biomechanical testing of the fractured bone was performed at 5 weeks post fracture. Results Mechanical testing data showed that the fracture stiffness was significantly higher in the group receiving 100 μg TP508 into the fracture gap than other groups. Histological and radiographic analysis revealed a trend of increase in bone formation in the 100 μg TP508 injected into the fracture gap group compared to the saline control group. It was noted that the scar tissues was significantly less in Group II comparing with the saline control group and there was increased blood vessel formation in the crushed muscles and fracture gap areas in the groups receiving TP508 comparing to the saline control group. Conclusion The results from this study demonstrated the use of thrombin related peptide TP508 in the situation of a high energy fracture can promote fracture healing and reduce the potential complications such as muscle fibrosis and fracture delayed or non-union.

  12. Self-healing efficiency of cementitious materials containing microcapsules filled with healing adhesive: mechanical restoration and healing process monitored by water absorption.

    Science.gov (United States)

    Li, Wenting; Jiang, Zhengwu; Yang, Zhenghong; Zhao, Nan; Yuan, Weizhong

    2013-01-01

    Autonomous crack healing of cementitious composite, a construction material that is susceptible to cracking, is of great significance to improve the serviceability and to prolong the longevity of concrete structures. In this study, the St-DVB microcapsules enclosing epoxy resins as the adhesive agent were embedded in cement paste to achieve self-healing capability. The self-healing efficiency was firstly assessed by mechanical restoration of the damaging specimens after being matured. The flexural and compressive configurations were both used to stimulate the localized and distributed cracks respectively. The effects of some factors, including the content of microcapsules, the curing conditions and the degree of damage on the healing efficiency were investigated. Water absorption was innovatively proposed to monitor and characterize the evolution of crack networks during the healing process. The healing cracks were observed by SEM-EDS following. The results demonstrated that the capsule-containing cement paste can achieve the various mechanical restorations depending on the curing condition and the degree of damage. But the voids generated by the surfactants compromised the strength. Though no noticeable improved stiffness obtained, the increasing fracture energy was seen particularly for the specimen acquiring 60% pre-damage. The sorptivity and amount of water decreased with cracks healing by the adhesive, which contributed to cut off and block ingress of water. The micrographs by SEM-EDS also validated that the cracks were bridged by the hardened epoxy as the dominated elements of C and O accounted for 95% by mass in the nearby cracks.

  13. Assessment of implant stability during various stages of healing placed immediately following extraction in an overdenture situation

    Directory of Open Access Journals (Sweden)

    Ashwin Thomas Koshy

    2017-01-01

    Full Text Available To assess the implant stability during different stages of healing in an immediate loaded implant soon after extraction. A 73-year-old female came with a chief complaint of bad smell and irritation in her lower front gum region. On examination, she was found to be completely edentulous in the maxillary arch and partially edentulous in the mandibular arch with only the canines present bilaterally. The posterior mandibular ridge was severely resorbed and hence could not be treated with a conventional mandibular complete denture. Considering the age of the patient and the preference of only a single surgical visit, we decided to plan for a conventional maxillary denture against an implant supported mandibular overdenture with two implants placed immediately after extraction of canines. The stability of these implants was assessed during the early phases of healing with the help of a resonance frequency analysis method (RFA using Osstell ISQ™. During the healing phase, implant stability quotient (ISQ values decrease by 4–5 values after installation with the lowest values at the 1st week postplacement. Following this, the ISQ values increased steadily for all implants up to 16 weeks. No significant differences were noted over time. At placement, the mean ISQ values at 33 and 43 regions were 74 and 75.2, respectively. The mean lowest ISQ values recorded at the 1st week were 58.8 and 65.4, respectively. At 16 weeks, the mean ISQ values were 70.5 and 67.9, respectively. The survival of such immediately placed implants, which are later used as overdenture supported implants, are highly predictable when the surgical and prosthetic part is done meticulously. However, there needs future studies oriented to understand better the healing pattern of immediately placed implants in extraction sockets, which would guide the clinician with the optimal loading time.

  14. 丹参和内固定对胫骨远端骨折愈合的影响研究%Study on the Effect of Salvia Miltiorrhiza and Internal Fixation on the Healing of Distal Tibial Fractures

    Institute of Scientific and Technical Information of China (English)

    董晓强; 王海涛

    2016-01-01

    Objective To discuss the effect of different internal fixation treatment combined with Salvia miltiorrhiza for distal tibial fractures and defining the value of Salvia miltiorrhiza for fracture healing.Methods A retrospective analysis of therapeutic efficacy was made in Department of orthopedics of Chenggang Steel Hospital where there were 226 cases of emergency patients with internal fixation of distal tibial fractures according to the use of Salvia miltiorrhiza. They were divided into the Salvia miltiorrhiza group 114 cases (Salvia miltiorrhiza and pressure plate sub group, Salvia miltiorrhiza and LCP group, Salvia miltiorrhiza and intramedullary nail group) and the internal fixation group 112 cases(compression ifxation group, locking compression plate and intramedullary fixation sub group), in 1 week, 2 weeks, 4 weeks and 8 weeks after the treatment, comparison of callus formation, the postoperative hospitalization time and fracture healing made among groups. ResultsAt the same time after 2 weeks, the callus score of Salvia miltiorrhiza group was significantly better than the internal fixation group, and fracture healing time, postoperative hospitalization time were signiifcantly lower than those of the internal fixation group. The indicators of salvia miltiorrhiza and locking compression plate group were better than other groups,P<0.05, so the difference was significant. Conclusion Salvia miltiorrhiza combined with internal ifxation can signiifcantly improve fracture healing, and Salvia miltiorrhiza combined with locking pressurized plate internal fixation can be the best choice of tibial fractures treatment. The treatment effect is remarkable and fast healing.%目的:探讨丹参结合不同内固定方案治疗胫骨远端骨折的效果,明确丹参对于骨折愈合的价值。方法回顾性分析承钢医院骨科226例胫骨远端骨折患者急诊内固定手术的治疗效果,根据丹参使用分为丹参组114例(丹参与加压板亚组、

  15. Discrete Fracture Network Models for Risk Assessment of Carbon Sequestration in Coal

    Energy Technology Data Exchange (ETDEWEB)

    Jack Pashin; Guohai Jin; Chunmiao Zheng; Song Chen; Marcella McIntyre

    2008-07-01

    A software package called DFNModeler has been developed to assess the potential risks associated with carbon sequestration in coal. Natural fractures provide the principal conduits for fluid flow in coal-bearing strata, and these fractures present the most tangible risks for the leakage of injected carbon dioxide. The objectives of this study were to develop discrete fracture network (DFN) modeling tools for risk assessment and to use these tools to assess risks in the Black Warrior Basin of Alabama, where coal-bearing strata have high potential for carbon sequestration and enhanced coalbed methane recovery. DFNModeler provides a user-friendly interface for the construction, visualization, and analysis of DFN models. DFNModeler employs an OpenGL graphics engine that enables real-time manipulation of DFN models. Analytical capabilities in DFNModeler include display of structural and hydrologic parameters, compartmentalization analysis, and fluid pathways analysis. DFN models can be exported to third-party software packages for flow modeling. DFN models were constructed to simulate fracturing in coal-bearing strata of the upper Pottsville Formation in the Black Warrior Basin. Outcrops and wireline cores were used to characterize fracture systems, which include joint systems, cleat systems, and fault-related shear fractures. DFN models were constructed to simulate jointing, cleating, faulting, and hydraulic fracturing. Analysis of DFN models indicates that strata-bound jointing compartmentalizes the Pottsville hydrologic system and helps protect shallow aquifers from injection operations at reservoir depth. Analysis of fault zones, however, suggests that faulting can facilitate cross-formational flow. For this reason, faults should be avoided when siting injection wells. DFN-based flow models constructed in TOUGH2 indicate that fracture aperture and connectivity are critical variables affecting the leakage of injected CO{sub 2} from coal. Highly transmissive joints

  16. A Comparison of 2- and 3-dimensional Healing Assessment after Endodontic Surgery Using Cone-beam Computed Tomographic Volumes or Periapical Radiographs.

    Science.gov (United States)

    Schloss, Tom; Sonntag, David; Kohli, Meetu R; Setzer, Frank C

    2017-07-01

    The aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging. The healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software). There was a significant difference between the mean preoperative lesion volumes of 95.34 mm(3) (n = 51, standard deviation [SD] ±196.28 mm(3)) versus 6.48 mm(3) (n = 51, SD ±17.70 mm(3)) at follow-up (P < .05). The mean volume reduction was 83.7%. Preoperatively, mean lesion areas on periapical films were 13.55 mm(2) (n = 51, SD ±18.80 mm(2)) and 1.83 mm(2) (n = 51, SD ±.68 mm(2)) at follow-up (P < .05). According to Molven's criteria, 40 teeth were classified as complete healing, 7 as incomplete healing, and 4 as uncertain healing. Based on the modified PENN 3D criteria, 33 teeth were classified as complete healing, 14 as limited healing, 1 as uncertain healing, and 3 as unsatisfactory healing. The variation in the distribution of the 2D and 3D healing classifications was significantly different (P < .05). Periapical healing statuses incomplete healing or uncertain healing according to Molven's criteria could be clearly classified using 3D criteria. CBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery. Copyright © 2017 American Association of Endodontists

  17. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

    Directory of Open Access Journals (Sweden)

    Vargaonkar Gauresh

    2014-07-01

    Full Text Available 【Abstract】Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist, increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner. The purpose of our study was to evaluate the difference in patients function among those treated by 1 closed reduction and Plaster of Paris cast, 2 distractor application, or 3 open reduction and internal fixation with a volar plate, and to assess the treatment choice for each particular fracture type. Methods: A prospective study was carried out on 60 patients with fractures of the distal end radius. Fractures were classified according to the AO classification into type A (extra-articular, type B (partial articular and type C (complete articular. After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years. Results: Anatomical results were evaluated according to the Sarmiento’s modification of Lindstrom Criteria, which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique. Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification, which was revealed to relate with the type of treatment techniques. Conclusion: There is no customized solution for all the fractures of the distal radius. The choice of treatment should be based on the fracture type, the patient’s characteristics, the patient’s demands and the treating surgeon’s experience and preference. Key words: Distal end radius fractures; Volar plate; Radial orthofix

  18. Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures.

    Science.gov (United States)

    Knutsen, Ashleen; Avoian, Tigran; Borkowski, Sean L; Ebramzadeh, Edward; Zionts, Lewis E; Sangiorgio, Sophia N

    2014-02-01

    Determining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap. A non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement). During pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05). Overall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.

  19. Assessment of microcirculation dynamics during cutaneous wound healing phases in vivo using optical microangiography.

    Science.gov (United States)

    Yousefi, Siavash; Qin, Jia; Dziennis, Suzan; Wang, Ruikang K

    2014-01-01

    Cutaneous wound healing consists of multiple overlapping phases starting with blood coagulation following incision of blood vessels. We utilized label-free optical coherence tomography and optical microangiography (OMAG) to noninvasively monitor healing process and dynamics of microcirculation system in a mouse ear pinna wound model. Mouse ear pinna is composed of two layers of skin separated by a layer of cartilage and because its total thickness is around 500 μm, it can be utilized as an ideal model for optical imaging techniques. These skin layers are identical to human skin structure except for sweat ducts and glands. Microcirculatory system responds to the wound injury by recruiting collateral vessels to supply blood flow to hypoxic region. During the inflammatory phase, lymphatic vessels play an important role in the immune response of the tissue and clearing waste from interstitial fluid. In the final phase of wound healing, tissue maturation, and remodeling, the wound area is fully closed while blood vessels mature to support the tissue cells. We show that using OMAG technology allows noninvasive and label-free monitoring and imaging each phase of wound healing that can be used to replace invasive tissue sample histology and immunochemistry technologies.

  20. Assessment of microcirculation dynamics during cutaneous wound healing phases in vivo using optical microangiography

    Science.gov (United States)

    Yousefi, Siavash; Qin, Jia; Dziennis, Suzan; Wang, Ruikang K.

    2014-07-01

    Cutaneous wound healing consists of multiple overlapping phases starting with blood coagulation following incision of blood vessels. We utilized label-free optical coherence tomography and optical microangiography (OMAG) to noninvasively monitor healing process and dynamics of microcirculation system in a mouse ear pinna wound model. Mouse ear pinna is composed of two layers of skin separated by a layer of cartilage and because its total thickness is around 500 μm, it can be utilized as an ideal model for optical imaging techniques. These skin layers are identical to human skin structure except for sweat ducts and glands. Microcirculatory system responds to the wound injury by recruiting collateral vessels to supply blood flow to hypoxic region. During the inflammatory phase, lymphatic vessels play an important role in the immune response of the tissue and clearing waste from interstitial fluid. In the final phase of wound healing, tissue maturation, and remodeling, the wound area is fully closed while blood vessels mature to support the tissue cells. We show that using OMAG technology allows noninvasive and label-free monitoring and imaging each phase of wound healing that can be used to replace invasive tissue sample histology and immunochemistry technologies.

  1. Tosic external fixator in the management of proximal tibial fractures in adults.

    Science.gov (United States)

    Tosic, A; Ebraheim, N A; Abou Chakra, I; Emara, K

    2001-06-01

    This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.

  2. Combined Measures of Dynamic Bone Quality and Postural Balance--A Fracture Risk Assessment Approach in Osteoporosis.

    Science.gov (United States)

    Bhattacharya, Amit; Watts, Nelson B; Dwivedi, Alok; Shukla, Rakesh; Mani, Ashutosh; Diab, Dima

    2016-01-01

    We evaluated functional measures of neuromuscular integrity and bone's resistance to fracture as a combined tool in discriminating osteoporosis patients with and without fractures. Functional aspects of neuromuscular integrity were quantified with a noninvasive measure of static and dynamic functional postural stability (FPS), and fracture resistance was obtained with bone shock absorption in patients with osteoporosis aged 65-85 and compared our measures with dual-energy X-ray absorptiometry and Fracture Risk Assessment Tool (FRAX [World Health Organization Collaborating Center for Metabolic Bone Diseases, Sheffield, UK]) in women with osteoporosis, some with and some without vertebral fractures. Patients with vertebral fracture showed larger static FPS (postural sway excursion) in the mediolateral and anterior-posterior directions, suggesting poorer balance. Most of the variables of dynamic FPS showed significant differences between fracture and no-fracture groups (e.g., the fracture group took significantly longer during turning, implying poorer dynamic balance control). Also, compared with healthy control subjects, all 4 dynamic FPS responses for osteoporosis patients with and without fracture were significantly poorer, suggesting potential risk for falls. In summary, patients with osteoporosis who have vertebral fractures (compared with patients with similarly low bone mineral density and other nonfracture risk fractures) have not only lower bone shock absorption damping (ζ) but also increased postural imbalance.

  3. An Improved Approach to Fracture Toughness Assessment of Brittle Coating on Ductile Substrate Systems under Indentation

    Science.gov (United States)

    Demidova, Natalia V.

    Fracture toughness is an important material property that determines the structural integrity of a component with pre-existing or service-generated flaws. In the present research, an indentation-based method and the associated fracture mechanics model are proposed for fracture toughness assessment of brittle coating/ductile substrate systems. The proposed models consider well-developed radial/median cracks generated under sharp indentation, despite that the crack formation process may have gone through crack initiation and propagation phases. For generality, the geometry of a well-developed crack is assumed to be semi-elliptical in shape. The driving force of the crack is considered to stem from the residual plastic zone expansion under the indenter, as well as the far-field Boussinesq (elastic) stress. Three well-defined configurations are studied. For the first configuration, a crack with a depth of less than 7% of the coating thickness is considered. In this case, the problem is treated as the one for the monolithic material with the coating material properties. For the second configuration, a crack that runs deeper than 7% of the coating thickness but is still within the coating layer is analyzed. In this case, the composite hardness is introduced into the analysis to account for the influence of the substrate material properties; and furthermore, an interface correction factor is proposed to take into account the presence of the coating/substrate interface and its influence on the stress intensity factor of the well-developed elliptical cracks. For the third configuration, a crack penetrating into the substrate is considered. In this case, based on the condition of deformation compatibility across the coating/substrate interface, the bulk modulus for the coating/substrate system is introduced into the analysis. A series of indentation tests are conducted on a WC/10Co/4Cr coating/1080 low carbon steel substrate specimen, which is a brittle coating on a ductile

  4. [The comparative assessment of the wound-healing effects of the treatment with the use of Bioptron, Minitag, Orion+ apparatuses and hollow cathode lamps (experimental study)].

    Science.gov (United States)

    Sharipova, M M; Voronova, S N; Rukin, E M; Vasilenko, A M

    2011-01-01

    The objective of the present experimental study was the comparative assessment of the wound-healing effects of radiation emitted from Bioptron, Minitag, Orion+ apparatuses and hollow cathode lamps (HCL). The emitters of any type were shown to be equally efficacious in that they accelerated wound epithelization by 30% on the average compared with control. Based on the difference between spectral and power characteristics of different sources of radiation and dynamics of their wound-healing efficacy (including that of two types of HCL), the authors arrived at the conclusion that the further development of the proposed approach to wound healing is a promising line of research in the field of spectral phototherapy.

  5. Detection of occult vertebral fractures by quantitative assessment of bone marrow attenuation values at MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Henes, Frank Oliver, E-mail: f.henes@uke.de [Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg (Germany); Groth, Michael [Department of Diagnostic and Interventional Neuroradiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg (Germany); Kramer, Harald [Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377 Munich (Germany); Department of Radiology, University of Wisconsin – Madison, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792 (United States); Schaefer, Christian [Department of Trauma-, Hand- and Reconstructive Surgery, Spine Center, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Regier, Marc; Derlin, Thorsten; Adam, Gerhard; Bannas, Peter [Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg (Germany)

    2014-01-15

    Objectives: To determine a cut-off value of Hounsfield attenuation units (HU) at multidetector computed tomography (MDCT) for valid and reliable detection of bone marrow oedema (BME) related to occult vertebral fractures. Methods: 36 patients underwent both MDCT and Magnetic Resonance Imaging (MRI) for evaluation of vertebral fractures of the thoracolumbar spine and were included in this retrospective study. Two readers independently assessed HU values at MDCT in a total of 196 vertebrae. Reliability was assessed by intraclass correlation coefficient and Bland–Altman analysis. For each patient we determined the vertebra with the lowest HU value and calculated the HU-difference to each other vertebral body. HU-differences were subjected to receiver operating characteristic (ROC) curve analysis to determine the diagnostic accuracy for detection of BME as determined by MRI, which served as the reference standard. Results of HU-measurements were compared with standard visual evaluation of MDCT. Results: HU measurements demonstrated a high interrater reliability (ICC = 0.984). ROC curve analysis (AUC = 0.978) exhibited an ideal cut-off value of 29.6 HU for detection of BME associated with vertebral fractures with an accuracy of 97.4% as compared to 93.4% accuracy of visual evaluation. Particularly, HU-measurements increased the sensitivity for detection of vertebral fractures from 78.0% to 92.7% due to the detection of 7 of 9 occult fractures that were missed by visual evaluation alone. Conclusions: Assessing bone marrow density by HU measurements using the cut-off of 29.6 HU is a valid and reliable tool for detection of BME related to occult vertebral fractures in MDCT. The introduced technique may allow more accurate treatment decisions and may make further diagnostic work-up with MRI unnecessary.

  6. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

    Institute of Scientific and Technical Information of China (English)

    Vargaonkar Gauresh

    2014-01-01

    Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist,increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner.The purpose of our study was to evaluate the difference in patients function among those treated by 1) closed reduction and Plaster of Paris cast,2) distractor application,or 3) open reduction and internal fixation with a volar plate,and to assess the treatment choice for each particular fracture type.Methods:A prospective study was carried out on 60 patients with fractures of the distal end radius.Fractures were classified according to the AO classification into type A (extra-articular),type B (partial articular) and type C (complete articular).After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years.Results:Anatomical results were evaluated according to the Sarmiento's modification of Lindstrom Criteria,which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique.Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification,which was revealed to relate with the type of treatment techniques.Conclusion:There is no customized solution for all the fractures of the distal radius.The choice of treatment should be based on the fracture type,the patient's characteristics,the patient's demands and the treating surgeon's experience and preference.

  7. Assessment of malnutrition in hip fracture patients: effects on surgical delay, hospital stay and mortality.

    Science.gov (United States)

    Symeonidis, Panagiotis D; Clark, David

    2006-08-01

    The importance of malnutrition in elderly hip fracture patients has long been recognised. All patients operated upon for a hip fracture over a five-year period were assessed according to two nutritional markers : a) serum albumin levels and b) peripheral blood total lymphocyte count. Patients were subdivided into groups according to the four possible combinations of these results. Outcomes according to four clinical outcome parameters were validated: a) waiting time to operation b) length of hospitalisation, c) in-hospital mortality, and d) one-year postoperative mortality. Significant differences were found between malnourished patients and those with normal laboratory values with regard to surgical delay and one year postoperative mortality. Malnourished patients were also more likely to be hospitalised longer than a month and to die during their hospital stay, but the difference was not significant. The combination of serum albumin level and total lymphocyte count can be used as an independent prognostic factor in hip fracture patients.

  8. The Waywardness of Knee Joint Affect Fracture Healing(annexal three Example Clinical Analysis)%膝关节不稳对骨折愈合的影响(附3例临床分析)

    Institute of Scientific and Technical Information of China (English)

    黄枫; 曾志奎; 黄学员; 曾展鹏

    2011-01-01

    Objective: To investigate the waywardness of knee joint affect fracture Healing. Methods: To review our hospital adduct three patients who because of fail to make a definite diagnosis of the Cruciate ligaments of knee joint injuries,which induce the homonymy Fracture of shaft of femur postoperative disunion. Author from the biomechanics point of view to analyze,cruciate ligament is very important to the steady of knee joint,conversely after the injuries of knee joint to mean a certain degree loss of physiological move-ment,as well as load conduction disturbance Followed by,which lead to the waywardness of knee joint. The waywardness of knee joint cause the stress of broken ends of fractured bone modify,which will bring what influence to fracture healing. Results: If we do not repair the injured cruciate ligament in time.when the patient who is postoperative of Fracture of shaft of femur is doing contineous passive motion or contineous passive motion working, there will be one shearing and revolving stress transmit to broken ends of fractured bone, meanwhile Vertical compressive stress of legs is hard to transmit to broken ends of fractured bone.which is likely to induce Fracture of shaft of femur to defer union even disunion. Conclusion: The waywardness of knee joint cause the stress of broken ends of fractured bone in homonymy limbs modify,which is likely to induce fracture to defer union even disunion.%目的:探讨膝关节不稳对骨折愈合的影响.方法:回顾性分析我院收治3例患者因早期未能准确诊治膝关节交叉韧带损伤,而导致同侧股骨干骨折术后不愈合的临床资料.我们从生物力学角度分析,交叉韧带对膝关节生理性制导及稳定作用,反之损伤后膝关节的生理运动一定程度的丧失,以及随之而来的载荷传导紊乱,从而导致膝关节不稳.膝关节不稳所引起骨折端应力改变,其对骨折愈合将产生怎样的影响.结果:如未能及时修复交叉韧带在患者

  9. In vitro assessment of biopolymer-modified porous silicon microparticles for wound healing applications.

    Science.gov (United States)

    Mori, Michela; Almeida, Patrick V; Cola, Michela; Anselmi, Giulia; Mäkilä, Ermei; Correia, Alexandra; Salonen, Jarno; Hirvonen, Jouni; Caramella, Carla; Santos, Hélder A

    2014-11-01

    The wound healing stands as very complex and dynamic process, aiming the re-establishment of the damaged tissue's integrity and functionality. Thus, there is an emerging need for developing biopolymer-based composites capable of actively promoting cellular proliferation and reconstituting the extracellular matrix. The aims of the present work were to prepare and characterize biopolymer-functionalized porous silicon (PSi) microparticles, resulting in the development of drug delivery microsystems for future applications in wound healing. Thermally hydrocarbonized PSi (THCPSi) microparticles were coated with both chitosan and a mixture of chondroitin sulfate/hyaluronic acid, and subsequently loaded with two antibacterial model drugs, vancomycin and resveratrol. The biopolymer coating, drug loading degree and drug release behavior of the modified PSi microparticles were evaluated in vitro. The results showed that both the biopolymer coating and drug loading of the THCPSi microparticles were successfully achieved. In addition, a sustained release was observed for both the drugs tested. The viability and proliferation profiles of a fibroblast cell line exposed to the modified THCPSi microparticles and the subsequent reactive oxygen species (ROS) production were also evaluated. The cytotoxicity and proliferation results demonstrated less toxicity for the biopolymer-coated THCPSi microparticles at different concentrations and time points comparatively to the uncoated counterparts. The ROS production by the fibroblasts exposed to both uncoated and biopolymer-coated PSi microparticles showed that the modified PSi microparticles did not induce significant ROS production at the concentrations tested. Overall, the biopolymer-based PSi microparticles developed in this study are promising platforms for wound healing applications.

  10. Radiologic assessment of bone healing after orthognathic surgery using fractal analysis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Soo; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul; Park, Tae Won [College of Dentistry, Seoul National University, Seoul (Korea, Republic of); Jeon, In Seong [Department of Dentistry, Inje University Sanggyepaik Hospital, Seoul (Korea, Republic of); Kim, Jong Dae [Division of Information and Communication Engineering, Hallym university, Chuncheon (Korea, Republic of)

    2002-12-15

    To evaluate the radiographic change of operation sites after orthognathic surgery using the digital image processing and fractal analysis. A series of panoramic radiographs of thirty-five randomly selected patients who had undergone mandibular orthognathic surgery (bilateral sagittal split ramus osteotomy) without clinical complication for osseous healing, were taken. The panoramic radiographs of each selected patient were taken at pre-operation (stage 0), 1 or 2 days after operation (stage 1), 1 month after operation (stage 2), 6 months after operation (stage 3), and 12 months after operation (stage 4). The radiographs were digitized at 600 dpi, 8 bit, and 256 gray levels. The region of interest, centered on the bony gap area of the operation site, was selected and the fractal dimension was calculated by using the tile-counting method. The mean values and standard deviations of fractal dimension for each stage were calculated and the differences among stage 0, 1, 2, 3, and 4 were evaluated through repeated measures of the ANOVA and paired t-test. The mean values and standard deviations of the fractal dimensions obtained from stage 0, 1, 2, 3, and 4 were 1.658 {+-} 0.048, 1.580 {+-} 0.050, 1.607 {+-} 0.046, 1.624 {+-} 0.049, and 1.641 {+-} 0.061, respectively. The fractal dimensions from stage 1 to stage 4 were shown to have a tendency to increase (p<0.05). The tendency of the fractal dimesion to increase relative to healing time may be a useful means of evaluating post-operative bony healing of the osteotomy site.

  11. Fracture assessment of the Oskarshamn 1 reactor pressure vessel under cold over-pressurization

    Energy Technology Data Exchange (ETDEWEB)

    Sattari-Far, I. [DNV Technical Consulting AB, Stockholm (Sweden)

    2001-03-01

    The major motivation of this study was to develop a methodology for fracture assessment of surface defects in the 01 reactor pressure vessel under cold loading scenarios, particularly the cold over-pressurization event. According to a previous study, the FENIX project, the cold over-pressurization of the O1 reactor is a limiting loading case, as the ductile/brittle transition temperature (RT{sub NDT}) of certain welds in the O1 beltline region may be over 100 deg C at the-end-of-life condition. The FENIX project gave values of the acceptable and critical crack depth to be equal to the thickness of the cladding layer (about 6 mm) under this load case using the ASME K{sub Ic} reference curve methodology. This study is aimed to develop a methodology to give a more precise fracture assessment of the O1 reactor under cold loading scenarios. Some of the main objectives of this study have been as below: To prepare a material which can simulate the mechanical properties and RT{sub NDT} of the O1 reactor at the end-of-life conditions. To conduct a fracture mechanics test program to cover the essential influencing factors, such as crack geometry (shallow and deep cracks) and loading condition (uniaxial and biaxial) on the cleavage fracture toughness. To perform fracture mechanics analyses to identify a suitable methodology for assessment of the experimental results. To study the responses of engineering fracture assessment methods to the experimental results from the clad specimens. To propose a fracture assessment procedure for determination of the acceptable and critical flaw sizes in the 01 reactor under the cold loading events. A test program consisted of experiments on standard SEN(B) specimens and clad beams, containing surface cracks was conducted during the course of this project. A total of nine clad beams and clad cruciform specimens were tested under uniaxial and biaxial loading. The test material is reactor steel of type A 508 Grade B, which is specially heat

  12. SR 97 - Alternative models project. Discrete fracture network modelling for performance assessment of Aberg

    Energy Technology Data Exchange (ETDEWEB)

    Dershowitz, B.; Eiben, T. [Golder Associates Inc., Seattle (United States); Follin, S.; Andersson, Johan [Golder Grundteknik KB, Stockholm (Sweden)

    1999-08-01

    As part of studies into the siting of a deep repository for nuclear waste, Swedish Nuclear Fuel and Waste Management Company (SKB) has commissioned the Alternative Models Project (AMP). The AMP is a comparison of three alternative modeling approaches for geosphere performance assessment for a single hypothetical site. The hypothetical site, arbitrarily named Aberg is based on parameters from the Aespoe Hard Rock Laboratory in southern Sweden. The Aberg model domain, boundary conditions and canister locations are defined as a common reference case to facilitate comparisons between approaches. This report presents the results of a discrete fracture pathways analysis of the Aberg site, within the context of the SR 97 performance assessment exercise. The Aberg discrete fracture network (DFN) site model is based on consensus Aberg parameters related to the Aespoe HRL site. Discrete fracture pathways are identified from canister locations in a prototype repository design to the surface of the island or to the sea bottom. The discrete fracture pathways analysis presented in this report is used to provide the following parameters for SKB's performance assessment transport codes FARF31 and COMP23: * F-factor: Flow wetted surface normalized with regards to flow rate (yields an appreciation of the contact area available for diffusion and sorption processes) [TL{sup -1}]. * Travel Time: Advective transport time from a canister location to the environmental discharge [T]. * Canister Flux: Darcy flux (flow rate per unit area) past a representative canister location [LT{sup -1}]. In addition to the above, the discrete fracture pathways analysis in this report also provides information about: additional pathway parameters such as pathway length, pathway width, transport aperture, reactive surface area and transmissivity, percentage of canister locations with pathways to the surface discharge, spatial pattern of pathways and pathway discharges, visualization of pathways, and

  13. Assessment and documentation of non-healing, chronic wounds in inpatient health care facilities in the Czech Republic: an evaluation study.

    Science.gov (United States)

    Pokorná, Andrea; Leaper, David

    2015-04-01

    The foundation of health care management of patients with non-healing, chronic wounds needs accurate evaluation followed by the selection of an appropriate therapeutic strategy. Assessment of non-healing, chronic wounds in clinical practice in the Czech Republic is not standardised. The aim of this study was to analyse the methods being used to assess non-healing, chronic wounds in inpatient facilities in the Czech Republic. The research was carried out at 77 inpatient medical facilities (8 university/faculty hospitals, 63 hospitals and 6 long- term hospitals) across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The results of this research have corroborated the suspicion of inconsistencies in procedures used by general nurses for assessment of non-healing, chronic wounds. However, the situation was found to be more positive with regard to evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of a wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were significantly improved when a consultant for wound healing was present (P = 0·047). The same applied to facilities possessing a certificate of quality issued by the Czech Wound Management Association (P = 0·010). In conclusion, an effective strategy for wound management depends on the method and scope of the assessment of non-healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of a 'non-healing, chronic wound assessment' algorithm.

  14. Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing.

    Science.gov (United States)

    Kuemmerle, Jan M; Auer, Jörg A; Rademacher, Nathalie; Lischer, Christoph J; Bettschart-Wolfensberger, Regula; Fürst, Anton E

    2008-02-01

    To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome. Retrospective study. Horses (n=10) with type Ia P1 fractures. Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses. Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively. Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture. Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.

  15. Clinical and radiographic evaluation of biodegradable bone plates in the treatment of mandibular body fractures

    Directory of Open Access Journals (Sweden)

    Sherin Kamal Elhalawany

    2015-01-01

    Full Text Available Background: Many different systems are available for the treatment of fractures ranging from the heavy compression plates for mandibular reconstruction to low profile plates for mid-facial fixation, and are made either from stainless steel, titanium or vitallium. Recently, biodegradable, self-reinforced polylactide plates and screws have been used for the internal fixation of fractures of the mandible with good results. Aim of this study: This study evaluated clinically the biodegradable bone plates for treatment of mandibular body fracture and to evaluate bone healing during the follow-up period using digital radiography. Materials and Methods : Eight patients had been suffered from mandibular body fractures were treated using Inion CPS TM bioresorbable fixation system and the healing process were followed up using digitised panoramic radiography at first week and after 1, 3 and 6 months. Results: Clinical examination of fractured segments revealed stable fixation across the fracture sites while visual and quantitative assessment of radiograph showed healing process was comparable with results previously reported by titanium bone plates. Conclusion: Open reduction and internal fixation of mandibular fractures using bioresorbable fixation system with a brief period of inter-maxillary fixation have evolved to the point where the physical properties are sufficient to withstand the post-operative loads required for fracture repair of mandibular body fractures. The foreign body reaction is a major material-related problem which requires further studies.

  16. Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE: a prospective study

    Directory of Open Access Journals (Sweden)

    West Sarah L

    2010-08-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD. Methods This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1 bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2 volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3 serum markers of bone turnover; 4 bone formation rate by bone biopsy; and 5 muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls. Discussion This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy - we will reduce the burden of disease due to fractures among patients with CKD.

  17. Risk assessment tools to identify women with increased risk of osteoporotic fracture. Complexity or simplicity?

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Friis-Holmberg, Teresa; Hermann, Anne Pernille

    2013-01-01

    A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview...... of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance each tool was sufficient for practical use and lastly to examine whether the complexity of the tools influenced their discriminative power. We searched Pub...... fracture outcomes. High quality studies in randomized design with population-based cohorts with different case mixes are needed. © 2013 American Society for Bone and Mineral Research....

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

    Science.gov (United States)

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

    2016-04-01

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

  19. Utility of double-contrast multidetector CT scans to assess cartilage thickness after tibial plafond fracture

    Directory of Open Access Journals (Sweden)

    Thaddeus P Thomas

    2009-11-01

    Full Text Available Thaddeus P Thomas1,2, Christopher J Van Hofwegen1, Donald D Anderson1,2, Thomas D Brown1,2, J Lawrence Marsh11Department of Orthopedics and Rehabilitation, 2Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USAAbstract: The pathophysiology of posttraumatic osteoarthritis (PTOA after intraarticular fractures is poorly understood. Pursuit of a better understanding of this disease is complicated by inability to accurately monitor its onset, progression and severity. Common radiographic methods used to assess PTOA do not provide sufficient image quality for precise cartilage measurements. Double-contrast multidetector computed tomography (MDCT is an alternative method that may be useful, since it produces high-quality images in normal ankles. The purpose of this study was to assess this technique’s performance in assessing cartilage maintenance in ankles with an intraarticular fracture. Thirty-six tibial plafond fractures were followed over two years, with 31 MDCTs being obtained four months after injury, and 22 MDCTs after two years. Unfortunately, clinical results with this technique were unreliable due to pathology (presumed arthrofibrosis and technical problems (pooling of contrast. The arthrofibrosis that developed in many patients inhibited proper joint access and contrast infiltration, although high-quality images were obtained in 11 patients. In this patient subset, in which focal regions of cartilage degeneration could be visualized, thickness could be measured with a high degree of fidelity. While thus useful in selected instances, double-contrast MDCT was too unreliable to be recommended to assess these particular types of injuries.Keywords: posttraumatic osteoarthritis, cartilage, imaging, fracture

  20. Integrated assessment procedure for determining the fracture strength of glass components in CSP systems

    Directory of Open Access Journals (Sweden)

    L. Guerra Rosa

    2014-10-01

    Full Text Available The structural integrity and reliability of glass components are key issues for concentrated solar power (CSP systems. For example, the glass windows in a solar furnace may suffer catastrophic fracture due to thermal and structural loadings, including reaction chamber pressure cycling. Predicting design strength provides the basis for which the optical components and mounting assembly can be designed so that failure does not occur over the operational lifetime of a given CSP system. The fracture strength of brittle materials is dependent on the size and distribution of cracks or surface flaws. Due to the inherent brittleness of glass resulting in catastrophic failure, conservative design approaches are currently used for the development of optical components made of glass, which generally neglect the specific glass composition as well as subcritical crack growth, surface area under stress, and nature of the load – either static or cyclic – phenomena. In this paper, several methods to characterize the strength of glass are discussed to aid engineers in predicting a design strength for a given surface finish, glass type, and environment. Based on the Weibull statistical approach and experimental data available on testing silica glass rod specimens, a theoretical model is developed for estimating their fracture strength under typical loading conditions. Then, an integrated assessment procedure for structural glass elements is further developed based on fracture mechanics and the theory of probability, which is based on the probabilistic modelling of the complex behaviour of glass fracture but avoids the complexity for calculation in applications. As an example, the design strength of a glass window suitable for a solar furnace reaction chamber is highlighted.

  1. Toe and Metatarsal Fractures (Broken Toes)

    Science.gov (United States)

    ... rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone. Avoid the offending activity. Because stress fractures result from repetitive stress, it ...

  2. Effect of different hemostasis methods on operative incision healing of calcaneal fracture%不同止血方法对跟骨骨折手术切口愈合的影响

    Institute of Scientific and Technical Information of China (English)

    代灿; 苟景跃; 邓子龙; 张晓星

    2016-01-01

    目的:观察和对比分析电凝止血、钳夹止血及压迫止血对跟骨骨折手术切口愈合的影响。方法收集2012年12月~2015年12月收治的60例66足跟骨骨折患者临床资料,其中男性48例,女性12例;年龄18~59岁,平均36.6岁。均经跟骨外侧L形切口行切开复位钛板内固定术,术中止血方法分别采用电凝止血、钳夹止血及压迫止血。记录三组患者年龄、骨折分型、伤后至手术时间、手术时间、切口干燥时间、切口愈合时间、切口并发症发生率及足部功能Maryland评分等,并进行统计学分析。结果在切口干燥时间、切口愈合时间及切口并发症等方面钳夹止血组显著优于电凝止血组和压迫止血组(P<0.05),而电凝止血组和压迫止血组之间无显著性差异(P>0.05),三组足部功能Maryland评分无显著性差异(P>0.05)。结论跟骨骨折术中行钳夹止血可明显降低切口并发症的发生率。%Objective To observe and compare the effects of electrocoagulation hemostasis, forceps hemo-stasis and compression hemostasis on the operative incision healing in calcaneal fracture patients.Methods From Dec.2012 to Dec.2015,60 patients with calcaneal fracture were treated.Among them 48 were male and 12 were fe-male ranged from 18 to 59 years(average,36.6 years).All cases (66 calcaneal fractures) were treated by open re-duction and internal fixation through L-type calcaneal lateral incision.Intra-operative hemostasis methods included the electrocoagulation hemostasis, forceps hemostasis and compression hemostasis. Indexes such as age, fracture classification,time from injury to operation,operation time,drying time and healing time of the incision,incidence of incision-related complications and Maryland foot function score among the 3 groups were recorded and statistically analyzed.Results The forceps hemostasis group was significantly better than the electrocoagulation

  3. Effect of He-Ne Laser and CO2 Laser on Bone Fracture Healing%He-Ne激光与扩束CO2激光照射对骨折愈合的影响

    Institute of Scientific and Technical Information of China (English)

    崔建胜; 章萍

    2011-01-01

    目的 比较相同剂量的He-Ne激光与CO激光照射对骨折的疗效.方法 36只健康雄性兔制成骨折模型,随机分为三组,每组12只.He-Ne激光组:He-Ne激光扩束照射骨折区;CO激光组:CO激光扩束照射骨折组;对照组:常规治疗.通过X片,观察骨折愈合情况,测定骨痂中钙和胶原含量及生物力学抗扭性能,比较三组的疗效.结果 (1)骨折愈合效果:两激光组均优于对照组(P激光组优于He-Ne激光组(P激光组好于He-Ne激光组(P)和瞬间扭矩(T)均高于对照组(P激光组T高于He-Ne激光组.结论 He-Ne激光与CO激光照射对骨折愈合均有促进作用,且CO激光更好于He-Ne激光.%Objective To obsere and compare the discrepancy of curative effect of He-Ne laser and CO2 laser irradiation under the same dosage.Methods The bone fracture pattern was made to 36 healthy male rabbits, who were randomly divided into 3 groups ( each 12) : He-Ne laser group: expanding a bunch of the He-Ne laser project light upon the bone fracture zone, CO2 laser group: expanding a bunch of the CO2 laser irradiation, and matched control group:the routine cures.The different therapy impact was observed on the bone fracture healing.Observed X-ray, detected the contents of collagen and calcium in the callus, and measured the biomechanics anti-torsion strength to evaluate curative effect.Results ( 1 ) Fracture healing effect: the two laser groups were better than the control group (P <0.05 or <0.01 ), and 25 days after treatment, CO2 laser group was better than He-Ne laser group ( P < 0.04 ).(2) Collagen and calcium content: two laser groups were higher than control group (P < 0.05), and CO2 laser group was better than He-Ne laser group ( P < 0.05 ).(3) Biomechanics anti-torsion strength: the minimum torque ( T8°) and instantaneous torque (Tmax) of both laser groups were higher than that of control group (P <0.01 ), and the Tmax of CO2 laser group was higher than that of He-Ne laser group

  4. 接骨木总苷片促进骨折愈合与抗炎作用研究Ⅰ%Study on Effects of Sambucus williamsii Total Glycosides Tablets on Fracture Healing and Inflammation: Part Ⅰ

    Institute of Scientific and Technical Information of China (English)

    杨炳友; 何娅雯; 朱晓清; 韩华; 杨柳; 王秋红; 匡海学

    2014-01-01

    目的:研究接骨木总苷片促进骨折愈合与抗炎作用.方法:复制兔骨折模型.60只新西兰大白兔随机均分为正常对照(等容生理盐水)组、模型(等容生理盐水)组、跌打丸(0.28 g/kg)组与接骨木总苷片高、中、低剂量(0.22、0.11、0.06 g/kg)组,以药物加入饲料给药,连续36 d.骨密度仪测定骨密度(BMD)、骨矿含量(BMC)、骨痂面积(Area),通过X光片观察兔骨折愈合程度.采用小鼠耳肿胀和大鼠足肿胀模型观察其抗炎作用,热板法观察其镇痛作用.结果:高、中、低剂量接骨木总苷片可增加模型大白兔BMD、BMC,使模型大白兔骨折断端接近消失,骨膜反应密度加深,骨痂量增多、增深;中剂量组接骨木总苷片可增加模型大白兔Area.高、中、低剂量接骨木总苷片可减轻模型小鼠耳肿胀度,降低模型大鼠足肿胀率,提高1h内模型小鼠痛阈值.结论:接骨木总苷片有较好的抵抗急性炎症和镇痛的作用,并能促进骨折愈合.%OBJECTIVE:To study the effects of Sambucus williamsii total glycosides tablets on fracture healing and inflammation.METHODS:Rabbit fracture model was induced.50 New Zealand white rabbits were randomly divided into normal control group (constant volume of normal saline),model group (constant volume of normal saline),Dieda pills group (0.28 g/kg),S.williamsii total glycosides tablets high-dose,medium-dose and low-dose groups(0.22,0.11,0.06 g/kg).They were given medicine via feedingstuff for consecutive 36 d.The bone mineral density (BMD),bone mineral content (BMC) and callus area (Area) were determined by dual energy X-ray absorptioumetry (DXA).The degree of fracture healing was observed by X-ray film.Anti-inflammatory effects were observed by mice ear swelling and rat foot swelling experiments; analgesic action was observed by hot plate method.RESULTS:High-dose,medium-dose and low-dose of S.williamsii total glycosides tablets could increase BMD and BMC in model group

  5. The application of fracture mechanics to the safety assessment of transport casks for radioactive materials

    Energy Technology Data Exchange (ETDEWEB)

    Zencker, U.; Mueller, K.; Droste, B.; Roedel, R.; Voelzke, H. [Bundesanstalt fuer Materialforschung und -pruefung (BAM), Berlin (Germany)

    2004-07-01

    BAM is the German responsible authority for the mechanical and thermal design safety assessment of packages for the transport of radioactive materials. The assessment has to cover the brittle fracture safety proof of package components made of potentially brittle materials. This paper gives a survey of the regulatory and technical requirements for such an assessment according to BAM's new ''Guidelines for the Application of Ductile Cast Iron for Transport and Storage Casks for Radioactive Materials''. Based on these guidelines higher stresses than before can become permissible, but it is necessary to put more effort into the safety assessment procedure. The fundamentals of such a proof with the help of the methods of fracture mechanics are presented. The recommended procedure takes into account the guidelines of the IAEA Advisory Material which are based on the prevention of crack initiation. Examples of BAM's research and safety assessment practices are given. Recommendations for further developments towards package designs with higher acceptable stress levels will be concluded.

  6. Fracture toughness and safety assessment of X65 offshore pipeline welded joints

    Institute of Scientific and Technical Information of China (English)

    Zhang Li; Zhang Yufeng; Huo Lixing; Deng Caiyan

    2005-01-01

    In this investigation, the mechanical properties and low-temperature fracture toughness of API 5L X65 offshore pipeline welded joints were studied. Structure Integrity Assessment Procedure (SINTAP)-Failure Assessment Diagram (FAD) method was applied to the pipe structure with surface flaw at the weld toe. According to the ISO standard BS7448,the CTOD fracture toughness of the welded joints was determined at the temperature of 0℃. For the heat-affected zone (HAZ) specimens, post-test metallographic analysis was performed to verify that the tip of the crack was located in the coarse crystal zone in order to confirm the validity of the above results. The failure lines of analysis level 1 and 3 of weld metal were derived from the results of the mechanical property test. The assessment was performed, considering the maximum lay stress, residual stress conservatively assumed to be uniform tensile stress, and minimum CTOD value. The results of the assessment showed that pipeline structure with a surface flaw ( the height and length are respectively 2. 2 mm and 5 mm) at the weld toe is safe. This study lays the foundation of application of SINTAP to pipeline structure assessment.

  7. Effect of in-hospital comprehensive geriatric assessment (CGA in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

    Directory of Open Access Journals (Sweden)

    Taraldsen Kristin

    2011-04-01

    Full Text Available Abstract Background Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT aims to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual in an orthopaedic unit. Methods/design The intervention of interest, a comprehensive geriatric assessment is compared with traditional care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility measured by the Short Physical Performance Battery (SPPB at 4 months after surgery. Secondary outcomes measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait, falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival. Discussion We believe that the design of the study, the randomisation procedure and outcome measurements will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility and other relevant outcomes in hip fracture patients. Trials registration ClinicalTrials.gov, NCT00667914

  8. 掌侧入路与背侧入路对腕舟骨骨折愈合率的影响%Effect of volar approach versus dorsal approach on the healing rate of scaphoid bone fractures

    Institute of Scientific and Technical Information of China (English)

    喻永新; 尚如国

    2014-01-01

    目的:探讨掌侧入路与背侧入路对腕舟骨骨折愈合率的影响。方法:中文数据库以“腕舟骨骨折”与“掌侧入路”和“背侧入路”的布尔逻辑搭配结果作为检索词,英文数据库以“scaphoid fractures”与“dorsal”、“volar”及“palmar”的布尔逻辑搭配结果作为检索词。用计算机检索中国知网、万方学术期刊数据库、维普中文期刊数据库、中国生物医学文献服务系统、中国生物医学期刊网引文数据库、Pubmed及Sciencedirect数据库建库至2013年11月收录的所有相关文献。利用Revman5.2统计软件进行统计分析。结果:共纳入9篇文献,涉及435例患者,其中随机对照实验2篇,非随机对照实验7篇;中文文献4篇,外文文献5篇。漏斗图显示文献不存在发表偏倚。掌侧入路组与背侧入路组总的骨折愈合率比较,差异无统计学意义[Z=149,P=0.140;OR=0.420,95%CI(0.140,1.310)];掌侧入路组术后6~8个月的骨折愈合率优于背侧入路组[Z=2.840,P=0.004;OR=6.930,95%CI(1.820,26.320)]。掌侧入路组与背侧入路组术后并发症发生率比较,差异无统计学意义[Z=0.590,P=0.560;OR=0.760,95%CI(0.310,1.890)]。掌侧入路组与背侧入路组术后腕部活动功能比较,差异无统计学意义[Z=0.990,P=0.320;OR=1.900,95%CI(-1.840,5.840)]。结论:掌侧入路与背侧入路治疗腕舟骨骨折对骨折愈合率的影响没有差异,但经掌侧入路固定的患者骨折愈合更快。%Objective:To explore the effect of volar approach versus dorsal approach on the healing rate of scaphoid bone fractures. Methods:The Boolean logical combination of Scaphoid fractures,Dorsal,Volar and Palmar were used as index terms.All the literatures of controlled trial included from database establishing to November 2013 were retrieved from

  9. Assessment of the Treatment Outcome of Closed Extra-Articular Distal Tibia Fracture: IM Nailing vs Plating

    Directory of Open Access Journals (Sweden)

    Seyed Abas Behgoo

    2009-11-01

    Full Text Available Background:The tibial diaphyseal fractures are the most common type of long bone fractures encountered by most orthopedic surgeons.In accordance with descriptive indices of tibia fractures on the basis of their location in the bone,distal tibia fractures have the second incidence of all tibia fractures after the middle tibia fractures.The purpose of the study was to assess the complications and treatment outcome of closed extra-articular distal tibia fracture. Methods:The results of the management for 76 patients with closed extra-articular distal tibia fracture by intramedullary nailing and plating were reviewed retrospectively.The variables included AO (Arbeitsgemeinschaft fur Osteosynthesefragenclassification of tibia fracture, the mean duration of union, malunion,and nonunion.   Results: Twenty seven and forty nine patients were treated by intramedullary(IM nailing and plating respectively.The most common type of fractures was A1 which was observed in twenty five patients. Initial union and nonunion occurred in   sixty three and thirteen patients respectively. Eight patients had nonunion in plating   group and five of twenty seven patients in IM nailing group. Eleven of twenty seven patients in IM nailing group suffered from malunion while only four patients in the other group had this complication.   Conclusion: The plating Technique in comparison with IM nailing has a satisfactory functional outcome.The technique has a lower incidence of malunion and nonunion, and it should be recommended as a good treatment option for the management of extra-articular closed fracture of distal tibia.  

  10. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

    LENUS (Irish Health Repository)

    Kennedy, J G

    2012-02-03

    Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

  11. Community-based risk assessment of water contamination from high-volume horizontal hydraulic fracturing.

    Science.gov (United States)

    Penningroth, Stephen M; Yarrow, Matthew M; Figueroa, Abner X; Bowen, Rebecca J; Delgado, Soraya

    2013-01-01

    The risk of contaminating surface and groundwater as a result of shale gas extraction using high-volume horizontal hydraulic fracturing (fracking) has not been assessed using conventional risk assessment methodologies. Baseline (pre-fracking) data on relevant water quality indicators, needed for meaningful risk assessment, are largely lacking. To fill this gap, the nonprofit Community Science Institute (CSI) partners with community volunteers who perform regular sampling of more than 50 streams in the Marcellus and Utica Shale regions of upstate New York; samples are analyzed for parameters associated with HVHHF. Similar baseline data on regional groundwater comes from CSI's testing of private drinking water wells. Analytic results for groundwater (with permission) and surface water are made publicly available in an interactive, searchable database. Baseline concentrations of potential contaminants from shale gas operations are found to be low, suggesting that early community-based monitoring is an effective foundation for assessing later contamination due to fracking.

  12. Estimation of Fracture Parameters for Leak-before-Break Assessment on Elevated Temperature

    Energy Technology Data Exchange (ETDEWEB)

    Lee, S. Y.; Kim, N. H.; Koo, G. H. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, D. J. [Korea Univ., Seoul (Korea, Republic of)

    2015-05-15

    When the liquid sodium leaks this interaction may cause the fire that is harmful to safety of the reactor. Therefore, it is necessary to prevent against sodium fire in SFRs. Leak-before-Break(LBB) concept, had been devised for this purpose and has following advantage than Double-ended Guillotine Break(DEGB) design. If DEGB is excluded, the number of extinguish facilities and firewalls against the sodium fire can be minimize. LBB concept, has been well established and had many experience in regard of light water reactors(LWRs). But LBB assessment to SFRs is more complicated because SFRs is operated on elevated temperature region. On this region, because creep damage occurs to material and grows defects LBB assessment to SFRs should be considering creep effects. The procedure and method for this purpose are provided RCC-MRx A16 that is France code. To calculate fracture parameters such as K and J are required to some coefficients and equations which have been limited in RCC-MRx A16. Thus, in this study obtained K and J using finite element analysis for the sub-model including the crack. In this study, fracture parameters for LBB assessment were estimated by finite element analysis. This result will be applicable to LBB assessment of PGSFR.

  13. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    Institute of Scientific and Technical Information of China (English)

    Ramji Lal Sahu; Rajni Ranjan; Ajay Lal

    2015-01-01

    Background:Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries.The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures.Methods:This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013.Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft.All patients were operated under general anesthesia and closed reamed interlocking nailing was done.All patients were followed for 9 months.Results:Out of 78 patients,69 patients underwent union in 90-150 days with a mean of 110.68 days.Complications found in four patients who had nonunion,and five patients had delayed union,which was treated with bone grafting.All the patients were assessed clinically and radiologically for fracture healing,joint movements and implant failure.The results were excellent in 88.46% and good in 6.41% patients.Complete subjective,functional,and clinical recovery had occurred in almost 100% of the patients.Conclusions:The results of the present study indicates that in the presence of proper indications,reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  14. Characterizing trabecular bone structure for assessing vertebral fracture risk on volumetric quantitative computed tomography

    Science.gov (United States)

    Nagarajan, Mahesh B.; Checefsky, Walter A.; Abidin, Anas Z.; Tsai, Halley; Wang, Xixi; Hobbs, Susan K.; Bauer, Jan S.; Baum, Thomas; Wismüller, Axel

    2015-03-01

    While the proximal femur is preferred for measuring bone mineral density (BMD) in fracture risk estimation, the introduction of volumetric quantitative computed tomography has revealed stronger associations between BMD and spinal fracture status. In this study, we propose to capture properties of trabecular bone structure in spinal vertebrae with advanced second-order statistical features for purposes of fracture risk assessment. For this purpose, axial multi-detector CT (MDCT) images were acquired from 28 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. A semi-automated method was used to annotate the trabecular compartment in the central vertebral slice with a circular region of interest (ROI) to exclude cortical bone; pixels within were converted to values indicative of BMD. Six second-order statistical features derived from gray-level co-occurrence matrices (GLCM) and the mean BMD within the ROI were then extracted and used in conjunction with a generalized radial basis functions (GRBF) neural network to predict the failure load of the specimens; true failure load was measured through biomechanical testing. Prediction performance was evaluated with a root-mean-square error (RMSE) metric. The best prediction performance was observed with GLCM feature `correlation' (RMSE = 1.02 ± 0.18), which significantly outperformed all other GLCM features (p GLCM feature correlation also significantly outperformed MDCTmeasured mean BMD (RMSE = 1.11 ± 0.17) (pGLCM-derived texture features.

  15. Case series: a clinical study of 27 cases of dentoalveolar root fractures in children and adolescents.

    Science.gov (United States)

    Kirzioglu, Z; Koseler Sentut, T; Karayilmaz, H; Ozay Erturk, S

    2008-06-01

    This was to assess fracture type, treatment delay, splinting periods and various treatment methods on periradicular healing of root fractures in a group of patients attending a Paediatric Dentistry clinic. Records and radiographs of children with root-fractured teeth, referred during 1999-2003, were assessed. Correlation analysis was performed using Spearman rank test. There were 27 root-fractured teeth in 20 patients aged between 8-18 years. One root-fracture occurred in 13 patients (65%) and 7 (35%) had two root-fractured teeth; all maxillary teeth and the most affected teeth were central, followed by lateral, incisors. Only 4 patients were seen on the day of the trauma. The commonest cause of injury was a fall (12 patients), followed by collisions, bicycle and motorcycle accidents. Treatments consisted of: splinting, splinting+pulp therapy, extraction of coronal fragment accompanied with orthodontic interventions and restorative procedures, and surgical operations. Healing was related to treatment delay, location and type of fracture, and splinting time. Statistical analysis showed significant correlations only between healing type and splinting time. Preventive educational programs concerning traumatic dental injuries are needed in Turkey and mandatory use of mouthguards and preventive use of helmets with bicycles and motorcycles.

  16. Self-healing efficiency of cementitious materials containing microcapsules filled with healing adhesive: mechanical restoration and healing process monitored by water absorption.

    Directory of Open Access Journals (Sweden)

    Wenting Li

    Full Text Available Autonomous crack healing of cementitious composite, a construction material that is susceptible to cracking, is of great significance to improve the serviceability and to prolong the longevity of concrete structures. In this study, the St-DVB microcapsules enclosing epoxy resins as the adhesive agent were embedded in cement paste to achieve self-healing capability. The self-healing efficiency was firstly assessed by mechanical restoration of the damaging specimens after being matured. The flexural and compressive configurations were both used to stimulate the localized and distributed cracks respectively. The effects of some factors, including the content of microcapsules, the curing conditions and the degree of damage on the healing efficiency were investigated. Water absorption was innovatively proposed to monitor and characterize the evolution of crack networks during the healing process. The healing cracks were observed by SEM-EDS following. The results demonstrated that the capsule-containing cement paste can achieve the various mechanical restorations depending on the curing condition and the degree of damage. But the voids generated by the surfactants compromised the strength. Though no noticeable improved stiffness obtained, the increasing fracture energy was seen particularly for the specimen acquiring 60% pre-damage. The sorptivity and amount of water decreased with cracks healing by the adhesive, which contributed to cut off and block ingress of water. The micrographs by SEM-EDS also validated that the cracks were bridged by the hardened epoxy as the dominated elements of C and O accounted for 95% by mass in the nearby cracks.

  17. ′Sutureless′ transconjunctival approach for infraorbital rim fractures

    Directory of Open Access Journals (Sweden)

    Vaibhav Nagaraj

    2015-01-01

    Full Text Available Aim: To analyze the ease and surgical outcome of using sutureless transconjunctival approach for repair of infra-orbital fractures. Design: Prospective clinical case series. Materials and Methods: Totally 5 patients with infra-orbital rim or orbital floor fractures were selected and the fractures were accessed through a pre-septal transconjunctival incision. After reduction and fixation, the conjunctiva was just re-approximated and re-draped into position. Incidence of post-operative complications such as diplopia, lid retraction, eyelid dystopia, foreign body granuloma and poor conjunctival healing was assessed at intervals of 1 week, 15 days and a month post-operatively. Results: No complications were observed in any of the 5 patients. Healing was satisfactory in all patients. Conclusion: The sutureless technique appears to be a time saving and technically simpler viable alternative to multilayered suturing in orbital trauma with minimal post-operative complications.

  18. ‘Sutureless’ transconjunctival approach for infraorbital rim fractures

    Science.gov (United States)

    Nagaraj, Vaibhav; Ghosh, Abhishek; Nanjappa, Madan; Ramesh, Keerthi

    2015-01-01

    Aim: To analyze the ease and surgical outcome of using sutureless transconjunctival approach for repair of infra-orbital fractures. Design: Prospective clinical case series. Materials and Methods: Totally 5 patients with infra-orbital rim or orbital floor fractures were selected and the fractures were accessed through a pre-septal transconjunctival incision. After reduction and fixation, the conjunctiva was just re-approximated and re-draped into position. Incidence of post-operative complications such as diplopia, lid retraction, eyelid dystopia, foreign body granuloma and poor conjunctival healing was assessed at intervals of 1 week, 15 days and a month post-operatively. Results: No complications were observed in any of the 5 patients. Healing was satisfactory in all patients. Conclusion: The sutureless technique appears to be a time saving and technically simpler viable alternative to multilayered suturing in orbital trauma with minimal post-operative complications. PMID:25821377

  19. Self-healing polymers

    Science.gov (United States)

    Klein, Daniel J. (Inventor)

    2011-01-01

    A three dimensional structure fabricated from a self-healing polymeric material, comprising poly(ester amides) obtained from ethylene glycol, azelaic acid and 1,1-aminoundecanoic acid, wherein polymeric material has a melt index above 2.5 g/10 min. as determined by ASTM D1238 at 190.degree. C. and 2.16kg, impact resistance and ductility sufficient to resist cracking and brittle fracture upon impact by a 9 mm bullet fired at a temperature of about 29.degree. C. at subsonic speed in a range from about 800 feet/sec to about 1000 feet/sec. It has been determined that the important factors necessary for self-healing behavior of polymers include sufficient impact strength, control of the degree of crystallinity, low melting point and the ability to instantly melt at impacted area.

  20. Effect of Zoledronic Acid on the Healing of Distal Radial Fracture%唑来膦酸对老年桡骨远端骨折术后疗效观察

    Institute of Scientific and Technical Information of China (English)

    尹自龙; 石磊; 王林; 刘驰; 郑念野; 纪泉; 张华俦; 良元; 薛庆云

    2014-01-01

    ,and a conventional calcium and calcitriol supplement,4 week and 3 month follow-up of fractures heal-ing and postoperative 1 year follow-up of bone mineral density. Results The fracture healing in elderly patients with no obvi-ous effect of zoledronic acid anti osteoporosis medicine after distal radius fracture,callus in A group is more than callus in group B,postoperative bone mineral density increased over one year ago. Conclusion The effect of osteoporosis treatment with zoledronic acid medicine in elderly patients with distal radius fractures is significant,while no obvious negative effect on the healing of the osteoporotic distal radius fracture.

  1. The Experimental Study of the Sound field of Low Intensity Pulsed Ultrasound Promoting Fracture Healing%低强度脉冲超声促进骨愈合的声场研究

    Institute of Scientific and Technical Information of China (English)

    王迪龙; 张冀; 菅喜岐

    2013-01-01

    目的 通过对圆形平面超声换能器近声场的实验测量,研究低强度脉冲超声(low intensity pulsed ultrasound,LIPUS)治疗骨折愈合时,骨组织的厚度和裂缝位置、形状等对近声场的影响,为LIPUS促进骨愈合治疗方案的制定提供理论依据.方法 选取圆形平面超声换能器近声场声轴上的一个声压极大值和极小值端点处作为参考位置,分别对这两个位置上垂直于声轴断面的声压分布进行测试,分析讨论不同功率、骨组织厚度、水体深度、骨折裂缝宽度及其位置,对垂直于声轴断面上的声压分布的影响.结果 近场声压随功率的增大而非线性增大;骨组织厚度在1~5 mm范围时,在声轴上极大值点处的声压随骨组织厚度增厚明显减小,但在极小值点变化较小;声压受骨组织和换能器之间水体的影响较小;随骨折裂缝宽度增大,声压在裂缝处增大.结论 骨组织厚度以及骨折裂缝的位置、形状等对声场分布均有影响,且对近声场内极大值和极小值处的声压影响程度不同;在进行LIPUS促进骨折愈合治疗时,需要根据骨折位置等不同条件设定不同的治疗参数.%Objective To study the effect of the thickness,the shape and location of the bone tissue on the near sound field of the circular plane ultrasonic transducer by experimentally measuring the near sound field,during the fracture healing treated by the low intensity pulsed ultrasound (LIPUS),which can provide theoretical basis for making the treatment plan of the fracture healing promoted by the LIPUS.Methods Select a maximum and minimum point of near field pressure on acoustic axis as the reference positions.Then,respectively obtain the axial pressure distribution of the two positions perpendicular to the cross-section of the acoustic axis.Analyze and discuss the effects of different power,the bone tissue thickness,the depth of water,the width of the fracture crack and the

  2. A risk assessment tool for contaminated sites in low-permeability fractured media

    DEFF Research Database (Denmark)

    Chambon, Julie Claire Claudia; Binning, Philip John; Jørgensen, Peter R.

    2011-01-01

    and history (including secondary sources) and can be applied to a wide range of compounds. The tool successfully simulates published data from short duration column and field experiments. The use for risk assessment is illustrated by three typical risk assessment case studies, involving pesticides......, chlorinated solvents, benzene and MTBE. The model is compared with field data and with results from a simpler approach based on an Equivalent Porous Media (EPM). Risk assessment conclusions of the DF and EPM approaches are very different due to the early breakthrough, long term tailing, and lower attenuation...... due to degradation associated with fractured media. While the DF tool simulates the field data, it is difficult to conclude that the DF model is superior to an EPM model because of a lack of long term monitoring data. However, better agreement with existing field data by the DF model using observed...

  3. Measurement of ulnar variance and radial inclination on X-rays of healed distal radius fractures. With the axis of the distal radius or ulna?

    Science.gov (United States)

    Thuysbaert, Gilles; Ringburg, Akkie; Petronilia, Steven; Vanden Berghe, Alex; Hollevoet, Nadine

    2015-06-01

    Ulnar variance and radial inclination are radiological parameters frequently used to evaluate displacement of distal radius fractures. In most studies measurements are based on the long central axis of the distal radius, although the axis of the distal ulna can also be used. The purpose of this study was to determine which axis is more reliable. Four observers performed measurements on standard anteroposterior digital wrist X-rays of 20 patients taken 1 and 2 months after sustaining an extra-articular distal radius fracture. Intraobserver reliability was similar with both methods. No difference was found in interobserver reliability between both methods for ulnar variance, but for radial inclination it was better with the axis through the radius. Measurements on two X-rays of the same wrist taken at a different moment were similar with both methods. It can be concluded that the central axis of the distal radius can remain the basis to determine ulnar variance and radial inclination.

  4. 罂粟碱促进跟骨骨折手术切口愈合的疗效评价%Evaluation of promotive effect on incision healing after the operation of calcaneus fractures by using papaverine

    Institute of Scientific and Technical Information of China (English)

    汤俊君; 张建; 吴克俭; 刘亭茹; 张永刚

    2015-01-01

    Objective To evaluate the promotive effect on incision healing after the operation of calcaneus fractures by using papaverine. Methods From 2010 to 2013, 52 patients with calcaneus fractures were divided into 2 groups according to whether papaverine was used or not after the operation. There were 29 patients ( 33 feet ) in treatment group and 23 patients ( 25 feet ) in control group. All the patients underwent open reduction and internal ifxation with L-type calcaneal lateral incision, and the time of regular drainage lasted for 48 hours after the operation. The clinical data were recorded in all the patients, including gender, age, degree of soft tissue injury, classiifcation of fracture, time from injury to operation, operation time, intraoperative amount of bleeding, drying time and healing time of the incision, length of unhealthy skin and incidence of complications of the incision and function score of the foot at 1 year after the operation. Statistical analysis was performed. Results There were no statistically signiifcant differences in gender, age, degree of soft tissue injury, classiifcation of fracture, time from injury to operation, operation time, intraoperative amount of bleeding and function score of the foot at 1 year after the operation between the 2 groups. In control group, the average time of incision drying was ( 6.2±1.9 ) days and the average time of incision healing was ( 17.8±3.1 ) days. The good ratio of incision health degree was 64.0%. While in treatment group, the average time of incision drying was ( 5.1±1.2 ) days and the average time of incision healing was ( 15.7±2.6 ) days. The good ratio of incision health degree was 84.8%. The differences between the 2 groups were statistically signiifcant ( P<0.0355, 0.0063, 0.0328 ). Conclusions Papaverine can promote incision healing and decrease complications after the operation of calcaneus fractures.%目的:评价跟骨骨折术后使用罂粟碱对手术切口

  5. Management of fractures in small animals.

    Science.gov (United States)

    Roush, James K

    2005-09-01

    Fracture repair in small animals has arrived at a crossroads because of advances in fracture repair and client demands. Research into bone healing and repair techniques, collective professional experience,economics, and client demands are obligating veterinarians to greater expertise in the actual act of repairing fractures. The influx of surgery specialists into burgeoning private practices has improved access to specialty service beyond what the limited number of academic practices could previously provide and has raised the local standard of practice for orthopedic surgery at the same time. The necessity to deal with the preoperative and postoperative management of traumatized small animals by the general practitioner has not changed, however. Treatment of the small animal patient with a fractured bone does involve accurate definition of the fracture, selection of an appropriate method of fracture fixation from the variety of devices available, and correct application of the fixation. Far more than these, however, it involves assessment and treatment of the traumatized patient as a whole,including preanesthetic evaluation of critical body systems, preoperative preparation of the patient and client, and postoperative management of the repaired fracture and patient.

  6. Accuracy of densitometric vertebral fracture assessment when performed by DXA technicians-a cross-sectional, multiobserver study

    DEFF Research Database (Denmark)

    Rud, B; Vestergaard, A; Hyldstrup, L

    2016-01-01

    Six dual-energy X-ray absorptiometry (DXA) technicians reviewed lateral images of the spine for deformed vertebrae. The images were acquired with a DXA scanner in 235 patients referred for osteoporosis assessment. The outcome was compared to findings on spinal radiographs assessed by two...... radiologists. Three DXA technicians performed acceptable or better in identifying patients with fractured vertebrae. INTRODUCTION: This is the first study to evaluate the accuracy of vertebral fracture assessment (VFA) when used by DXA technicians as a triage test to select patients with deformed vertebrae...

  7. A Randomized, Controlled Trial to Assess the Effect of Topical Insulin Versus Normal Saline in Pressure Ulcer Healing.

    Science.gov (United States)

    Stephen, Shine; Agnihotri, Meenakshi; Kaur, Sukhpal

    2016-06-01

    Insulin has been used in wound healing to increase wound collagen, granulation tissue, wound tensile strength, and local production of insulin-like growth factors by fibroblasts. Saline is a widely used irrigating and wound dressing solution. Patients admitted to an acute care facility who had a Grade 2 or Grade 3 pressure ulcer were recruited to participate in a randomized, controlled trial to compare the effect of normal saline-impregnated gauze and insulin dressing in pressure ulcer healing. Persons with immunodeficiency, diabetes mellitus, pregnancy, osteomyelitis, and peripheral vascular illness were not eligible for the study. Study participants were randomized to receive either normal saline dressing gauze or insulin dressing twice daily for 7 days. At baseline, patient demographic data and ulcer history were recorded. Baseline and follow-up ulcer assessments (days 4 and day 7) included ulcer measurement (length and width) and completion of the Pressure Ulcer Scale for Healing (PUSH version 3.0) tool. Patients in the control group received dressings of sterile gauze soaked with normal saline; patients in the intervention group received topical insulin (1 U/cm2 wound area). The insulin was sprayed over the wound surface with an insulin syringe, allowed to dry for 15 minutes, and then covered with sterile gauze. To ascertain the safety of study participants, blood glucose levels were measured with a glucometer 10 minutes before and 1 hour after the topical insulin application in the intervention group. Treatment efficacy was deter- mined by assessing the reduction in wound area and PUSH scores at follow-up. Statistical analysis was performed; data are expressed as mean ± SD and percentage for continuous and categorical variables respectively. The differences in PUSH score and ulcer sizes between the 2 groups were analyzed using independent t-test, and within-group differences were analyzed using ANOVA with repeated measures; Greenhouse-Geisser correction was

  8. Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?

    Science.gov (United States)

    Labronici, Pedro José; Ferreira, Leonardo Termis; Dos Santos Filho, Fernando Claudino; Pires, Robinson Esteves Santos; Gomes, Davi Coutinho Fonseca Fernandes; da Silva, Luiz Henrique Penteado; Gameiro, Vinicius Schott

    2017-02-01

    Several so-called casting indices are available for objective evaluation of plaster cast quality. The present study sought to investigate four of these indices (gap index, padding index, Canterbury index, and three-point index) as compared to a reference standard (cast index) for evaluation of plaster cast quality after closed reduction of pediatric displaced distal forearm fractures. Forty-three radiographs from patients with displaced distal forearm fractures requiring manipulation were reviewed. Accuracy, sensitivity, specificity, false-positive probability, false-negative probability, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for each of the tested indices. Comparison among indices revealed diagnostic agreement in only 4.7% of cases. The strongest correlation with the cast index was found for the gap index, with a Spearman correlation coefficient of 0.94. The gap index also displayed the best agreement with the cast index, with both indices yielding the same result in 79.1% of assessments. When seeking to assess plaster cast quality, the cast index and gap index should be calculated; if both indices agree, a decision on quality can be made. If the cast and gap indices disagree, the padding index can be calculated as a tiebreaker, and the decision based on the most frequent of the three results. Calculation of the three-point index and Canterbury index appears unnecessary. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Dynamical effect of fractures combined with brain injury on the bone healing and bone metabolism%骨折合并脑损伤对骨愈合和骨代谢的影响

    Institute of Scientific and Technical Information of China (English)

    周青; 刘进炼; 刘超群; 周耀东; 陈豪

    2015-01-01

    BACKGROUND:Peri-fracture nerve injury can inhibit osteoclast activity and promote early fracture healing. OBJECTIVE:To investigate dynamical y the effects of traumatic brain injury on the bone mineral density, microstructure, biomechanics property and bone metabolism in rat models of fractures. METHODS:Sixty-three male rats were randomly divided into three groups:sham group, simple fracture group and fracture combined with brain injury group. After 3, 6, and 3 months, the animals were sacrificed in batches under anesthesia, and then, the bones and serum specimens were used to detect the bone mineral density, microstructure, biomechanics property, serum cross-linked N-telopeptide of col agen type I and osteocalcin levels. RESULTS AND CONCLUSION:Compared with the simple fracture group, the fracture combined brain injury group had significantly increased bone mineral density of the proximal tibia, bone volume fraction of the cancel ous bone, trabecular thickness, cross-sectional area of tibial cortical bone and total area of the bone marrow, ultimate load and stress of the tibia, serum cross-linked N-telopeptide of col agen type I and osteocalcin levels at 3 and 6 weeks after modeling (P  目的:观察了大鼠肢体骨折合并脑损伤对骨密度、骨微结构、骨生物力学特征和骨代谢影响。  方法:63只大鼠随机分为假手术组、单纯骨折组和脑损伤合并骨折组。在术后3周、6周和3个月分批麻醉处死动物保存骨骼和血清标本,检测骨密度、骨微结构和生物力学性能以及血清Ⅰ型胶原氨基末端肽和骨钙素水平的变化。  结果与结论:与单纯骨折组相比,在造模3周和6周后,脑损伤合并骨折组胫骨近端的骨密度、松质骨微结构骨体积分数、骨小梁厚度、胫骨皮质骨截面总面积和骨髓腔面积、胫骨极限载荷和极限应力、血清原氨基末端肽和骨钙素水平均显著增高(P<0.05),造模后3个月,3组间

  10. Assessment of the Potential Impacts of Hydraulic Fracturing for Oil and Gas on Drinking Water Resources (External Review Draft)

    Science.gov (United States)

    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 o...

  11. A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

    Science.gov (United States)

    OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

    2017-04-01

    The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

  12. Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment.

    Science.gov (United States)

    Zaia, Annamaria

    2015-03-18

    Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density (BMD) estimate by means of dual-energy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture (TBA) during aging and osteoporosis. Magnetic resonance imaging (MRI) has recently arisen as a useful tool to measure bone structure in vivo. In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest

  13. Reconsiderações sobre o tempo de consolidação das fraturas na picnodisostose Reconsiderations regarding time of fracture healing in Pycnodysostosis

    Directory of Open Access Journals (Sweden)

    Flávio Dorcilo Rabelo

    2010-01-01

    Full Text Available OBJETIVO: Discutir o que vem sendo descrito na literatura até então a respeito do tempo de consolidação das fraturas na picnodisostose. MÉTODOS: Treze novos casos foram estudados por questão de disponibilidade de prontuários e exames radiográficos, totalizando 44 fraturas englobando pacientes avaliados no período de novembro de 1970 a agosto de 2004, no Hospital Ortopédico de Goiânia. Pesquisa em campo, acompanhamento clínico simultâneo, por novas fraturas, de duas pacientes e avaliação retrospectiva de prontuários foram feitos, com base em se determinar o número de fraturas totais de cada paciente e quais destas tinham viabilidade para esta pesquisa. O grupo de pacientes compõe-se de três mulheres e dois homens com idade média de 51,4 anos. A tíbia foi o osso mais acometido, seguido pelo fêmur. Foram excluídas as fraturas cujo acompanhamento tenha sido feito em outro serviço. RESULTADOS: Das 12 fraturas consideradas plenas para o estudo, nove aconteceram em fêmures (seis no fêmur E e três no fêmur D; uma em tíbia (D; uma em clavícula (D e uma em ulna (E. Dentre as 12 fraturas, oito evoluíram com pseudartrose em um tempo médio de 29,25 meses; três consolidaram bem em uma média de 5,83 meses e um paciente evoluiu com retardo de consolidação em apenas dois meses. CONCLUSÃO: Associadas à pesquisa gênica e estudos micromorfológicos, aguarda-se novos estudos para reconfirmação diagnóstica numa entidade clínica tão rara.OBJECTIVE: To discuss what has been described so far in the literature regarding the time of consolidation of fractures in Pycnodysostosis. MATERIALS AND METHODS: Thirteen new cases were studied, as a matter of the availability of medical records and radiographic examinations, totaling 44 patients in the period from November 1970 to August 2004 in the Hospital Ortopédico de Goiânia. Field research and simultaneous clinical monitoring for new fractures in two patients, and the retrospective

  14. Environmental impact assessment: chemical explosive fracturing project, Petroleum Technology Corporation, Leslie, Letcher and Perry counties, Kentucky

    Energy Technology Data Exchange (ETDEWEB)

    Tonnessen, K.A.

    1977-05-19

    This review of the plans for a gas stimulation program by chemical explosive fracturing (CEF) in the Devonian shales of Letcher, Leslie and Perry counties, Kentucky also includes an assessment of the environmental consequences of the proposed project. This document was prepared at the request of the Nevada Operations Office of the Energy Research and Development Administration, and is intended to provide the information and data required for the preparation of an environmental assessment of the construction and testing program. This report was compiled from material provided by the Petroleum Technology Corporation of Redmond, Washington, Kentucky-West Virginia Gas Transmission Corporation of Prestonsburg, Kentucky and the State of Kentucky Bureau of Mines and Minerals during site visits in October, 1976.

  15. Changes in the ultimate load and static bone histomorphometery parameters during the fracture healing process of denervated rats with tibial fracture%胫骨骨折大鼠失神经支配条件下骨折愈合过程中最大载荷及静态骨计量学参数变化

    Institute of Scientific and Technical Information of China (English)

    苗军; 刘春蓉; 夏群; 张继东; 金鸿宾

    2006-01-01

    背景:临床观察表明,截瘫患者骨折常常愈合加快或在下肢有异位骨化形成,表明周围神经系统对骨折愈合有重要的调节作用.目的:观察一侧下肢失神经胫骨骨折愈合过程中骨计量学参数及骨痂形成和生物力学的变化.设计:自身对照动物实验.单位:天津医院.材料:健康雄性Wistar大鼠36只,6个月龄,平均体质量210 g.方法:实验于2001-03/2004-03在天津医院动物实验中心完成.将大鼠一侧下肢制成失神经胫骨骨折模型,对侧制成正常神经支配骨折模型.骨折后2周、4周麻醉状态下处死大鼠,取双侧胫骨,拍X射线片、测定生物力学强度,制备不脱钙切片,进行骨计量学观察.主要观察指标:①两组大鼠骨折后双侧胫骨和骨痂湿质量比较.②X射线平片计分.③胫骨标本生物力学测试结果.④骨折愈合组织形态学观察.结果:①两组大鼠骨折后双侧胫骨和骨痂湿质量比较:骨折后2,4周失神经组重量远大于正常神经支配组[(0.94±0.15)比(0.76±0.14)g,(1.06±0.26)比(0.81±0.10)g,P<0.05].②X射线平片计分结果:失神经组骨痂形成量明显增多(P<0.01).③胫骨标本三点弯曲生物力学测试结果:骨折后2,4周失神经组骨痂的强度明显低于正常神经支配组[(9.88±8.49)比(16.62±13.38)N,(12.77±7.55)比(20.19±10.60)N,P<0.05].④骨计量学检测结果:静态参数与正常神经支配组比较,失神经组矿化骨小梁宽度明显减小(P<0.05),类骨质宽度增加,破骨细胞指数及骨吸收表面明显增大(P<0.05),成骨细胞指数及骨形成表面两组无差别;动态参数与正常神经支配组比较,失神经组矿化沉积率明显变小(P<0.05),类骨质成熟时间延长(P<0.05).结论:周围神经在骨折愈合早、中期起重要的调节作用,完整的神经支配是骨折愈合所必需的.%BACKGROUND: Clinical observation demonstrates that accelerated fracture healing or lower limb

  16. 鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎OPF疗效分析%The study on treatment of vertebral osteoporotic fracture by salmon calcitonin and Heng Gu bone healing reagent

    Institute of Scientific and Technical Information of China (English)

    罗德军; 赵宏斌; 周旭; 董锡亮; 李林芝; 王文志; 熊海

    2011-01-01

    Objective To study effects of salmon calcitonin and Heng Gu bone healing reagent on vertebral osteoporotic fracture(OPF).Methods From Nov.2007 to Dec.2009,82 cases of vertebral OPF were treated.These cases were randomly divided into treatment group and control group.The treatment group(42 cascs)were treated with salmon calcitonin and Heng Gu bone healing reagent.The control group(40 cases)received salmon calcitonin only.Pain relief of the 2 groups wag compared.Results Before treatment,the 82 patients were scored 6-9 points by visual analogue scales(VAS)and pain scores of the 2 groups were similar (P>0.05).3 days,5 days,8 days and 15 days after treatment,VAS scores of the 2 groups were significantly different(P0.05).治疗后3、5、8、15 d,2组疼痛VAS评分分别经秩和检验差异有统计学意义(P<0.01).治疗组不但疼痛缓解快,3个月后复查骨矿物密度改善程度亦明显优于对照组.结论 鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎骨质疏松性骨折具有良好止痛和促进成骨作用,是一种安全、有效的方法.

  17. [Histologic assessment of tissue healing of hyaline cartilage by use of semiquantitative evaluation scale].

    Science.gov (United States)

    Vukasović, Andreja; Ivković, Alan; Jezek, Davor; Cerovecki, Ivan; Vnuk, Drazen; Kreszinger, Mario; Hudetz, Damir; Pećina, Marko

    2011-01-01

    Articular cartilage is an avascular and aneural tissue lacking lymph drainage, hence its inability of spontaneous repair following injury. Thus, it offers an interesting model for scientific research. A number of methods have been suggested to enhance cartilage repair, but none has yet produced significant success. The possible application of the aforementioned methods has brought about the necessity to evaluate their results. The objective of this study was to analyze results of a study of the effects of the use of TGF-beta gene transduced bone marrow clot on articular cartilage defects using ICRS visual histological assessment scale. The research was conducted on 28 skeletally mature sheep that were randomly assigned to four groups and surgically inflicted femoral chondral defects. The articular surfaces were then treated with TGF-beta1 gene transduced bone marrow clot (TGF group), GFP transduced bone marrow clot (GFP group), untransduced bone marrow clot (BM group) or left untreated (NC group). The analysis was performed by visual examination of cartilage samples and results were obtained using ICRS visual histological assessment scale. The results were subsequently subjected to statistical assessment using Kruskal-Wallis and Mann-Whitney tests. Kruskal-Wallis test yielded statistically significant difference with respect to cell distribution. Mann-Whitney test showed statistically significant difference between TGF and NC groups (P = 0.002), as well as between BM and NC groups (P = 0.002 with Bonferroni correction). Twenty-six of the twenty-eight samples were subjected to histologic and subsequent statistical analysis; two were discarded due to faulty histology technique. Our results indicated a level of certainty as to the positive effect of TGF-beta1 gene transduced bone marrow clot in restoration of articular cartilage defects. However, additional research is necessary in the field. One of the significant drawbacks on histologic assessment of cartilage

  18. Assessment of the Acute and Chronic Health Hazards of Hydraulic Fracturing Fluids.

    Science.gov (United States)

    Wattenberg, Elizabeth V; Bielicki, Jeffrey M; Suchomel, Ashley E; Sweet, Jessica T; Vold, Elizabeth M; Ramachandran, Gurumurthy

    2015-01-01

    There is growing concern about how hydraulic fracturing affects public health because this activity involves handling large volumes of fluids that contain toxic and carcinogenic constituents, which are injected under high pressure through wells into the subsurface to release oil and gas from tight shale formations. The constituents of hydraulic fracturing fluids (HFFs) present occupational health risks because workers may be directly exposed to them, and general public health risks because of potential air and water contamination. Hazard identification, which focuses on the types of toxicity that substances may cause, is an important step in the complex health risk assessment of hydraulic fracturing. This article presents a practical and adaptable tool for the hazard identification of HFF constituents, and its use in the analysis of HFF constituents reported to be used in 2,850 wells in North Dakota between December 2009 and November 2013. Of the 569 reported constituents, 347 could be identified by a Chemical Abstract Service Registration Number (CASRN) and matching constituent name. The remainder could not be identified either because of trade secret labeling (210) or because of an invalid CASRN (12). Eleven public databases were searched for health hazard information on thirteen health hazard endpoints for 168 identifiable constituents that had at least 25 reports of use. Health hazard counts were generated for chronic and acute endpoints, including those associated with oral, inhalation, ocular, and dermal exposure. Eleven of the constituents listed in the top 30 by total health hazard count were also listed in the top 30 by reports of use. This includes naphthalene, which along with benzyl chloride, has the highest health hazard count. The top 25 constituents reportedly used in North Dakota largely overlap with those reported for Texas and Pennsylvania, despite different geologic formations, target resources (oil vs. gas), and disclosure requirements

  19. Assessment of "YouTube" Content for Distal Radius Fracture Immobilization.

    Science.gov (United States)

    Addar, Abdullah; Marwan, Yousef; Algarni, Nizar; Berry, Gregory

    Distal radius fractures (DRFs) are the most common orthopedic fractures, with >70% of cases treated by closed immobilization using a short arm cast or a sugar tong splint. However, inadequate immobilization is a risk factor for loss of reduction requiring repeat reduction or surgical treatment. Therefore, education of clinical skills for appropriate immobilization of DRFs is important. With the increasing use of web-based information by medical learners, our aim was to assess the quality and quantity of videos regarding closed immobilization of DRFs on YouTube. Retrospective review of YouTube videos on distal radius fracture immobilization using specific search terms. Identified videos were analyzed for their educational value, quality of the technical skill demonstrated, and overall metrics. Educational value was scored on a 5-point scale, with "1" indicative of low quality and "5" of high quality. Not applicable. Among the 68,366 videos identified, 16 met our inclusion criteria of being in English; performed by a health care professional or institution; and with casting being the major theme of the educational information provided. Of these 16 videos, 6 had an educational value score of 4 or 5, with the remaining 10 having a score ≤3. Although immobilization was demonstrated by cast technician specialized in orthopedics, skills were also performed by orthopedic attendants, urgent care physicians, orthopedic residents, and nurse practitioners. The credentials of the performer in 3 videos were not identified. There is a need to promote high-quality educational videos produced by established medical school faculty members on open, web-based, portals. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  20. Influência do componente protéico na consolidação de fraturas: trabalho experimental em ratos Influence of the protein component upon fracture healing: an experimental study in rats

    Directory of Open Access Journals (Sweden)

    Roberto Guarniero

    2003-12-01

    Full Text Available Os autores estudaram a influência da nutrição protéica na consolidação de fraturas em 40 ratos Lewis divididos em 4 grupos de 10. Durante 6 semanas os grupos 1, 2 e 3 receberam respectivamente dietas com 0, 19% e 36% de proteínas. O grupo 4 recebeu dieta sem proteínas durante as 2 primeiras semanas e com 36% de proteínas nas 4 semanas seguintes. Foram realizadas fraturas nas tíbias esquerdas ao final de 2 semanas e após 4 semanas das fraturas os animais foram sacrificados para estudo dos calos ósseos. Para a avaliação dos resultados foram utilizadas medidas clínicas, bioquímicas, radiográficas, densitométricas, e histomorfométricas. Concluiu-se que a dieta hiperprotéica alterou a consolidação óssea produzindo um calo maior e mais resistente, mas não alterou a qualidade em concentração de cálcio e em porcentagem a quantidade de tecido ósseo.The authors investigated the influence of a protein diet on fracture healing in 40 Lewis rats divided into four groups of ten. During 6 weeks, Groups 1, 2 and 3 were fed diets containing, respectively, 0.19% and 36% protein. Group 4 was fed a proteinless diet during the first two weeks and a 36%-protein diet during the next 4 weeks. At two weeks, fractures were performed in the left tibias; all animals were killed 4 weeks later so that the bone calluses could be investigated. Clinical, biochemical, radiographic, densitometry and histomorphometry measurements were performed to evaluate the findings. The conclusion was that the hyperprotein diet altered bone healing by producing a larger, more resistant callus, although it did not change quality as regards calcium levels and the percentage amount of bone tissue.

  1. The effect of PDGFmRNA and IGFmRNA in the platelet concentrated liquid on ulna fracture healing in rabbit%血小板浓缩液中血小板源性生长因子及胰岛素样生长因子对兔尺骨骨折愈合的影响

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective By hybridization in situ and biomechanical approach of platelet derived growth fator mRNA(PDGFmRNA) and insulin like growth factor mRNA(IGFmRNA),we discussed the influence of the platelet concentrated liquid on the healing of rabbit ulna fracture.Method We selected 24 New Zealand rabbits,divided them into 4 groups randomly (blank group, serum control group, group with platelet concentrated liquid and group with bone graft and platelet concentrated liquid), and then made the fracture model on the middle of ulna which was fixed by finger armor plate.Before the operation, we drew out 6 ml blood from femoral artery, performed anti coagulation with the Sodium Citrate and centrifugated by low and the followed high speed.We purified the white blood plate and injected it into the fracture position.The rabbits were killed at 1st, 2nd, 4th and 6th week.Qualitative analysis by hybridization in situ of PDGFmRNA and IGFmRNA and biomechanical measurement on the 6th week sample were made.Result Bone callus could be seen on the radius specimen in various degrees when the rabbits were killed at 1st,2nd,4th and 6th week, particularly in the last week.The average maximum destructive load on the fracture tip is higher to the control, and there is significant difference(P< 0.01). Conclusion The local application of platelet concentration on the fracture tip can accelerate its healing.

  2. Effect of Jieguqili chip and simvastatin in promoting fracture Healing: An animal experiment%接骨七厘片、辛伐他汀对促进骨折愈合的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    张勇妹; 丁妍; 郭贵宾; 陈邦元

    2013-01-01

    目的 探讨接骨七厘片和辛伐他汀对促进骨折愈合的机制,并分析联合应用接骨七厘片和辛伐他汀与单独应用接骨七厘片或辛伐他汀对促进骨折愈合的差异.方法 用蒸馏水将接骨七厘片和辛伐他汀片分别溶解,配成一定浓度的溶解液.将实验大鼠随机分成4组,将双侧尺桡骨中1/3段徒手折断,造成闭合性完全性骨折,不给予外固定.术后接骨七厘片组给予接骨七厘片溶液,1次/d,连续28 d;辛伐他汀片组给予辛伐他汀溶液,1次/d,连续28d;联合应用组同时给予接骨七厘片溶液及辛伐他汀溶液,1次/d,连续28d;对照组灌胃给予生理盐水1 mL,1次/d,连续28d.结果 在一般行为表现、X线表现、组织形态学、骨痂干重等方面,接骨七厘片组和(或)辛伐他汀组与联合应用接骨七厘片和辛伐他汀组相比,差异有统计学意义(P<0.05).结论 本实验研究发现接骨七厘片及辛伐他汀在骨折愈合的过程中,均能增加成骨细胞的活性,使成骨细胞大量增生,促进骨痂的形成,提高骨痂的质量,而联合应用接骨七厘片及辛伐他汀比单纯使用接骨七厘片或辛伐他汀片作用更明显,骨折愈合较快.%Objective To analyze the mechanism of Jieguqili chip and simvastatin in promoting fracture healing, and to compare the difference between the combined use of the Jieguqili chip and simvastatin and single use of Jieguqili chip or simvastatin in promoting fracture healing. Methods The Jieguqili chip and simvastatin tablets were dissolved with distilled, dubbed a certain concentration of solvent. Rats were randomly divided into 4 groups, and their bilateral radius and ulna 1/3 of unarmed were broken, which created the closed complete bone fracture. No external fixation was done. After the technique, the 1st group was treated the Jieguqili chip solution, once a day, continually 28 days. The second group was treated with simvastatin solution, once a day

  3. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  4. Distribution assessment of maxillofacial fractures in trauma admitted patients in Yazd hospitals: An epidemiologic study

    Directory of Open Access Journals (Sweden)

    Hasan Momeni

    2011-01-01

    Conclusion: According to our result, most sites of fractures were in nasal bone. The main cause of maxillofacial fractures was motorcycle accident. However, in each age range the most common cause of accident was different.

  5. Once-Daily Bedtime Dose of Roxatidine and Ranitidine in Acute Duodenal Ulcer: A Combined Assessment of Acid Inhibitory Activity and Healing Rate.

    Science.gov (United States)

    Savarino, Vincenzo; Mela, Giuseppe Sandro; Zentilin, Patrizia; Mele, Maria Raffaella; Vigneri, Sergio; Termini, Rosanna; Di Mario, Francesco; Ferrana, Marina; Malesci, Alberto; Belicchi, Monica

    1995-12-01

    This study was carried out in order to compare the antisecretory effect of a single bedtime dose of roxatidine 150 mg and ranitidine 300 mg and to assess the relationship between the degree and the duration of acid suppression and the healing rates obtained in duodenal ulcer patients treated with the above regimens. Sixty-three patients with endoscopically proven ulcer underwent 24-h gastric pH-metry on day 0, day 1, and day 28 of treatment with both roxatidine and ranitidine. Ulcer healing was checked endoscopically after 4 weeks of therapy. RESULTS: Eight patients did not complete the study, leaving 55 patients eligible for final analysis, 28 in the roxatidine group and 27 in the ranitidine group. Duodenal ulcers were healed in 24--28 (85%) patients of the former and in 22--27 (81%) patients of the latter group (p minus sign NS). Gastric pH was significantly higher (p roxatidine and ranitidine. There was also do difference between the two active treatments. The pattern of gastric acidity significantly differed (p roxatidine 150 mg and ranitidine 300 mg was able to heal more than 80% of duodenal ulcers within 4 weeks of treatment. The lack of tolerance to H2-blockers in duodenal ulcer patients contributes to this good result. The antisecretory effect of H2-antagonists is reduced in nonresponder patients with respect to responder patients and this is mainly due to an impaired control of nocturnal acidity.

  6. Ulnar nerve palsy after closed forearm fracture: a case report

    Directory of Open Access Journals (Sweden)

    Levent Kucuk

    2012-04-01

    Full Text Available Closed double bone forearm fractures are among the most common fractures of childhood. These fractures often heal without problems with closed reduction and casting. The leading complications are known as malunion and compartment syndrome. The reports about nerve injuries related with these fractures are very limited. We present an eight years old boy who admitted to our hospital with ulnar nerve palsy symptomps three months after his initial trauma. His initial trauma was a simple fall which caused radius and ulna fractures. Radiological assessment showed proper union of the fractures. We performed surgical exploration to the ulnar nerve. We found a trapped and damaged nerve in the fracture region. Even though the rate of complications about nerve injuries are extremely rare in forearm fractures, neurologic examinations should be performed before and after the reduction maneuvers. Neurologic examination will be not only a guide for fracture management but also an important point for medicolegal problems. [Hand Microsurg 2012; 1(1.000: 30-32

  7. Assessment of osteoporotic vertebral fractures using specialized workflow software for 6-point morphometry

    Energy Technology Data Exchange (ETDEWEB)

    Guglielmi, Giuseppe [Department of Radiology, University of Foggia, Viale Luigi Pinto, Foggia 71100 (Italy); Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: g.guglielmi@unifg.it; Palmieri, Francesco [Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: francescopalmieri@hotmail.com; Placentino, Maria Grazia [Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: placentino_mg@tiscali.it; D' Errico, Francesco [Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: fra.derrico@tiscali.it; Stoppino, Luca Pio [Department of Radiology, University of Foggia, Viale Luigi Pinto, Foggia 71100 (Italy)], E-mail: l.stoppino@hotmail.it

    2009-04-15

    Purpose: To evaluate the time required, the accuracy and the precision of a model-based image analysis software tool for the diagnosis of osteoporotic fractures using a 6-point morphometry protocol. Materials and methods: Lateral dorsal and lumbar radiographs were performed on 92 elderly women (mean age 69.2 {+-} 5.7 years). Institutional review board approval and patient informed consent were obtained for all subjects. The semi-automated and the manual correct annotations of 6-point placement were compared to calculate the time consumed and the accuracy of the software. Twenty test images were randomly selected and the data obtained by multiple perturbed initialisation points on the same image were compared to assess the precision of the system. Results: The time requirement data of the semi-automated system (420 {+-} 67 s) were statistically different (p < 0.05) from that of manual placement (900 {+-} 77 s). In the accuracy test, the mean reproducibility error for semi-automatic 6-point placement was 2.50 {+-} 0.72% [95% CI] for the anterior-posterior reference and 2.16 {+-} 0.5% [95% CI] for the superior-inferior reference. In the precision test the mean error resulted averaged over all vertebrae was 2.6 {+-} 1.3% in terms of vertebral width. Conclusions: The technique is time effective, accurate and precise and can, therefore, be recommended in large epidemiological studies and pharmaceutical trials for reporting of osteoporotic vertebral fractures.

  8. 信号选择性甲状旁腺素模拟肽促进去势雄性小鼠的骨折愈合%Effects of signaling-selective parathyroid hormone peptide analog on fracture healing in orchiectomized mouse models

    Institute of Scientific and Technical Information of China (English)

    袁亮; 林振; 付兆宗; 孟越; 黄志平; 吴秀华; 杨德鸿; 江建明

    2013-01-01

    Objective To assess the effect of intermittent subcutaneous injections of signal-selective parathyroid hormone (PTH) peptide analog on fracture healing in orchiectomized mouse models. Methods Thirty-six 7-week-old C57/BL male mice were orchiectomized and injected with hPTH(l-34), the signal-selective PTH peptide analog [Gly1, Arg19]hPTH (1-34), or an identical volume of vehicle 1 week after induction of femoral fracture. At 14 and 28 days after the operation, the mice were sacrificed for measurement of bone mineral density (BMD) and bone mineral content (BMC) of the callus using by dual energy X-ray absorptiometry. The bone healing was evaluated by radiography, biomechanical testing, micro-computed tomography (Micro-CT) and histological examination. Results At 14 days after the operation, BMD in PTH peptide analog group was significantly increased (P<0.05). The mouse models treated with the PTH peptide analog showed significantly lower ultimate bending force and bending rigidity than those with hPTH(l-34) treatment. X-ray and Micro-CT scanning showed that callus transformation and remodeling was better in PTH peptide analog group than in the vehicle control group but poorer than in hPTH(l-34) group. Conclusion The signaling-selective PTH peptide analog G1, R19 (1-28) can accelerate fracture healing in orchiectomized mouse models, in which process cAMP/PKA pathway plays an important role.%目的 观察间断皮下注射信号选择性甲状旁腺素(PTH)模拟肽对去势雄性小鼠骨折愈合的影响.方法 36只7周龄C57/BL雄性小鼠去势,1周后制作股骨中段骨折模型,术后用人重组甲状旁腺素(hPTH(1-34)),信号选择性PTH模拟肽[Gly1,Arg19] hPTH (1-34)(G1,R19(1-28))和等量溶解剂注射,于术后14d和28 d处死,双能X线骨密度仪测量骨痂区骨密度以及骨矿物含量;术侧骨折愈合情况通过X线、显微CT、生物力学和组织学显示.结果 术后14d,G1,R19(1-28)组骨密度显著高于对照组(P<0.05).

  9. Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review.

    Science.gov (United States)

    Rubin, Katrine Hass; Friis-Holmberg, Teresa; Hermann, Anne Pernille; Abrahamsen, Bo; Brixen, Kim

    2013-08-01

    A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence, and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance of each tool was sufficient for practical use, and last, to examine whether the complexity of the tools influenced their discriminative power. We searched PubMed, Embase, and Cochrane databases for papers and evaluated these with respect to methodological quality using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist. A total of 48 tools were identified; 20 had been externally validated, however, only six tools had been tested more than once in a population-based setting with acceptable methodological quality. None of the tools performed consistently better than the others and simple tools (i.e., the Osteoporosis Self-assessment Tool [OST], Osteoporosis Risk Assessment Instrument [ORAI], and Garvan Fracture Risk Calculator [Garvan]) often did as well or better than more complex tools (i.e., Simple Calculated Risk Estimation Score [SCORE], WHO Fracture Risk Assessment Tool [FRAX], and Qfracture). No studies determined the effectiveness of tools in selecting patients for therapy and thus improving fracture outcomes. High-quality studies in randomized design with population-based cohorts with different case mixes are needed.

  10. Robotic Assessment of Upper Limb Function after Proximal Humeral Fracture: Personal Experience as A Patient and Occupational Therapist.

    Science.gov (United States)

    Nishimoto, Atsuko; Otaka, Yohei; Kasuga, Shoko; Otaka, Eri; Yamazaki, Kotaro; Ushiba, Junichi; Liu, Meigen

    2016-01-01

    Robotics is an emerging field in rehabilitation medicine. Robots have the potential to complement traditional clinical assessments because they can measure functions more precisely and quantitatively than current clinical assessments. We present a patient with a proximal humeral fracture whose recovery process was evaluated with an exoskeleton robotic device. The patient, a 34-year-old woman, suffered a left proximal humeral fracture while snowboarding. She is an occupational therapist and is the first author of this study. With conservative therapy, fracture union was seen on X-ray at 6 weeks post-injury. At that time, the patient was permitted to move her left upper limb actively within the tolerance of pain. We assessed the function of the injured upper limb at 6, 7, and 12 weeks post-injury with the KINARM exoskeleton robotic device and with conventional clinical measures. The active range of motion and the muscle strength of the left shoulder improved over time. Using robotic assessment, the precise movement profiles, position sense, and functional ability of both arms were quantified and also showed progressive improvement over time. Assessment with a robotic device of the recovery process after proximal humeral fracture allowed quantification of functional impairments that could not be felt subjectively nor identified with conventional clinical assessments.

  11. Assessment of fractures classified as non-mineralised in the Sicada database

    Energy Technology Data Exchange (ETDEWEB)

    Claesson Liljedahl, Lillemor; Munier, Raymond (Swedish Nuclear Fuel and Waste Management Co., Stockholm (Sweden)); Sandstroem, Bjoern (WSP Sverige AB, Goeteborg (Sweden)); Drake, Henrik (Isochron GeoConsulting, Varberg (Sweden)); Tullborg, Eva-Lena (Terralogica AB, Graabo (Sweden))

    2011-03-15

    The general objective of this report was to describe the results of the investigation of fractures classified as non-mineralised in Sicada. Such fractures exist at Forsmark and at Laxemar. The main aims of the investigation of these fractures were to: - Quantify the number of non-mineralised fractures (i.e. fractures lacking mineral coating) in Sicada (table: p{_}fract{_}core{_}eshi). - Closely examine a selection of fractures recorded as non-mineralised in Sicada. - Outline possible reasons for the existence of non-mineralised fractures. The work has involved extraction of fracture data from Sicada and subsequent statistical analysis. Since several thousand fractures are classified as non-mineralised in Sicada, it was not a practical possibility to include all these in this study, we examined one fracture sub-set from each site. We investigated a sample of 204 of these fractures in detail (see Sections 1.1 and 2.4). Rock mechanical differences between Forsmark and Laxemar and kinematic analysis of fracture surfaces is not discussed in this report

  12. A risk assessment tool for contaminated sites in low-permeability fractured media

    DEFF Research Database (Denmark)

    In Denmark, many contaminated sites are located in areas with low permeability or fractured geologies such as glacial moraine clays. Fractures increase the risk of fast transport of contaminants to underlying groundwater systems. It is therefore important to consider fracture transport when...... evaluating the risk of contaminated sites to drinking water resources....

  13. Healing Architecture

    DEFF Research Database (Denmark)

    Folmer, Mette Blicher; Mullins, Michael; Frandsen, Anne Kathrine

    2012-01-01

    The project examines how architecture and design of space in the intensive unit promotes or hinders interaction between relatives and patients. The primary starting point is the relatives. Relatives’ support and interaction with their loved ones is important in order to promote the patients healing...... process. Therefore knowledge on how space can support interaction is fundamental for the architect, in order to make the best design solutions. Several scientific studies document that the hospital's architecture and design are important for human healing processes, including how the physical environment...... architectural and design solutions in order to improve quality of interaction between relative and patient in the hospital's intensive unit....

  14. Computed Tomography Assessment of Peroneal Tendon Displacement and Posteromedial Structure Entrapment in Pilon Fractures.

    Science.gov (United States)

    Fokin, Alex; Huntley, Samuel R; Summers, Spencer H; Lawrie, Charles M; Miranda, Alejandro D; Caban-Martinez, Alberto J; Steinlauf, Steven D

    2016-11-01

    To determine the proportion of (1) peroneal tendon displacement (PTD) and posteromedial structure entrapment (PMSE) cases in a sample of pilon fractures, (2) missed diagnoses of PTD and PMSE on computed tomography (CT) by radiologists and attending orthopaedic trauma surgeons, and PTD and PMSE cases by (3) OTA/AO classification, and (4) fibular fracture. Retrospective cohort review. Regional level 1 Trauma Center. Two hundred patients treated between July 2008 and November 2014. Axial and reconstructed CT images were used in bone and soft tissue windows to identify PTD and PMSE. Medical charts were reviewed to identify OTA/AO fracture classification, the presence of concomitant fibular fracture, whether radiologist CT interpretation noted PTD or PMSE, and whether attending orthopaedic trauma surgeons' operative notes mentioned recognition of and management of PTD or PMSE. From the retrospective review of CT, PTD was identified in 11.0% and PMSE in 19.0% of all pilon fractures. Of the 22 patients with PTD, 59.1% sustained a concomitant fibular fracture and 90.9% sustained a 43-C fracture. Patients with PTD sustained more 43-C fractures (90.9% vs. 62.9%) but significantly fewer fibular fractures (59.1% vs. 80.3%; P = 0.023) than patients without PTD. Of the 38 patients with PMSE, 81.6% sustained a fibular fracture and 86.8% sustained a 43-C fracture. PMSE was more common in patients with 43-C fractures (86.8% vs. 61.1%). The final preoperative radiologist CT interpretation commented on PTD and PMSE in 50.0% of cases. Higher energy pilon fractures (43-C) are associated with higher incidence of PMSE and PTD. Concomitant fibula fracture may play a protective role in PTD in the setting of pilon fractures. Both attending radiologists and attending orthopaedic trauma surgeons frequently fail to recognize the diagnoses of PTD and PMSE. Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

  15. Comparing the Effect of Different Voxel Resolutions for Assessment of Vertical Root Fracture of Permanent Teeth

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    Uzun

    2015-07-01

    Full Text Available Background The teeth with undiagnosed vertical root fractures (VRFs are likely to receive endodontic treatment or retreatment, leading to frustration and inappropriate endodontic therapies. Moreover, many cases of VRFs cannot be diagnosed definitively until the extraction of tooth. Objectives This study aimed to assess the use of different voxel resolutions of two different cone beam computerized tomography (CBCT units in the detection VRFs in vitro. Materials and Methods The study material comprised 74 extracted human mandibular single rooted premolar teeth without root fractures that had not undergone any root-canal treatment. Images were obtained by two different CBCT units. Four image sets were obtained as follows: 1 3D Accuitomo 170, 4 × 4 cm field of view (FOV (0.080 mm3; 2 3D Accuitomo 170. 6 × 6 cm FOV (0.125 mm3; 3 NewTom 3G, 6˝ (0.16 mm3 and 4 NewTom 3G, 9˝ FOV (0.25 mm3. Kappa coefficients were calculated to assess both intra- and inter-observer agreements for each image set. Results No significant differences were found among observers or voxel sizes, with high average Z (Az results being reported for all groups. Both intra- and inter-observer agreement values were relatively better for 3D Accuitomo 170 images than the images from NewTom 3G. The highest Az and kappa values were obtained with 3D Accuitomo 170, 4 × 4 cm FOV (0.080 mm3 images. Conclusion No significant differences were found among observers or voxel sizes, with high Az results reported for all groups.

  16. Bisphosphonates and Nonhealing Femoral Fractures: Analysis of the FDA Adverse Event Reporting System (FAERS) and International Safety Efforts

    Science.gov (United States)

    Edwards, Beatrice J.; Bunta, Andrew D.; Lane, Joseph; Odvina, Clarita; Rao, D. Sudhaker; Raisch, Dennis W.; McKoy, June M.; Omar, Imran; Belknap, Steven M.; Garg, Vishvas; Hahr, Allison J.; Samaras, Athena T.; Fisher, Matthew J.; West, Dennis P.; Langman, Craig B.; Stern, Paula H.

    2013-01-01

    Background: In the United States, hip fracture rates have declined by 30% coincident with bisphosphonate use. However, bisphosphonates are associated with sporadic cases of atypical femoral fracture. Atypical femoral fractures are usually atraumatic, may be bilateral, are occasionally preceded by prodromal thigh pain, and may have delayed fracture-healing. This study assessed the occurrence of bisphosphonate-associated nonhealing femoral fractures through a review of data from the U.S. FDA (Food and Drug Administration) Adverse Event Reporting System (FAERS) (1996 to 2011), published case reports, and international safety efforts. Methods: We analyzed the FAERS database with use of the proportional reporting ratio (PRR) and empiric Bayesian geometric mean (EBGM) techniques to assess whether a safety signal existed. Additionally, we conducted a systematic literature review (1990 to February 2012). Results: The analysis of the FAERS database indicated a PRR of 4.51 (95% confidence interval [CI], 3.44 to 5.92) for bisphosphonate use and nonhealing femoral fractures. Most cases (n = 317) were attributed to use of alendronate (PRR = 3.32; 95% CI, 2.71 to 4.17). In 2008, international safety agencies issued warnings and required label changes. In 2010, the FDA issued a safety notification, and the American Society for Bone and Mineral Research (ASBMR) issued recommendations about bisphosphonate-associated atypical femoral fractures. Conclusions: Nonhealing femoral fractures are unusual adverse drug reactions associated with bisphosphonate use, as up to 26% of published cases of atypical femoral fractures exhibited delayed healing or nonhealing. PMID:23426763

  17. "Assessment of spontaneous healing rate of traumatic tympanic membrane perforations and three months follow up; Yazd Forensic Medicine"

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    Mirvakili S.A

    2007-06-01

    Full Text Available Background: Traumatic tympanic membrane (TM perforation is a common injury of the ear with a high rate of spontaneous healing if the patients strictly adhere to water precautions. The purpose of this study was to determine the factors involved in the spontaneous healing of traumatic TM perforations in order to ascertain the best treatment plan including observation, paper patch and finally surgery. Methods: In this correlative–descriptive study, we recorded the outcome of each patient with three-month follow up. Included in this study were a total of 202 forensic medicine patients from the Dept. of Otolaryngology Head & Neck Surgery at the Yazd University of Medical Sciences, Yazd, Iran. All patients included in this study had traumatic TM perforation. Based on otoscopic examination, the perforations were classified as pinpoint or large. All patients received an audiometry exam and were followed for three months. The data was collected using a special form and analyzed by chi-square test, Fisher exact test and ANOVA. Results: This study consisted of 118 male and 84 female patients with a mean age of 23.6 years (6-48 years. The types of trauma included compression injury (104 patients, instrumental injury (59 patients, burn–slag injury (2 patients and blast injury (1 patient. One hundred and eighty patients had pinpoint TM perforations, 99.4% of which healed spontaneously by the second month, and 32 patients had large TM perforations, 50% of which healed spontaneously by the second month. During the first month, 87.3% of the patients observing water precautions had healed, however the healing rate was only 5.6% in patients not adhering to water precautions, who suffered from otorrhea. Therefore, during this study, 185 (91.58% patients had spontaneous healing by two months and only 6 patients of remaining 17 patients healed with paper patch. The mean hearing loss at 500, 1000 and 2000 Hz was 10.55 dB (5-30 dB. Conclusion: In our experience

  18. Feasibility and Value of Radiographic Union Score Hip Fracture after Treatment with Intramedullary Nail of Stable Hip Fractures

    Science.gov (United States)

    Maiettini, Daniele; Bisaccia, Michele; Caraffa, Auro; Rinonapoli, Giuseppe; Piscitelli, Luigi; Bisaccia, Olga; Rollo, Giuseppe; Meccariello, Luigi; Ceccarini, Paolo; Rebonato, Alberto

    2016-01-01

    Introduction: Given the importance of fracture healing on patient outcome in clinical practice, it is critical to assess fracture healing. Aim: The aim of this study was to evaluate the feasibility of the Radiographic Union Score Hip fracture after treatment with intramedullary nail of stable hip fractures. Patients and Methods: We retrospectively collected the data from the clinical records of our institution of the 47 patientswho had undergone intertrochanteric hip fracture treatment using an intramedullary nail. Pain visual analogic score (VAS) was collected the same day that X-rays were taken. Plain hip X-rays were performed, in two radiographic views, at 40 and 90 days after the surgical procedure. The correlation between the RUSH and VAS score was evaluated. Results: Mean RUSH and VAS scores showed a strong statistical improvement between the 40 and 90 day follow-ups. RUSH value at 40 days fitted an inverse linear regression with VAS, p-value of 0.0063 and r2 of 0.15. At 90 days the regression between RUSH and VAS scores was not significant. Conclusion: RUSH could be proposed as an objective system to evaluate union in hip fractures treated with intramedullary nail. PMID:28077901

  19. The Prevention of Postmenopausal Osteoporotic Fractures: Results of the Health Technology Assessment of a New Antiosteoporotic Drug

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    Chiara de Waure

    2014-01-01

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

  20. 鲑鱼降钙素促进老年转子间骨折愈合的疗效观察%Efficacy Observation of Salmon Calcitonin for Femoral Intertrochanteric Fractures Healing in Elderly Patients

    Institute of Scientific and Technical Information of China (English)

    谭美云; 郭杏; 税巍; 王远辉; 张忠杰

    2011-01-01

    目的:观察鲑鱼降钙素促进老年转子问骨折愈合的疗效.方法:将40例老年患者随机分为2组:治疗组20例,肌肉注射鲑鱼降钙素;对照组20例,在相同的部位肌肉注射等量注射用生理盐水.自术后第1天开始,2组均连续用药3个月.用药后的第1、3个月复查X线片,观察骨痂生长情况.治疗前和治疗后3个月检测患者腰椎(L4)骨密度(BMD)及血清钙、磷、碱性磷酸酶等浓度.结果:所有患者均得到随访.术后第1、3个月x线评估发现,治疗组比同时期对照组的骨痂生成量多.治疗后3个月,治疗组腰椎(L4)BMD明显高于对照组(P0.05),治疗组碱性磷酸酶明显高于对照组(P<0.05).治疗组1例出现恶心、呕吐等胃肠道症状,2例出现面颈部潮红.结论:鲑鱼降钙素能显著促进老年转子间骨折的愈合.%OBJECTIVE: To observe the therapeutic efficacy of salmon calcitonin for femoral intertrochanteric fractures healing in elderly patients. METHODS: A total of 40 elderly patients with femoral intertrochanteric fractures were randomly divided into 2 groups. 20 cases in treatment group received intramuscular injection of salmon calcitonin and 20 cases in control group received equal dose of normal saline at the same site. Both groups were given medicine after operation for 3 months. The X-ray plate of 2 groups was examined at 1 and 3 months after treatment to investigate the condition of bony callus. The BMD of the lumbar spine at LA, the concentration of serum calcium, serum phosphorus and alkaline phosphate were measured before treament and 3 months after treatment. RESULTS: All patients were followed up. The X-ray plate showed that the bony callus in treatment group was more abundant than in control group at 1 and 3 months after treatment. 3 months after treatment, the BMD of the lumbar spine at L4 in treatment group was significantly higher than in control group (P<0.05). The concentration of serum calcium in treatment group was

  1. Biomechanics Significance of Femoral Head and Neck of Grafting-bone Group After Femoral Neck Fracture-healing%股骨颈骨折愈合后钉道植骨的生物力学意义

    Institute of Scientific and Technical Information of China (English)

    唐洪涛; 仝允辉; 杨茹萍; 朱太永; 张美超; 赵卫东

    2011-01-01

    Objective To study biomechanical performance of fracture-healing femoral head and neck after the hollow compressionb screws are taken out in ungrafting-bone group, grafting-bone group, normal group, and provide theoretical basis for the treatment of necrosis of the femoral head by bone grafting in the channel of screws. Methods Nine femurs fixed and preserved by formalin were used in this test. They were randomly divided into three groups: normal group, ungrafting-bone group, grafting-bone group. According to inversed-triangle, at the range of physiological load, it tested the defixed bias-value of three group femoral head at different load. The data were collected and analyzed. The three-dimension finite element model of the femoral head and neck was calculated. Nodal solution of stress value and max-offset was calculated at area of femoral head and neck, then the data were compared and analyzed.Results Compared with the mean of load-offset about the femoral head and neck, biomechanical capability of ungrafting-bone group was lowest with regard to other two groups , the influence was very hard, P <0.05. But there was no singnificant difference between normal group and graflng-bone group, P >0.05. Analysis of the three-dimension finite element model showed that the massive stress was concentrated at weight loading region of ungrafting-bone group's femoral head, it was an dangerous chance to lead to femoral head collapse. Conclusion For the treatment of femur neck fractures with cannulated compression screws, bone grafting in the channel of screw should be used to improve biomechanical integrity after fracture healed and cannulated compression screws are taken out. This is of benefit to loading in early stage and to preventing the collapse of femoral head, etc.%目的 探讨股骨颈骨折愈合后取出空心加压螺钉遗留钉道不植骨、植骨及正常的股骨头颈部的生物力学特性,为临床提供实验依据.方法 收集9付股骨标本测量

  2. Displaced patella fractures.

    Science.gov (United States)

    Della Rocca, Gregory J

    2013-10-01

    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

    Directory of Open Access Journals (Sweden)

    Haili Wang

    2012-01-01

    Conclusion: The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.

  4. Geometry reconstruction method for patient-specific finite element models for the assessment of tibia fracture risk in osteogenesis imperfecta.

    Science.gov (United States)

    Caouette, Christiane; Ikin, Nicole; Villemure, Isabelle; Arnoux, Pierre-Jean; Rauch, Frank; Aubin, Carl-Éric

    2017-04-01

    Lower limb deformation in children with osteogenesis imperfecta (OI) impairs ambulation and may lead to fracture. Corrective surgery is based on empirical assessment criteria. The objective was to develop a reconstruction method of the tibia for OI patients that could be used as input of a comprehensive finite element model to assess fracture risks. Data were obtained from three children with OI and tibia deformities. Four pQCT scans were registered to biplanar radiographs, and a template mesh was deformed to fit the bone outline. Cortical bone thickness was computed. Sensitivity of the model to missing slices of pQCT was assessed by calculating maximal von Mises stress for a vertical hopping load case. Sensitivity of the model to ±5 % of cortical thickness measurements was assessed by calculating loads at fracture. Difference between the mesh contour and bone outline on the radiographs was below 1 mm. Removal of one pQCT slice increased maximal von Mises stress by up to 10 %. Simulated ±5 % variation of cortical bone thickness leads to variations of up to 4.1 % on predicted fracture loads. Using clinically available tibia imaging from children with OI, the developed reconstruction method allowed the building of patient-specific finite element models.

  5. Assessment of the Potential Impacts of Hydraulic Fracturing for Oil and Gas on Drinking Water Resources (ERD)

    Science.gov (United States)

    In this report, EPA reviews and synthesizes scientific literature to assess the potential for hydraulic fracturing for oil and gas to change the quality or quantity of drinking water resources. This report also identifies factors affecting the frequency or severity of any potenti...

  6. Reliability of Radiographic Assessments of Adolescent Midshaft Clavicle Fractures by the FACTS Multicenter Study Group.

    Science.gov (United States)

    Li, Ying; Donohue, Kyna S; Robbins, Christopher B; Pennock, Andrew T; Ellis, Henry B; Nepple, Jeffrey J; Pandya, Nirav; Spence, David D; Willimon, Samuel Clifton; Heyworth, Benton E

    2017-09-01

    There is a recent trend toward increased surgical treatment of displaced midshaft clavicle fractures in adolescents. The primary purpose of this study was to evaluate the intrarater and interrater reliability of clavicle fracture classification systems and measurements of displacement, shortening, and angulation in adolescents. The secondary purpose was to compare 2 different measurement methods for fracture shortening. This study was performed by a multicenter study group conducting a prospective, comparative, observational cohort study of adolescent clavicle fractures. Eight raters evaluated 24 deidentified anteroposterior clavicle radiographs selected from patients 10-18 years of age with midshaft clavicle fractures. Two clavicle fracture classification systems were used, and 2 measurements for shortening, 1 measurement for superior-inferior displacement, and 2 measurements for fracture angulation were performed. A minimum of 2 weeks after the first round, the process was repeated. Intraclass correlation coefficients were calculated. Good to excellent intrarater and interrater agreement was achieved for the descriptive classification system of fracture displacement, direction of angulation, presence of comminution, and all continuous variables, including both measurements of shortening, superior-inferior displacement, and degrees of angulation. Moderate agreement was achieved for the Arbeitsgemeinschaft für Osteosynthesefragen classification system overall. Mean shortening by 2 different methods were significantly different from each other (P < 0.0001). Most radiographic measurements performed by investigators in a multicenter, prospective cohort study of adolescent clavicle fractures demonstrated good-to-excellent intrarater and interrater reliability. Future consensus on the most accurate and clinically appropriate measurement method for fracture shortening is critical.

  7. The Water Risks of Hydraulic Fracturing (Fracking): Key Issues from the New California Assessment

    Science.gov (United States)

    Gleick, P. H.

    2015-12-01

    A key component of the Water-Energy Nexus is the effort over the past decade or so to quantify the volumes and form of water required for the energy fuel cycle from extraction to generation to waste disposal. The vast majority of the effort in this area has focused on the water needs of electricity generation, but other fuel-cycle components also entail significant water demands and threats to water quality. Recent work for the State of California (managed by the California Council on Science and Technology - CCST) has produced a new state-of-the-art assessment of a range of potential water risks associated with hydraulic fracturing and related oil and gas extraction, including volumetric water demands, methods of disposal of produced water, and aquifer contamination. For example, this assessment produced new information on the disposal of produced water in surface percolation pits and the potential for contamination of local groundwater (see Figure). Understanding these risks raises questions about current production and future plans to expand production, as well as tools used by state and federal agencies to manage these risks. This talk will summarize the science behind the CCST assessment and related policy recommendations for both water and energy managers.

  8. Study on the Effects of Differrent Compatibility of Traditonal Chinese Medicine on VEGF Expression at Fracture Site and Healing of Early Radius Fracture of Rats%桃仁、木香、黄芪分别与红花配伍对大鼠早期桡骨骨折愈合及VEGF表达的影响

    Institute of Scientific and Technical Information of China (English)

    王轩; 李引刚

    2009-01-01

    Objective:To observe the effect of different compatibility of herbs on VEGF expression at fracture site and thickness of callus of early radius fracture rat models. Methods:256 SD rats were divided into four groups randomly,model group,Semen Persicae and Flos Carthami group,Radix Aucklandiae and Flos Carthami group,Radix Astragali and Flos Carthami group.Left radius fracture rat models were established. Conventional haematoxylin and eosin staining and im-munostaining for bone section were carried out on clays 3,7,10 and 14 after model establishment. Results:On days 7,10 and 14 after model establishment, compared with model group, VEGF positive cells at fracture site and thickness of callus were significantly increased in all the treatment groups;compared with Radix Aucklandiae and Flos Carthami group,VEGF positive cells at fracture site and thickness of callus were significantly decreased in Semen Persicae and Flos Carthami group,Radix Astragali and Flos Carthami group. Conclusions:Radix Aucklandiae and Flos Carthami can increase obvi-ously VEGF expression at fracture site and thickness of callus in the healing of early radius fracture rats.We can get a con-clusion that the therapy of regulating the flow of qi and promoting the circulation of blood is an effective therapy on early extremities closed fracture from this experiment.%目的:观察桃仁、木香、黄芪分别与红花配伍对成年SD大鼠早期桡骨骨折愈合过程中骨痂厚度及VEGF表达的影响,为理气活血法用于四肢闭合性骨折早期临床治疗提供实验支持.方法:256只SD大鼠随机分为模型组、桃仁红花组、木香红花组、黄芪红花组4组,每组各64只,各组大鼠均造成左侧桡骨骨折模型.于造模后第3天、第7天、第10天、第14天,各组大鼠分4次处死,每次每组处死16只,取材进行常规HE染色观察骨痂厚度,VEGF-DAB显色计数观察VEGF阳性细胞数.结果:造模后第3天,各给药组与模型组比较,标本VEGF

  9. Effects of different compatibility of TCM on BMP-2 expression at fracture site and healing of early radius fracture of rats%桃仁、木香、黄芪分别与红花配伍对大鼠早期桡骨骨折愈合过程中BMP-2表达的影响

    Institute of Scientific and Technical Information of China (English)

    王轩; 潘琪; 张慧萍; 李引刚

    2011-01-01

    Carthami group, BMP-2 positive cells at fracture site and thickness of callus were significantly decreased in Semen Persicae and Flos Carthami group, Radix Astragali and Flos Carthami group.Conclusions: Radix Aueklandiae and Flos Carthami can increase obviously BMP-2 expression at fracture site and thickness of callus in the healing of early radius fracture rats. We can get a conclusion that the therapy of regulating the flow of qi and promoting the circulation of blood was an effective therapy on early extremities closed fracture from this experiment.

  10. Outcome Assessment of Hybrid External Fixation in the Treatment of Comminuted Distal Femur and Proximal Tibial Fractures

    Directory of Open Access Journals (Sweden)

    Sarrafan

    2016-02-01

    Full Text Available Background Treatment of comminuted fractures of the distal femur and proximal tibia is difficult, and a challenge in the field of orthopedic trauma. Objectives The aim of this study was to assess the short-term results of hybrid external fixation in the treatment of these fractures. Patients and Methods In a prospective study, 44 patients with comminuted fractures of the distal femur or proximal tibia, with an overlying soft tissue injury treated by closed reduction and hybrid external fixation, were included. Parameters such as pin-track infection, union, limb shortening, knee motion, and alignment were evaluated during a mean follow-up period of 14 months. Results Forty-four patients with distal femoral (n = 23 and proximal tibial (n = 21 fractures were treated using hybrid external fixation. Bone union was seen in 35 (80% of the patients. Pin tract infection was seen in three patients (6.8%, one case (4.6% with a PTF and two cases (8% with DFFs. Malunion was observed in 4 patients (9.1%; of these, three cases (13% had DFF and one case (4.8% of pain was detected in the DFF group. One case had malunion and three cases had union. Findings showed satisfactory results in more than 80% of patients. In general, lower postoperative complications were detected in the proximal tibial fractures than the distal femoral fractures. According to a chi-square test, the difference between the patients with PTFs and those with DFFs was not clinically significant. Conclusions Closed reduction and hybrid external fixation can be used as a definitive treatment for severe comminuted fractures of the distal femur and proximal tibia, when the concomitant contusion of the skin and soft tissue damage prohibits safe open reduction and internal fixation.

  11. Tooth mobility changes subsequent to root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth mobility changes in root-fractured permanent teeth and relate this to type of interfragment healing (hard tissue healing (HT), interfragment healing with periodontal ligament (PDL) and nonhealing with interposition of granulation tissue (GT) because...... of pulp necrosis in the coronal fragment. Furthermore, the effect of age, location of the fracture on the root, and observation period on mobility values was analyzed. Mobility values were measured for 44 of 95 previous reported root-fractured permanent incisors. Mobility changes were measured...... after 3 months and 1 year, and a normalization of mobility value was usually found after 5 and 10 years. In 17 cases of PDL healing, generally a higher mobility was found in comparison with root fractures healing with hard tissue, and a consistent decrease in mobility value was found in the course...

  12. Interactions between MSCs and Immune Cells: Implications for Bone Healing

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    Tracy K. Kovach

    2015-01-01

    Full Text Available It is estimated that, of the 7.9 million fractures sustained in the United States each year, 5% to 20% result in delayed or impaired healing requiring therapeutic intervention. Following fracture injury, there is an initial inflammatory response that plays a crucial role in bone healing; however, prolonged inflammation is inhibitory for fracture repair. The precise spatial and temporal impact of immune cells and their cytokines on fracture healing remains obscure. Some cytokines are reported to be proosteogenic while others inhibit bone healing. Cell-based therapy utilizing mesenchymal stromal cells (MSCs is an attractive option for augmenting the fracture repair process. Osteoprogenitor MSCs not only differentiate into bone, but they also exert modulatory effects on immune cells via a variety of mechanisms. In this paper, we review the current literature on both in vitro and in vivo studies on the role of the immune system in fracture repair, the use of MSCs in the enhancement of fracture healing, and interactions between MSCs and immune cells. Insight into this paradigm can provide valuable clues in identifying cellular and noncellular targets that can potentially be modulated to enhance both natural bone healing and bone repair augmented by the exogenous addition of MSCs.

  13. Carbon Dots as Fillers Inducing Healing/Self-Healing and Anticorrosion Properties in Polymers.

    Science.gov (United States)

    Zhu, Cheng; Fu, Yijun; Liu, Changan; Liu, Yang; Hu, Lulu; Liu, Juan; Bello, Igor; Li, Hao; Liu, Naiyun; Guo, Sijie; Huang, Hui; Lifshitz, Yeshayahu; Lee, Shuit-Tong; Kang, Zhenhui

    2017-08-01

    Self-healing is the way by which nature repairs damage and prolongs the life of bio entities. A variety of practical applications require self-healing materials in general and self-healing polymers in particular. Different (complex) methods provide the rebonding of broken bonds, suppressing crack, or local damage propagation. Here, a simple, versatile, and cost-effective methodology is reported for initiating healing in bulk polymers and self-healing and anticorrosion properties in polymer coatings: introduction of carbon dots (CDs), 5 nm sized carbon nanocrystallites, into the polymer matrix forming a composite. The CDs are blended into polymethacrylate, polyurethane, and other common polymers. The healing/self-healing process is initiated by interfacial bonding (covalent, hydrogen, and van der Waals bonding) between the CDs and the polymer matrix and can be optimized by modifying the functional groups which terminate the CDs. The healing properties of the bulk polymer-CD composites are evaluated by comparing the tensile strength of pristine (bulk and coatings) composites to those of fractured composites that are healed and by following the self-healing of scratches intentionally introduced to polymer-CD composite coatings. The composite coatings not only possess self-healing properties but also have superior anticorrosion properties compared to those of the pure polymer coatings. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. The effects of psychological interventions on wound healing: A systematic review of randomized trials.

    Science.gov (United States)

    Robinson, Hayley; Norton, Sam; Jarrett, Paul; Broadbent, Elizabeth

    2017-11-01

    Psychological stress has been shown to delay wound healing. Several trials have investigated whether psychological interventions can improve wound healing, but to date, this evidence base has not been systematically synthesized. The objective was to conduct a systematic review of randomized controlled trials in humans investigating whether psychological interventions can enhance wound healing. A systematic review was performed using PsychINFO, CINAHL, Web of Science, and MEDLINE. The searches included all papers published in English up until September 2016. The reference lists of relevant papers were screened manually to identify further review articles or relevant studies. Nineteen studies met inclusion criteria and were included in the review. Fifteen of nineteen studies were of high methodological quality. Six studies were conducted with acute experimentally created wounds, five studies with surgical patients, two studies with burn wounds, two studies with fracture wounds, and four studies were conducted with ulcer wounds. Post-intervention standardized mean differences (SMD) between groups across all intervention types ranged from 0.13 to 3.21, favouring improved healing, particularly for surgical patients and for relaxation interventions. However, there was some evidence for publication bias suggesting negative studies may not have been reported. Due to the heterogeneity of wound types, population types, and intervention types, it is difficult to pool effect sizes across studies. Current evidence suggests that psychological interventions may aid wound healing. Although promising, more research is needed to assess the efficacy of each intervention on different wound types. Statement of contribution What is already known on this subject? Psychological stress negatively affects wound healing. A number of studies have investigated whether psychological interventions can improve healing. However, no systematic reviews have been conducted. What does this study add

  15. Bilateral Distal Radius Fracture in Third Trimester of Pregnancy with Accelerated Union: A Rare Case Report

    OpenAIRE

    2015-01-01

    Bilateral distal radius fracture is a rare entity. There is no literature reporting a bilateral distal radius fracture in pregnancy. Fracture healing is influenced by hormones. Hormonal changes of pregnancy will affect the healing of a fracture. A 28-year-old female at 34 wk of pregnancy sustained a bilateral distal radius fracture after a self fall. One side was managed conservatively and open reduction was done for the other side. Both fractures united at four weeks. This case is unique in ...

  16. Multifunctional composites: Healing, heating and electromagnetic integration

    Science.gov (United States)

    Plaisted, Thomas Anthony John

    2007-12-01

    Multifunctional materials, in the context of this research, integrate other functions into materials that foremost have outstanding structural integrity. Details of the integration of electromagnetic, heating, and healing functionalities into fiber-reinforced polymer composites are presented. As a result of fiber/wire integration through textile braiding and weaving, the dielectric constant of a composite may be tuned from negative to positive values. These wires are further leveraged to uniformly heat the composite through resistive heating. A healing functionality is introduced by utilizing a polymer matrix with the ability to heal internal cracking through thermally-reversible covalent bonds based on Diels-Alder cycloaddition. The Double Cleavage Drilled Compression (DCDC) specimen is applied to study the fracture and healing characteristics of the neat polymer. This method allows for quantitative evaluation of incremental crack growth, and ensures that the cracked sample remains in one piece after the test, improving the ability to re-align the fracture surfaces prior to healing. Initially, the fracture strength of PMMA is studied with various DCDC geometries to develop a model of the propagation of a crack within this type of specimen. Applied to the healable polymer (2MEP4F), repeated fracture-healing cycles demonstrate that treatment at temperatures between 85 to 95°C results in full fracture toughness recovery and no dimensional changes due to creep. The fracture toughness after each fracturing and healing cycle has been calculated, using the model, to yield a fracture toughness of about 0.71 MPa·m1/2 for this material at room temperature. Glass and carbon fiber-reinforced composites have been fabricated with the 2MEP4F polymer, and the ability of this polymer to heal microcracks in fiber-reinforced composites is demonstrated. Microcracks have been introduced into the composites by cryogenic cycling in liquid nitrogen, causing a reduction in the storage

  17. Rotation and Displacement Predict Adverse Events in Pediatric Supracondylar Fractures.

    Science.gov (United States)

    Flierl, Michael A; Carry, Patrick M; Scott, Frank; Georgopoulos, Gaia; Hadley-Miller, Nancy

    2015-08-01

    The goal of this study was to identify supracondylar fracture patterns that were predictive of adverse events and poor outcomes. The study consisted of a retrospective review of patients admitted for surgical treatment of a supracondylar humerus fracture between June 2008 and August 2010. Preoperative radiographs were assessed based on appearance (simple vs oblique vs comminuted), coronal plane displacement (angulated, posterior, posteromedial vs posterolateral), and rotation (rotation vs no rotation). Logistic regression models were used to examine the relationship between fracture pattern and clinical outcome parameters in 373 patients who were followed for 4 weeks or more postoperatively. Outcome parameters included postoperative complications (infection, delayed healing, pin migration, revision surgery), need for physical or occupational therapy, need for postoperative intravenous narcotics, and preoperative nerve injury. Rotation and coronal displacement patterns of the fracture segments were significantly associated with postoperative complications, postoperative need for physical or occupational therapy as a result of residual stiffness, and nerve injury (P<.05). Compared with posteriorly displaced fractures, posterolaterally displaced fractures were associated with significantly greater odds of complications (P=.045), need for physical or occupational therapy (P<.001), and nerve injury (P<.001). Additionally, fractures with rotation were associated with significantly greater odds of complications (P<.001), need for physical or occupational therapy (P<.001), and nerve injury (P<.001) compared with fractures without rotation. Rotation and coronal plane displacement were predictive of complications, need for physical or occupational therapy, and nerve injury, and thus should be considered as potential prognostic variables when evaluating the initial injury pattern.

  18. Activities of MSCs Derived from Transgenic Mice Seeded on ADM Scaffolds in Wound Healing and Assessment by Advanced Optical Techniques

    Directory of Open Access Journals (Sweden)

    Ning Wang

    2017-06-01

    Full Text Available Background/Aims: Bone marrow Mesenchymal stem cells (MSCs are promising for promoting cutaneous wound healing through reinforcing cellular processes. We evaluated the effect of GFP-tagged MSCs transplantation on skin regeneration in excisional wounds in mice. Methods: MSCs from GFP-labeled transgenic mice were co-cultured with acellular dermal matrix (ADM scaffolds, and MSC-ADM scaffolds were transplanted into surgical skin wounds of BALB/c mice. After implantation, the survival and behavior of MSCs were examined by second harmonic generation and two-photon excitation fluorescence imaging, western blotting and DNA amplification and sequencing. Results: GFP-tagged MSCs were retained inside the regenerating skin until day 14 post-transplantation. Alpha-smooth muscle actin (α-SMA and vimentin (VIM were detected at 3, 5, 7, and 14 days post-transplantation by immunofluorescence double labeling. Although the GFP+/α-SMA+- and GFP+/VIM+-cell numbers decreased gradually with healing time, α-SMA+- and VIM+-cell numbers significantly increased, most of them were endogenous functional cells which were related to angiogenesis and collagen fiber structural remodeling. Conclusion: Therefore, in the initial stage of wound healing, transplanted MSCs differentiated into functional cells and played paracrine roles to recruit more endogenous cells for tissue remodeling. With the disappearance of exogenous cells, endogenous cells were responsible for the latter stage of cutaneous wound healing.

  19. Effects of Methanolic Jatropha multifida L. Extract in Wound Healing Assessed by the Total Number of PMN Leukocytes and Fibroblasts

    Directory of Open Access Journals (Sweden)

    Juniarti

    2012-12-01

    Full Text Available Objective: The aim of this study was to evaluate the effects of methanol extract of Jatropha multifida leaves on the wound healing process and to investigate the wound healing activity based on reduced numbers of PMN (polymorpho nuclear leukocytes and increased numbers of fibroblasts. Method: methanol extract of dried leaves of Jatropha multifida was used in the wound healing activity studies. The study subjects were 36 white male Sprague Dawlay rats aged 2 months with 150-200 gram body weight. The subjects were divided into 4 groups and experimentally injured: Group I (negative control underwent injury without subsequent treatment; group II (positive control received topical treatment with Bethasone-N after injury; group III (solvent control was treated with 70% methanol; group IV (treatment group was treated with 10 mg methanol extract of Jatropha multifida Each group consisted of 3 rats, which were decapitated on days 3, 6, and 13 after the start of treatment. Histological preparation was stained with hematoxyline-eosin (HE and was continuously examined by counting the numbers of PMN leukocytes and fibroblasts as indicators of wound healing on days 3, 6, and 13 of treatment. The study showed lower numbers of PMN leukocytes in subjects treated with the extract of Jatropha multifida as compared to the other groups. The numbers of fibroblasts were significantly higher on days 6 and 13 of treatment. In conclusion, the treatment of injuries with methanol extract of leaves from Jatropha multifida provided better results compared to the other groups in our study.

  20. Hydraulic fracturing in unconventional reservoirs - Identification of hazards and strategies for a quantitative risk assessment

    Science.gov (United States)

    Helmig, R.; Kissinger, A.; Class, H.; Ebigbo, A.

    2012-12-01

    fractured reservoir, fracture propagation, fault zones and their role in regard to fluid migration into shallow aquifers). A quantitative risk assessment which should be the main aim of future work in this field has much higher demands, especially on site specific data, as the estimation of statistical parameter uncertainty requires site specific parameter distributions. There is already ongoing research on risk assessment in related fields like CO2 sequestration. We therefore propose these methodologies to be transferred to risk estimation relating to the use of the hydraulic fracking method, be it for unconventional gas or enhanced geothermal energy production. The overall aim should be to set common and transparent standards for different uses of the subsurface and their involved risks and communicate those to policy makers and stake holders.

  1. Forearm Fractures in Children

    Science.gov (United States)

    ... secure them in place. Your doctor may recommend surgery if: Casts support and protect broken bones while they heal. Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014. • The bone ...

  2. The biomechanical role of periodontal ligament in bonded and replanted vertically fractured teeth under cyclic biting forces

    Institute of Scientific and Technical Information of China (English)

    Ya-Nan Zhu; Wei-Dong Yang; Paul V Abbott; Nicolas Martin; Wen-Jia Wei; Jing-Jing Li; Zhi Chen; Wen-Mei Wang

    2015-01-01

    After teeth are replanted, there are two possible healing responses:periodontal ligament healing or ankylosis with subsequent replacement resorption. The purpose of this study was to compare the fatigue resistance of vertically fractured teeth after bonding the fragments under conditions simulating both healing modes. Thirty-two human premolars were vertically fractured and the fragments were bonded together with Super-Bond C&B. They were then randomly distributed into four groups (BP, CP, CA, BA). The BP and CP groups were used to investigate the periodontal ligament healing mode whilst the BA and CA groups simulated ankylosis. All teeth had root canal treatment performed. Metal crowns were constructed for the CP and CA groups. The BP and BA groups only had composite resin restorations in the access cavities. All specimens were subjected to a 260 N load at 4 Hz until failure of the bond or until 23106 cycles had been reached if no fracture occurred. Cracks were detected by stereomicroscope imaging and also assessed via dye penetration tests. Finally, interfaces of the resin luting agent were examined by scanning electron microscope. The results confirmed that the fatigue resistance was higher in the groups with simulated periodontal ligament healing. Periodontal reattachment showed important biomechanical role in bonded and replanted vertically fractured teeth.

  3. Risk Assessment of Bone Fracture During Space Exploration Missions to the Moon and Mars

    Science.gov (United States)

    Lewandowski, Beth E.; Myers, Jerry G.; Nelson, Emily S.; Griffin, Devon

    2008-01-01

    The possibility of a traumatic bone fracture in space is a concern due to the observed decrease in astronaut bone mineral density (BMD) during spaceflight and because of the physical demands of the mission. The Bone Fracture Risk Module (BFxRM) was developed to quantify the probability of fracture at the femoral neck and lumbar spine during space exploration missions. The BFxRM is scenario-based, providing predictions for specific activities or events during a particular space mission. The key elements of the BFxRM are the mission parameters, the biomechanical loading models, the bone loss and fracture models and the incidence rate of the activity or event. Uncertainties in the model parameters arise due to variations within the population and unknowns associated with the effects of the space environment. Consequently, parameter distributions were used in Monte Carlo simulations to obtain an estimate of fracture probability under real mission scenarios. The model predicts an increase in the probability of fracture as the mission length increases and fracture is more likely in the higher gravitational field of Mars than on the moon. The resulting probability predictions and sensitivity analyses of the BFxRM can be used as an engineering tool for mission operation and resource planning in order to mitigate the risk of bone fracture in space.

  4. Incorporating in vivo fall assessments in the simulation of femoral fractures with finite element models

    NARCIS (Netherlands)

    van der Zijden, A.M.; Janssen, D.; Verdonschot, Nicolaas Jacobus Joseph; Groen, B.E.; Nienhuis, B.; Weerdesteyn, V.; Tanck, E.

    2015-01-01

    Femoral fractures are a major health issue. Most experimental and finite element (FE) fracture studies use polymethylmethacrylate cups on the greater trochanter (GT) to simulate fall impact loads. However, in vivo fall studies showed that the femur is loaded distally from the GT. Our objective was

  5. Fracture mechanics

    Science.gov (United States)

    Shannon, John L., Jr.

    1986-01-01

    The application of fracture mechanics to the design of ceramic structures will require the precise measurement of crack growth and fracture resistance of these materials over their entire range of anticipated service temperatures and standardized test methods for making such measurements. The development of a standard test for measuring the plane strain fracture toughness is sought. Stress intensity factor coefficients were determined for three varieties of chevron-notch specimens, and fracture toughness measurements were made on silicon nitrides, silicon carbides, and aluminum oxides to assess the performance of each specimen variety. It was determined that silicon nitride and silicon carbides have flat crack growth resistance curves, but aluminum oxide does not. Additionally, batch-to-batch differences were noticed for the aluminum oxide. Experiments are continuing to explain the rising crack growth resistance and batch-to-batch variations for the aluminum oxide.

  6. Bone quality parameters of the distal radius as assessed by pQCT in normal and fractured women.

    Science.gov (United States)

    Schneider, P; Reiners, C; Cointry, G R; Capozza, R F; Ferretti, J L

    2001-01-01

    The aim of this study was to test the ability of some indicators of different aspects of bone quality (assessed by peripheral quantitative computed tomography in the distal radius) to discriminate between fractured and nonfractured individuals. The study compared 214 women aged 45-85 years, free of any bone-affecting treatment, of whom 107 had suffered a Colles' fracture in the previous 6 months and 107 did not. The determinations included bone tissue or mineral 'mass' indicators (trabecular, cortical and total volumetric mineral content, cortical bone area); bone 'density' estimates (trabecular, cortical and total volumetric mineral density), and the Cartesian (rectangular) and polar moments of inertia as influences of cross-sectional architecture on resistance to bending and torsional loads, respectively. The influences of body height, weight and age on the tomographic indicators were minimized by adjusting the data according to the partial coefficients of multiple stepwise regressions. The adjusted values of all the indicators were lower in fractured than in nonfractured groups. The prevalence of fractures was directly related to the actual values of the indicators, rather than the age or body habitus of the individuals. The significance of these differences between the assessed indicators decreased in the following order: trabecular 'mass' > trabecular 'density' > cortical or total 'mass' > cortical architecture > total or cortical 'density' indicators. Within the same type of bone, the tissue or mineral 'mass' indicators performed better than the 'density' indicators. The cortical bone density did not give useful information, probably because of technical difficulties. Odds-ratios and receiver-operating characteristic (ROC) analyses confirmed those features. The selected 'cut-off' values of the indicators as determined by the ROC curves (very close to those determined by the inflexion points of the logistic reression curves) may indicate reference limits to

  7. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-10-01

    The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

  8. Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults

    Institute of Scientific and Technical Information of China (English)

    Amit Aggarwal; Mahipal Singh; Aditya N Aggarwal; Shuchi Bhatt

    2014-01-01

    Objective:To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior (AP) view and also assess if the addition of lateral view changes the classification and management plan.Methods:Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan.Then the same films were reshown in conjunction with their lateral view after 10 days.Results were compared with respect to the classification and management plan between two groups.Interobserver agreement was calculated using Fleiss' kappa.Results:There was only a fair interobserver agreement (kappa value 0.39) on Garden classification on AP view only which improved to moderate agreement (kappa value 0.52) after adding a lateral view.While there was only a slight improvement in the interobserver agreement on the management plan on AP view only (kappa value 0.50) and AP combined with lateral views (kappa value 0.52).Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases.Conclusion:We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.

  9. Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research

    Directory of Open Access Journals (Sweden)

    Jia-zuo SHEN, Jian-fei YAO, Da-sheng LIN, Ke-jian LIAN, Zhen-qi DING, Bin LIN, Zhi-min GUO, Ming-hua ZHANG, Qiang LI, Lin LI, Peng QI

    2012-01-01

    Full Text Available Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise.Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS and standard dynamic hip screws (DHS in an animal model.Design: Testing of specifically designed fixation devices in a pig animal model.Interventions/Methods: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each. Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively.Results: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05. There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively.Conclusions: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.

  10. 高能震波对老年桡骨远端骨折愈合及骨密度的影响%The Effects of High Energy Shock Waves on the Healing and the Bone Mineral Density of Elders′ Distal Radius Fracture

    Institute of Scientific and Technical Information of China (English)

    聂玮; 李晓林; 张博; 曾炳芳

    2011-01-01

    Objective The purpose of this study was to evaluate the effect and observe the clinical efficacy of the high energy shock waves treatment on the distal radius fracture of the elders. Methods Seventy five patients with distal radius fracture were selected and randomly divided into two groups: the control group,with 38 patients who were received only the manual reduction and cast immobilization;the HESW group ,with 37 patients who were treated with HESW(0.5~0.6 mJ/mm2 energy flux density with 4000 impulses) after the manual reduction and cast immobilization. The rate of clinical healing after four weeks, the rate of bone union after ten weeks, bone mineral density (BMD) during the treatment and the wrist function,PRWE results after bone union were assessed as measurements. Results While the bone mineral density (BMD) values in four weeks between the two groups were not statistically significant(P=0. 694),but the BMD values of the HESW group were significantly higher (P<0.05) than the control group at eight weeks/twelve weeks after fractured. And the HESW group' BMD values after twelve weeks show significantly different from that before treatment (P<0.05). With regard to the rate of clinical healing after four weeks, the rate of bone union after ten weeks,the VAS scores,wrist function scores and PRWE scores,there were significantly different between the two groups. Conclusion HESW,with effective effects on the treatment on the distal radius fracture of the elders, could promote the healing of fractures effectively. It is efficacious against regional osteoporosis, joint stiffness and persistent pain. Good functional outcomes and the high quality of life could be obtained by the patients.%目的 观察高能震波(high energy shock waves,HESW)对老年桡骨远端骨折愈合过程中的作用及其临床意义.方法 筛选75 例桡骨远端骨折患者,随机分为震波组(37 例)和对照组(38 例);震波组应用高能震波仪对石膏固定患者进行治

  11. Nano-silver-decorated microfibrous eggshell membrane: processing, cytotoxicity assessment and optimization, antibacterial activity and wound healing

    OpenAIRE

    Menglong Liu; Gaoxing Luo; Yuzhen Wang; Rui Xu; Ying Wang; Weifeng He; Jianglin Tan; Malcolm Xing; Jun Wu

    2017-01-01

    An ideal wound dressing can both promote wound healing and prevent bacterial infection. Here, we report a potential dressing prepared by incorporating an optimized concentration of silver nanoparticles (AgNPs) into the microfibers of a natural eggshell membrane (EM) using environmentally friendly and mussel-inspired dopamine. Briefly, acid-treated EM was used as a porous membrane for polydopamine-reduced AgNPs synthesis. To obtain the optimal cytocompatible silver concentration, cellular atta...

  12. Access to fracture risk assessment by FRAX and linked National Osteoporosis Guideline Group (NOGG) guidance in the UK-an analysis of anonymous website activity.

    Science.gov (United States)

    McCloskey, E V; Johansson, H; Harvey, N C; Compston, J; Kanis, J A

    2017-01-01

    In the UK, fracture risk guidance is provided by the National Osteoporosis Guideline Group (NOGG). NOGG usage showed widespread access through direct web-based linkage to FRAX. The facilitated interaction between fracture risk assessment and clinical guidelines could usefully be adopted in other countries.

  13. Treatment of humeral shaft fractures with antegrade intramedullary locking nail.

    Science.gov (United States)

    Tsourvakas, Stefanos; Alexandropoulos, Christos; Papachristos, Ioannis; Tsakoumis, Grigorios; Ameridis, Nikolaos

    2011-12-01

    Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department. Eight patients were polytraumatized, and four patients had an open fracture. The mean age of patients was 51.7 years. Forty-eight patients had an adequate duration of clinical follow-up (a mean of 18 months) for analysis. Complications were recorded, and the time to union was measured. Shoulder and elbow functions were assessed using the Constant Score and the Morrey Score, respectively. Forty-six fractures healed, with a mean time to clinical union of 10.3 weeks. Two patients developed pseudarthroses. There were four adverse events: two proximal screws backed out, one superficial infection at the insertion point, and one fracture at the distal end of the nail. Ninety-one percentage of patients had an excellent or good shoulder function. Five further operations were necessary: two for treatment of pseudarthroses, two for removal the backed out proximal screws, and one wound debridement for superficial infection. Antegrade humeral nailing is a valid therapeutic option for stabilization of humeral shaft fractures. By strictly adhering to the operation technique, the number and the severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional results is the rule.

  14. In vivo Assessment of Antioxidant and Wound Healing Improvement of a New Schiff Base Derived Co (II) Complex in Rats

    Science.gov (United States)

    El-Ferjani, Rashd. M.; Ahmad, Musa; Dhiyaaldeen, Summaya M.; Harun, Farah Wahida; Ibrahim, Mohamed Yousif; Adam, Hoyam; Mohd. Yamin, Bohari; Al-Obaidi, Mazen M. Jamil; Batran, Rami Al

    2016-01-01

    Co (II) complex (CMLA) was investigated to evaluate the rate of wound healing in rats. Animals were placed into four groups: gum acacia, Intrasite gel, 10 and 20 mg/ml of CMLA. Wounds were made on the dorsal neck area, then treated with Intrasite gel or CMLA; both of these treatments led to faster healing than with gum acacia. Histology of the wounds dressed with CMLA or Intrasite gel displayed a smaller scar width, required less time to heal and showed more collagen staining and fewer inflammatory cells in comparison to wounds dressed with the vehicle. Immunohistochemistry for Hsp70 and TGF-β showed greater staining intensity in the treated groups compared to the vehicle group. Bax staining was less intense in treated groups compared to the vehicle group, suggesting that CMLA and Intrasite gel provoked apoptosis, responsible for the development of granulation tissue into a scar. CD31 protein analysis showed that the treated groups enhanced angiogenesis and increased vascularization compared to the control group. Furthermore, a significant increase in the levels of GPx and SOD and a decrease in MDA were also observed in the treated groups. This results suggest that CMLA is a potentially promising agent for the wounds treatment. PMID:27958299

  15. An updated fracture-flow model for total-system performance assessment of Yucca Mountain

    Energy Technology Data Exchange (ETDEWEB)

    Gauthier, J.H. [SPECTRA Research Institute, Albuquerque, NM (United States)

    1994-12-31

    Improvements have been made to the fracture-flow model being used in the total-system performance assessment of a potential high-level radioactive waste repository at Yucca Mountain, Nevada. The {open_quotes}weeps model{close_quotes} now includes (1) weeps of varied sizes, (2) flow-pattern fluctuations caused by climate change, and (3) flow-pattern perturbations caused by repository heat generation. Comparison with the original weeps model indicates that allowing weeps of varied sizes substantially reduces the number of weeps and the number of containers contacted by weeps. However, flow-pattern perturbations caused by either climate change or repository heat generation greatly increases the number of containers contacted by weeps. In preliminary total-system calculations, using a phenomenological container-failure and radionuclide-release model, the weeps model predicts that radionuclide releases from a high-level radioactive waste repository at Yucca Mountain will be below the EPA standard specified in 40 CFR 191, but that the maximum radiation dose to an individual could be significant. Specific data from the site are required to determine the validity of the weep-flow mechanism and to better determine the parameters to which the dose calculation is sensitive.

  16. Growth hormone does not stimulate early healing in rat tendons

    OpenAIRE

    2012-01-01

    Growth Hormone stimulates bone growth and fracture repair. It acts mainly by increasing the systemic levels of IGF-1. Local treatment with IGF-1 appears to stimulate tendon healing. We therefore hypothesized that systemic treatment with Growth Hormone would also stimulate tendon healing. Rat Achilles tendons were transected and left to heal. 4 groups were studied. Intramuscular injections of botulinum toxin A (Botox) were used to reduce loading in 2 groups. The animals were randomized to twic...

  17. Utility of double-contrast multi-detector CT scans to assess cartilage thickness after tibial plafond fracture

    Science.gov (United States)

    Thomas, Thaddeus P.; Van Hofwegen, Christopher J.; Anderson, Donald D.; Brown, Thomas D.; Marsh, J. Lawrence

    2010-01-01

    The pathophysiology of post-traumatic osteoarthritis (PTOA) after intra-articular fractures is poorly understood. Pursuit of a better understanding of this disease is complicated by inability to accurately monitor its onset, progression and severity. Common radiographic methods used to assess PTOA do not provide sufficient image quality for precise cartilage measurements. Double-contrast MDCT is an alternative method that may be useful, since it produces high-quality images in normal ankles. The purpose of this study was to assess this technique’s performance in assessing cartilage maintenance in ankles with an intra-articular fracture. Thirty-six tibial plafond fractures were followed over two years, with thirty-one MDCTs being obtained four months after injury, and twenty-two MDCTs after two years. Unfortunately, clinical results with this technique were unreliable due to pathology (presumed arthrofibrosis) and technical problems (pooling of contrast). The arthrofibrosis that developed in many patients inhibited proper joint access and contrast infiltration, although high-quality images were obtained in eleven patients. In this patient subset, in which focal regions of cartilage degeneration could be visualized, thickness could be measured with a high degree of fidelity. While thus useful in selected instances, double-contrast MDCT was too unreliable to be recommended to assess these particular types of injuries. PMID:20634971

  18. Preliminary experience with biodegradable implants for fracture fixation

    Directory of Open Access Journals (Sweden)

    Dhillon Mandeep

    2008-01-01

    Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

  19. Treatment of stable and unstable intertrochanteric fractures with selfdynamisable internal fixator (concept of double dynamisation

    Directory of Open Access Journals (Sweden)

    Kostić Igor M.

    2015-01-01

    Full Text Available Bacground/Aim. Intertrochanteric fractures of the femur are the third most common fractures among all bone fractures. Today in everyday orthopedic practice a number of different methods of treatment of trochanteric fractures of the femur are applied. Despite the improvement in the development of new implants, the percentage of serious complications of the treatment of these fractures remains very high, varying from 10% to 20%. One of the most serious complications of internal fixation of intertrochanteric fractures is nonunion of fractures due to the lack of additional axial dynamisation of implants. The aim of this study was to determine the efficacy of double dynamisation in stable and unstable intertrochanteric fractures treatment using the self dynamisable internal fixator. Methods. During the period from 2000 to 2009 we analyzed the use of selfdynamisable internal fixator (SIF implant in the treatment of 247 patients with stable and unstable intertrochanteric fractures. Fracture types were classified according to the AO Fracture Classification/Orthopaedic Trauma Association Scheme. Salvati and Wilson scoring systems were used for functional assessment considering pain, walking ability and hip movements of operated patients. Results. Of the total number of treated patients, 134 were males and 113 females, aged 19 to 90 (average 49.6 years. More than a half of the patients were older than 50 years. Monitoring of the patients after the operation was carried out clinically and radiographically for a period of three to six months in all the patients, whereas a 2-year follow-up was conducted in 176 (71.2% patients. The average duration of surgery was 47 min, the average blood loss 145 mL, and the average fluoroscopy time was 16 sec (8-97 sec. The average time for union was 3.7 months (3-6.5 months. Double dynamisation (dynamisation along the neck and shaft of the femur was observed in 85 (34.4% patients, and was on average 4.3 mm (1.5-8 mm. All

  20. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Dixon AC

    2015-06-01

    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  1. Shape-based assessment of vertebral fracture risk in postmenopausal women using discriminative shape alignment

    DEFF Research Database (Denmark)

    Crimi, Alessandro; Loog, Marco; de Bruijne, Marleen

    2012-01-01

    but the result of a decaying process. To evaluate fracture risk, a shape-based classifier, identifying possible small prefracture deformities, may be constructed. MATERIALS AND METHODS: During a longitudinal case-control study, a large population of postmenopausal women, fracture free at baseline, were followed....... The 22 women who sustained at least one lumbar fracture on follow-up represented the case group. The control group comprised 91 women who maintained skeletal integrity and matched the case group according to the standard osteoporosis risk factors. On radiographs, a radiologist and two technicians...

  2. Solvent-based self-healing approaches for fiber-reinforced composites

    Science.gov (United States)

    Jones, Amanda R.

    -solvent ratio of 3:97, a maximum of 100% IFSS recovery is achieved-- a significant enhancement over prior work that reported 44% average recovery of IFSS with microencapsulated dicyclopentadiene (DCPD) monomer and Grubbs' 1st Generation catalyst healing agents. The effects of capsule coverage, resin-solvent ratio, and capsule size on recovery of IFSS are also determined, providing guidelines for integration of this healing system into high fiber volume fraction structural composites. High healing efficiencies are achieved with capsules as small as 0.6 mum average diameter. The resin-solvent healing system is then extended to repair of a carbon fiber/epoxy interfacial bond. A binder is necessary to improve the retention of capsules on the carbon fiber surface. Two different methods for applying a binder to a carbon fiber surface are investigated. Healing efficiency is assessed by recovery of IFSS of a single functionalized fiber embedded in an epoxy microbond specimen. The two binder protocols produce comparable results, both yielding higher recovery of IFSS than samples prepared without a binder. A maximum of 91% recovery of IFSS is achieved. In the next study, the resin-solvent healing system is applied to both interfacial damage and matrix cracking in a model composite specimen, consisting of discrete fiber tows embedded in a room temperature cured epoxy. Glass fiber tows are precisely placed in a compact tension specimen for controlled crack growth. The progression of matrix cracking and fiber debonding is observed optically during testing. Healing potential is assessed by injection of the healing agents into reference specimens (no capsules). The area under the load-displacement curve recovered during the healing event serves as a metric for evaluation of healing performance. Though full recovery is achieved in neat epoxy specimens, healing efficiency in multi-tow specimens is limited to 50%, due to the larger crack separations and energy lost during fiber fracture. In the

  3. Monitoring of Postoperative Bone Healing Using Smart Trauma-Fixation Device With Integrated Self-Powered Piezo-Floating-Gate Sensors.

    Science.gov (United States)

    Borchani, Wassim; Aono, Kenji; Lajnef, Nizar; Chakrabartty, Shantanu

    2016-07-01

    Achieving better surgical outcomes in cases of traumatic bone fractures requires postoperative monitoring of changes in the growth and mechanical properties of the tissue and bones during the healing process. While current in-vivo imaging techniques can provide a snapshot of the extent of bone growth, it is unable to provide a history of the healing process, which is important if any corrective surgery is required. Monitoring the time evolution of in-vivo mechanical loads using existing technology is a challenge due to the need for continuous power while maintaining patient mobility and comfort. This paper investigates the feasibility of self-powered monitoring of the bone-healing process using our previously reported piezo-floating-gate (PFG) sensors. The sensors are directly integrated with a fixation device and operate by harvesting energy from microscale strain variations in the fixation structure. We show that the sensors can record and store the statistics of the strain evolution during the healing process for offline retrieval and analysis. Additionally, we present measurement results using a biomechanical phantom comprising of a femur fracture fixation plate; bone healing is emulated by inserting different materials, with gradually increasing elastic moduli, inside a fracture gap. The PFG sensor can effectively sense, compute, and record continuously evolving statistics of mechanical loading over a typical healing period of a bone, and the statistics could be used to differentiate between different bone-healing conditions. The proposed sensor presents a reliable objective technique to assess bone-healing progress and help decide on the removal time of the fixation device.

  4. Insights into the use of thermography to assess burn wound healing potential: a reliable and valid technique when compared to laser Doppler imaging

    Science.gov (United States)

    Jaspers, Mariëlle E. H.; Maltha, Ilse; Klaessens, John H. G. M.; de Vet, Henrica C. W.; Verdaasdonk, Rudolf M.; van Zuijlen, Paul P. M.

    2016-09-01

    Adequate assessment of burn wounds is crucial in the management of burn patients. Thermography, as a noninvasive measurement tool, can be utilized to detect the remaining perfusion over large burn wound areas by measuring temperature, thereby reflecting the healing potential (HP) (i.e., number of days that burns require to heal). The objective of this study was to evaluate the clinimetric properties (i.e., reliability and validity) of thermography for measuring burn wound HP. To evaluate reliability, two independent observers performed a thermography measurement of 50 burns. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the limits of agreement (LoA) were calculated. To assess validity, temperature differences between burned and nonburned skin (ΔT) were compared to the HP found by laser Doppler imaging (serving as the reference standard). By applying a visual method, one ΔT cutoff point was identified to differentiate between burns requiring conservative versus surgical treatment. The ICC was 0.99, expressing an excellent correlation between two measurements. The SEM was calculated at 0.22°C, the LoA at -0.58°C and 0.64°C. The ΔT cutoff point was -0.07°C (sensitivity 80% specificity 80%). These results show that thermography is a reliable and valid technique in the assessment of burn wound HP.

  5. Readability assessment of internet-based patient education materials related to facial fractures.

    Science.gov (United States)

    Sanghvi, Saurin; Cherla, Deepa V; Shukla, Pratik A; Eloy, Jean Anderson

    2012-09-01

    Various professional societies, clinical practices, hospitals, and health care-related Web sites provide Internet-based patient education material (IPEMs) to the general public. However, this information may be written above the 6th-grade reading level recommended by the US Department of Health and Human Services. The purpose of this study is to assess the readability of facial fracture (FF)-related IPEMs and compare readability levels of IPEMs provided by four sources: professional societies, clinical practices, hospitals, and miscellaneous sources. Analysis of IPEMs on FFs available on Google.com. The readability of 41 FF-related IPEMs was assessed with four readability indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG). Averages were evaluated against national recommendations and between each source using analysis of variance and t tests. Only 4.9% of IPEMs were written at or below the 6th-grade reading level, based on FKGL. The mean readability scores were: FRES 54.10, FKGL 9.89, SMOG 12.73, and Gunning FOG 12.98, translating into FF-related IPEMs being written at a "difficult" writing level, which is above the level of reading understanding of the average American adult. IPEMs related to FFs are written above the recommended 6th-grade reading level. Consequently, this information would be difficult to understand by the average US patient. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  6. Management of subtrochanteric femur fractures with internal fixation and recombinant human bone morphogenetic protein-7 in a patient with osteopetrosis: a case report

    Directory of Open Access Journals (Sweden)

    Golden Robert D

    2010-05-01

    Full Text Available Abstract Introduction Osteopetrosis is a group of conditions characterized by defects in the osteoclastic function of the bone resulting in defective bone resorption. Clinically, the condition is characterized by a dense, sclerotic, deformed bone which, despite an increased density observable by radiography, often results in an increased propensity to fracture and delayed union. Case Presentation We report the case of a 27-year-old Asian man presenting with bilateral subtrochanteric femur fractures. He had a displaced right subtrochanteric femur fracture after a low-energy fall, which was treated surgically. The second fracture that our patient endured was diagnosed as a stress fracture ten weeks later when he complained of pain in the contralateral left thigh. By that time, the right-sided fracture exhibited no radiographic evidence of healing, and when the left-sided stress fracture was being treated surgically, bone grafting with recombinant human bone morphogenetic protein-7 was also performed on the right side. Conclusion While there are no data supporting the use of bone morphogenic proteins in the management of delayed healing in patients with osteopetrosis, no other reliable osteoinductive grafting options are available to treat this condition. Both fractures in our patient healed, but based on the serial radiographic assessment it is uncertain to what degree the recombinant human bone morphogenetic protein-7 may have contributed to the successful outcome. It may have also contributed to the formation of heterotopic bone around the fracture site. Further investigation of the effectiveness and indications of bone morphogenic protein use for the management of delayed fracture healing in patients with osteopetrosis is warranted.

  7. Pedicular stress fracture in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Chong, V.F.H.; Htoo, M.M. [Singapore General Hospital, Singapore, (Singapore). Department of Diagnostic Radiology

    1997-08-01

    Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle (`pediculolysis`) is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal. (authors). 10 refs., 2 figs.

  8. Effects of low power laser irradiation on bone healing in animals: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Houghton Pamela

    2010-01-01

    Full Text Available Abstract Purpose The meta-analysis was performed to identify animal research defining the effects of low power laser irradiation on biomechanical indicators of bone regeneration and the impact of dosage. Methods We searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment. Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis. Results Studies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08 - 1.37, p 0.028. While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.

  9. Solubility of uranium and thorium from a healing earth in synthetic gut fluids: a case study for use in dose assessments.

    Science.gov (United States)

    Höllriegl, Vera; Li, Wei Bo; Leopold, Karsten; Gerstmann, Udo; Oeh, Uwe

    2010-11-01

    The aim of this case study was to estimate the bioaccessibility of uranium ((238)U) and thorium ((232)Th) from a healing earth by analysing the solubility of these radionuclides in synthetic gastric and intestinal fluids. An easy applicable in vitro test system was used to investigate the fractional mobilization of the soil contaminants being potentially available for absorption under human in vivo conditions. These findings provided the basis for a prospective dose assessment. The solubility experiments were performed using two different in vitro digestion methods. The concentrations of (238)U and (232)Th in the solutions extracted from the soil were measured by inductively coupled plasma mass spectrometry (ICP-MS). The dissolved fractions in the synthetic gastrointestinal fluid ranged in average from 10.3% to 13.8% for (238)U and from 0.3% to 1.6% for (232)Th, respectively, depending on the digestion method. Subsequently, the committed effective doses from intake of (238)U and (232)Th after ingestion of the healing earth during 1 year were evaluated for adult persons. Thereby ingestion dose coefficients calculated as a function of bioaccessibility were used. The dose assessments ranged between 4.3 × 10(-7)-1.9 × 10(-6) Sv y(-1) for (238)U and 5.6 × 10(-7)-3.3 × 10(-6) Sv y(-1) for (232)Th, respectively. On the basis of the assumptions and estimations made, the present work indicates a relatively low radiation risk due to (238)U and (232)Th after internal exposure of the healing earth. Copyright © 2010 Elsevier B.V. All rights reserved.

  10. Fracture mechanics safety assessment based on mechanics of materials. Werkstoffmechanische Grundlagen bruchmechanischer Sicherheitsanalysen

    Energy Technology Data Exchange (ETDEWEB)

    Roos, E.; Demler, T.; Eisele, U.; Gillot, R. (Stuttgart Univ. (Germany). Staatliche Materialpruefungsanstalt)

    1990-01-01

    Investigations are reported of pressure vessel and piping steels (22 NiMoCr 3 7) of various toughness and strength, for determining the influence of the testing temperature on fracture-mechanical characteristics with regard to static and dynamic crack initiation, crack growth and crack stop. The tests have been made in a temperature range where both linear-elastic and elastic-plastic materials behaviour is possible. Within the linear-elastic fracture-mechanical regime, the conservativity of the limiting curves given in American and German technical codes and standards have been confirmed. Within the regime of upper-shelf toughness, where characteristics of elastic-plastic fracture-mechanical behaviour are to be used for analysis, application of the limiting curves given in standards leads to an overassessment of real fracture-mechanical characteristics. (orig./DG).

  11. Effects of the Crack Tip Constraint on the Fracture Assessment of an Al 5083-O Weldment for Low Temperature Applications

    Directory of Open Access Journals (Sweden)

    Dong Hyun Moon

    2017-07-01

    Full Text Available The constraint effect is the key issue in structural integrity assessments based on two parameter fracture mechanics (TPFM to make a precise prediction of the load-bearing capacity of cracked structural components. In this study, a constraint-based failure assessment diagram (FAD was used to assess the fracture behavior of an Al 5083-O weldment with various flaws at cryogenic temperature. The results were compared with those of BS 7910 Option 1 FAD, in terms of the maximum allowable stress. A series of fracture toughness tests were conducted with compact tension (CT specimens at room and cryogenic temperatures. The Q parameter for the Al 5083-O weldment was evaluated to quantify the constraint level, which is the difference between the actual stress, and the Hutchinson-Rice-Rosengren (HRR stress field near the crack tip. Nonlinear 3D finite element analysis was carried out to calculate the Q parameter at cryogenic temperature. Based on the experimental and numerical results, the influence of the constraint level correction on the allowable applied stress was investigated using a FAD methodology. The results showed that the constraint-based FAD procedure is essential to avoid an overly conservative allowable stress prediction in an Al 5083-O weldment with flaws.

  12. A unified theory of bone healing and nonunion: BHN theory.

    Science.gov (United States)

    Elliott, D S; Newman, K J H; Forward, D P; Hahn, D M; Ollivere, B; Kojima, K; Handley, R; Rossiter, N D; Wixted, J J; Smith, R M; Moran, C G

    2016-07-01

    This article presents a unified clinical theory that links established facts about the physiology of bone and homeostasis, with those involved in the healing of fractures and the development of nonunion. The key to this theory is the concept that the tissue that forms in and around a fracture should be considered a specific functional entity. This 'bone-healing unit' produces a physiological response to its biological and mechanical environment, which leads to the normal healing of bone. This tissue responds to mechanical forces and functions according to Wolff's law, Perren's strain theory and Frost's concept of the "mechanostat". In response to the local mechanical environment, the bone-healing unit normally changes with time, producing different tissues that can tolerate various levels of strain. The normal result is the formation of bone that bridges the fracture - healing by callus. Nonunion occurs when the bone-healing unit fails either due to mechanical or biological problems or a combination of both. In clinical practice, the majority of nonunions are due to mechanical problems with instability, resulting in too much strain at the fracture site. In most nonunions, there is an intact bone-healing unit. We suggest that this maintains its biological potential to heal, but fails to function due to the mechanical conditions. The theory predicts the healing pattern of multifragmentary fractures and the observed morphological characteristics of different nonunions. It suggests that the majority of nonunions will heal if the correct mechanical environment is produced by surgery, without the need for biological adjuncts such as autologous bone graft. Cite this article: Bone Joint J 2016;98-B:884-91.

  13. Validation of FRC, a fracture risk assessment tool, in a cohort of older men: the Osteoporotic Fractures in Men (MrOS) Study.

    Science.gov (United States)

    Ettinger, Bruce; Liu, Hau; Blackwell, Terr