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  1. LATERAL APPROACH UNDER FLUROSCOPIC GUIDANCE WITH NONLOCKING CALCANEAL PLATE IS AN EFFECTIVE TECHNIQUE FOR CLOSED CALCANEAL FRACTURE

    OpenAIRE

    Alok Sobhan; De, Soumya; Rana

    2014-01-01

    Intra-articular calcaneal fractures which accounts for about 75% of calcaneal fractures is usually associated with poor functional outcome. The present was under taken to evaluate the efficacy of open reduction and internal fixation of displaced articular fractures of calcaneum in adults through lateral approach under fluroscopic guidance with non-locking calcaneal plate and ipsilateral iliac crest bone graft. 30 adult patients (25 males and 5 females) with closed displaced in...

  2. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    Science.gov (United States)

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. PMID:27111072

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

    Science.gov (United States)

    Faroug, Radwane; Stirling, Paul; Ali, Farhan

    2013-01-01

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

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

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    Radwane Faroug

    2013-01-01

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

  5. LATERAL APPROACH UNDER FLUROSCOPIC GUIDANCE WITH NONLOCKING CALCANEAL PLATE IS AN EFFECTIVE TECHNIQUE FOR CLOSED CALCANEAL FRACTURE

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    Alok Sobhan

    2014-06-01

    Full Text Available Intra-articular calcaneal fractures which accounts for about 75% of calcaneal fractures is usually associated with poor functional outcome. The present was under taken to evaluate the efficacy of open reduction and internal fixation of displaced articular fractures of calcaneum in adults through lateral approach under fluroscopic guidance with non-locking calcaneal plate and ipsilateral iliac crest bone graft. 30 adult patients (25 males and 5 females with closed displaced intra articular fractures of calcaneum of less than 15 days constituted the study group. All cases were operated by lateral approach as described by Seligson, a modification of Gould’s technique under spinal anaesthesia. All machers Arthrosis Rating Scale were used for the evaluation of posttraumatic posterior facet degenerative changes. Primarily27 of all 35 wounds (77% healed without any form of wound complications. Excellent to good results noted in 3 (100% patients with preoperative Bohler´s angle larger or equal to 20° (n = 3 whereas patients with preoperative Bohler´s angle smaller than 20° (n=32 achieved excellent to good results in 16 cases (50% Clinically significant subtalararthrosis (Allmacher grade 2-4 noted in 7 cases (20% cases with Bohler´s angle smaller than 20° (n=32. In 5 cases, clinically significant complaints (Allmachers Arthrosis Rating Scale grades II to V noted. Therapeutic success of such fracture depends on timely open reduction and internal fixation with proper fracture reduction and early rehabilitation. Thus management of these injuries as well as complications should be performed in a specialized orthopaedics or traumatology center.

  6. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

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    Jain Saurabh; Jain Anil Kumar; Kumar Ish

    2013-01-01

    【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fr...

  7. MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES BY CLOSED REDUCTION WITH PERCUTANEOUS STEINMANN PIN

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    Padmanabh

    2014-05-01

    Full Text Available BACKGROUND & OBJECTIVES: Calcaneum is the most common tarsal bone to fracture and is attended by considerable morbidity. Many treatment techniques are described in literature but indications for specific techniques are vague. This study analyzes the outcome of treatment of intra articular calcaneum fractures treated by Essex-Lopresti technique. METHODS: Between January 2011 and December 2012, 20 patients with tongue-type fracture of Calcaneum who got admitted at Srinivas Institute of Medical Sciences, Mangalore in the Department of Orthopedics were subjected to closed reduction and percutaneous pin fixation (Method of Essex-Lopresti. Creighton Nebraska Health Foundation Assessment sheet for calcaneum fractures was used for analysis. STATISTICAL ANALYSIS: Wilcoxon Rank-sum test was used to compare repeated measurements on a single sample to assess whether their mean population ranks differ. Kruskal Wallis test was used for analysis of variance. RESULTS: Incidence was more common in males with right and left side involvement being almost equal and no bilateral involvement. The commonest mechanism of injury was fall from height and landing on the heel. It was found to be more common in age group 30-39 years. Associated spine and lower extremity injuries were seen in 30%. There were 45% excellent, 30% good, 25% fair results and no poor results. CONCLUSION: The Essex-Lopresti method of closed reduction and pin fixation is a safe technique with overall good results and an acceptable complication rate for the treatment of tongue-type fracture of calcaneum

  8. MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES BY CLOSED REDUCTION WITH PERCUTANEOUS STEINMANN PIN

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    Padmanabh, MR; Niaz; Ramachandra,

    2014-01-01

    BACKGROUND & OBJECTIVES: Calcaneum is the most common tarsal bone to fracture and is attended by considerable morbidity. Many treatment techniques are described in literature but indications for specific techniques are vague. This study analyzes the outcome of treatment of intra articular calcaneum fractures treated by Essex-Lopresti technique. METHODS: Between January 2011 and December 2012, 20 patients with tongue-type fracture of Calcaneum who got admitted at Srinivas I...

  9. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Directory of Open Access Journals (Sweden)

    Jain Saurabh

    2013-12-01

    Full Text Available 【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of com- minution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiologi- cal assessment was done by Bohler’s angle and Gissane’s angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Or- thopaedics Foot and Ankle Society (AOFAS scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97, with 86% having excellent to good results and 2 (7.7% and 1 (3.7% having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler’s angle, mean Gissane’s angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap ne- crosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and

  10. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Institute of Scientific and Technical Information of China (English)

    Saurabh Jain; Anil Kumar Jain; Ish Kumar

    2013-01-01

    Objective:Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods:In this series,28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale.Results:At average follow-up of 14.5 months,average AOFAS score was 86.3 (range 66 to 97),with 86% having excellent to good results and 2 (7.7%) and 1 (3.7%) having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler's angle,mean Gissane's angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion:Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome

  11. Joint-Preserving Osteotomies for Malaligned Intraarticular Calcaneal Fractures.

    Science.gov (United States)

    Benirschke, Stephen K; Kramer, Patricia A

    2016-03-01

    Intraarticular calcaneal fracture treatments that result in malalignment often require reconstructive surgery. Seven cases are used to demonstrate the intricacies of reconstructive case management. Reestablishment of calcaneal height, length, orientation, and position relative to the other tarsals is necessary to reestablish appropriate foot function. Inherent or acquired gastrocnemius equinus should be treated with recession to reduce destructive forces on the reconstruction. PMID:26915782

  12. Comparison Between Sinus Tarsi Approach and Extensile Lateral Approach for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures: A Multicenter Prospective Study.

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    Basile, Attilio; Albo, Francesco; Via, Alessio Giai

    2016-01-01

    The purpose of our investigation was to prospectively review and compare the early outcomes of Sanders II and III closed displaced intra-articular calcaneal fractures (DIACFs) in a group of patients treated by open reduction and internal fixation with plate and screws using the extended lateral approach or the sinus tarsi approach (STA). Thirty-eight patients with DIACFs were prospectively enrolled and operatively treated using either the extended lateral approach or the STA. Patients underwent a careful clinical and radiographic examination and were evaluated according to the American Orthopaedic Foot and Ankle Society score, visual analog scale, and the Foot Function Index. The results from our study showed similar clinical and radiographic outcomes between the 2 groups. In our series, Sanders II and III DIACFs were sufficiently exposed using the STA to achieve anatomic reduction and stable fixation. The STA group had a lower incidence of wound complications (p ≥ .05), the surgical procedure was faster, and the waiting time to surgery was shorter (p ≤ .05). Despite the limited number of patients and the short follow-up period, our results suggest that the STA is a useful method for the treatment of DIACFs, with a low incidence of complications and results comparable to those for patients treated using the extended lateral approach. PMID:26810127

  13. Calcaneal chondroblastoma with pathologic fracture and recurrence.

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    Dutt, Laksha; Schade, Valerie L; Manoso, Mark W

    2015-01-01

    Chondroblastomas account for 80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point.

  14. Calcaneal chondroblastoma with pathologic fracture and recurrence.

    Science.gov (United States)

    Dutt, Laksha; Schade, Valerie L; Manoso, Mark W

    2015-01-01

    Chondroblastomas account for 80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point. PMID:25624038

  15. Novel Technique for Treatment of Calcaneal Tuberosity Fractures.

    Science.gov (United States)

    Yan, Alan Y; Bertrand, Todd E; Zura, Robert D; Adams, Samuel B; Parekh, Selene G

    2016-01-01

    Calcaneal tuberosity fractures comprise only 1% to 2% of all calcaneal fractures. Treatment of these injuries has traditionally included open reduction and internal fixation with various means including lag screws, suture anchors, and K-wires. This article reports on a series of cases treated with excision of the tuberosity fragment with repair of the Achilles tendon supplemented by a flexor hallucis longus tendon transfer. PMID:27082890

  16. Radiologic aspects of calcaneal fractures in childhood and adolescence

    International Nuclear Information System (INIS)

    One hundred and forty-three calcaneal fractures in 140 patients under the age of19 years were reviewed. Of the total number, 75% were in males. Eighty fractures were seen in females under 13 years of age and in males under 16 years of age. Fifteen (19%) of these fractures were initially not recognized. Four projections were available in the majority of the cases, and were reviewed: lateral, axial, straight dorsoplantar and oblique dorsoplantar views. The various types of fractures had different courses and localizations. The optimum demonstration of a fracture in a certain projection will therefore be dependent on the type of fracture present. It is clinically difficult to foresee a specific type of calcaneal fracture, and consequently it is recommended that all four views should be obtained routinely following trauma to the calcaneal region in patients of the pertinent age groups. (orig.)

  17. Radiographic imaging of calcaneal fractures - the surgeons view point

    International Nuclear Information System (INIS)

    This paper presents a detailed description of calcaneal fractures, which are underestimated and neglected despite their relatively high frequency. In association with significant anatomic destruction of the calcaneus they lead to unsatisfactory results of fracture treatment. Radiographic features of a healthy calcaneal bone together with pathomechanism and radiographic attributes of most common fracture types are presented. The prognostic role of the posterior talo-calcaneal joint and extraarticular anatomy of the calcaneus are emphasized. Special attention is directed to the methods of calcaneal imaging, especially the most valuable in the authors opinion - lateral radiographic view and computed tomography. Other commonly used views: axial, antero-posterior or Broden, are also described, with explanation why they are rarely recommended. The widely used standard classification system for calcaneal fractures introduced by Sanders, based on computed tomography is presented. Correct x-ray imaging is the basis for further diagnostic workup and treatment, giving also valuable prognostic information. The orthopedic surgeon, who undertakes the difficult task of treating the broken calcaneus receives thorough information about bone damage, which helps to realize the consequences of injury and of possible negligence. According to the authors experience, problems discussed in this paper are rarely fully appreciated by radiologists and orthopedic surgeons resulting in, often, catastrophic consequences. (author)

  18. Biomechanical comparison of conventional and anatomical calcaneal plates for the treatment of intraarticular calcaneal fractures - a finite element study.

    Science.gov (United States)

    Yu, Bin; Chen, Wen-Chuan; Lee, Pei-Yuan; Lin, Kang-Ping; Lin, Kun-Jhih; Tsai, Cheng-Lun; Wei, Hung-Wen

    2016-10-01

    Initial stability is essential for open reduction internal fixation of intraarticular calcaneal fractures. Geometrical feature of a calcaneal plate is influential to its endurance under physiological load. It is unclear if conventional and pre-contoured anatomical calcaneal plates may exhibit differently in biomechanical perspective. A Sanders' Type II-B intraarticular calcaneal fracture model was reconstructed to evaluate the effectiveness of calcaneal plates using finite element methods. Incremental vertical joint loads up to 450 N were exerted on the subtalar joint to evaluate the stability and safety of the calcaneal plates and bony structure. Results revealed that the anatomical calcaneal plate model had greater average structural stiffness (585.7 N/mm) and lower von Mises stress on the plate (774.5 MPa) compared to those observed in the conventional calcaneal plate model (stiffness: 430.9 N/mm; stress on plate: 867.1 MPa). Although both maximal compressive and maximal tensile stress and strain were lower in the anatomical calcaneal plate group, greater loads on fixation screws were found (average 172.7 MPa compared to 82.18 MPa in the conventional calcaneal plate). It was noted that high magnitude stress concentrations would occur where the bone plate bridges the fracture line on the lateral side of the calcaneus bone. Sufficient fixation strength at the posterolateral calcaneus bone is important for maintaining subtalar joint load after reduction and fixation of a Sanders' Type II-B calcaneal fracture. In addition, geometrical design of a calcaneal plate should worth considering for the mechanical safety in practical usage. PMID:26813403

  19. Early Weight-bearing Using Percutaneous External Fixator for Calcaneal Fracture

    OpenAIRE

    Sengodan, Vetrivel Chezian; Sengodan, Mugundhan Moongilpatti

    2012-01-01

    Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patients. We have used a biplanar percutaneous external fixator for treating calcaneal fractures without operative and per operative visualization of the fractures. We have treated 17 calcaneal fractures in 16 patients, 12 i...

  20. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    Energy Technology Data Exchange (ETDEWEB)

    Petrover, David [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Hopital Beaujon, Service de Radiologie, Paris (France); Schweitzer, Mark E. [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Laredo, J.D. [Hopital Lariboisiere, Service de Radiologie, Paris (France)

    2007-07-15

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  1. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    International Nuclear Information System (INIS)

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  2. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

    Science.gov (United States)

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-01-01

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

  3. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature.

    Science.gov (United States)

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-07-16

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients. PMID:27458594

  4. Sanders II–III calcaneal fractures fixed with locking plate in elderly patients

    OpenAIRE

    Long, Cheng; Fang, Yue; HUANG Fu-guo; Zhang, Hui; Wang, Guang-Lin; YANG Tian-fu; Liu, Lei

    2016-01-01

    Purpose To evaluate the clinical outcomes of locking calcaneal plate in treating calcaneal fracture (Sanders II–III) in elderly patients. Methods From October 2012 to December 2013, 23 elderly patients suffering from calcaneal fracture (Sanders II–III) were treated and followed up. There were 15 males and 8 females with the mean age of 68.5 years (range: 65–79 years). According to Sander's classification, 16 cases (16 feet) were type II fractures and 7 cases (7 feet) were type III fractures. ...

  5. Minimally invasive plate internal fixation for calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    SHAN Shu-lan; XU Jun-ling; YAO Shu-zhang; YU Guo-sheng; LIU Yu-qin

    2010-01-01

    Objective: To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures.Methods: Manual reduction, rectification of deformity,and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union.Results: All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%.Conclusion: Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation,good recovery, and rare complications in the treatment of intraarticular fractures.

  6. [Vascularization of the lateral heel in relation to extensive skin incisions in osteosynthesis of calcaneal fractures].

    Science.gov (United States)

    Rak, V; Matonoha, P; Otáhal, M; Masek, M M

    2007-09-01

    The aim of the study was to document soft tissue vascularization of the lateral heel on cadavers and, therefore, to indirectly demonstrate the importance to perform perfectly precise incisions, in order to prevent ischemic complications. Sections of 8 human lower limb cadavers were performed in cooperation with the Anatomical Institute of the MU Medical Faculty in Brno, according to current common standards for anatomical preparations. In successive steps, cutaneous and subcutanous covers of the lateral ankle, malleolar and heel regions were preparated. Final branches of the individual arteries were followed and the authors aimed to demonstrate their vascular arcade consisting of anastomosis of the lateral calcaneal artery--LCA (a branch of a. peronea)--which is a clinical term for rami calcaneares laterales, ventrolateral tarsal arteries--LTA (a branch of a. dorsalis pedis) and lateral malleolar artery branching off medially--LMA (a branch of a. tibialis ant.). The course of the arteries and their location is related to a reference point--a lateral tip of the lateral ankle. The investigators found out that all three arteries, as well as the arterial arch, had standard courses. The course of the arch defines the outline of the lateral extensive incision during osteosynthesis in calcaneal fractures, which lies fairly close to the lateral outline of this vascular arcade. Incorrect performance of the incision results, invitably, in serious ischemic complications. Open reduction and internal fixation of intraarticular calcaneal fractures has become a standard surgical method. Correct indication, good timing and saving open reduction, internal fixation using arthroscopy and early mobilization are the prerequisites to prevent further postoperative complications and to achieve complete healing of the fracture. Considering the demandingness of these fractures treatment and their rare incidence, their management should be centred in specialized traumatological clinics. PMID

  7. A STUDY OF FUNCTIONAL OUT COME OF INTRA - ARTICULAR CALCANEAL FRACTURES TREATED SURGICALLY

    Directory of Open Access Journals (Sweden)

    Prashanth

    2015-10-01

    Full Text Available The calcaneus (O scalcis is the largest and most often fractured tarsal bone. The treatment of calcaneal fractures continues to pose a challenge for the trauma surgeons despite advancement in surgical technique and implant devices. The prognosis for an extra - articular fra cture is uniformly good, but that for an intra - articular fracture is varied. The management of every aspect of intra - articular calcaneal fractures is controversial. Although some studies have demonstrated good results after open reduction and internal fixa tion of intra - articular calcaneal fractures, a few other studies say otherwise. The method of internal fixation is also a point of debate, with various proponents advocating fixation with pins, screws or plate fixation with screws. Even there is no consens us regarding the surgical approach, with many having been described, including medial, lateral, combined medial and lateral, extended lateral and sinus tarsi approaches. So it is the need of the hour, to identify treatment techniques, which use lesser hard ware, to provide better functional outcomes in terms of shorter duration of treatment, better stability and early weight bearing and so also the role of non - operative treatment in the calcaneal fracture management. In this study, we have attempted to evalu ate the results of calcaneal fracture management by open reduction and internal fixation. Ours is a prospective study centered in the Gandhi hospital from Nov 2012 to April 2014 in which 30 patients with intra - articular calcaneal fractures were treated by open reduction and internal fixation and the results were evaluated with AOFAS scoring system. In our analysis, we observed that an anatomical reduction to restore Bohler’s and Gissanes angles associated with rigid internal fixation is essential for better fu n ctional results.

  8. Percutaneous reduction and fixation of intraarticular calcaneal fractures

    OpenAIRE

    Schepers, Tim; Vogels, Lucas; Schipper, Inger; Patka, Peter

    2008-01-01

    textabstractObjective: Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment and, secondly, to reduce infectious complications compared to open reduction and internal fixation (ORIF). Indications: Sanders type II-IV displaced intraarticular calcaneal...

  9. Percutaneous Reduction and Fixation with Kirschner Wires versus Open Reduction Internal Fixation for the Management of Calcaneal Fractures: A Meta-Analysis.

    Science.gov (United States)

    Wu, Jianbin; Zhou, Feiya; Yang, Lei; Tan, Jun

    2016-01-01

    The aim of our meta-analysis was to compare outcomes for two surgical treatments of calcaneal fractures, percutaneous reduction and fixation with Kirschner wires (PRFK) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to inform practice. Search of MEDLINE, Cochrane and CNKI databases to identify randomized controlled trials (RCTs) comparing PRKF and ORIF on the following outcomes: post-operative function, complications and quality of the reduction. Odd ratios (OR) and weighted mean differences were pooled using either a fixed-effects or random-effects model, depending on the heterogeneity of the trials included in the analysis. Eighteen RCTs provided the data from 1407 patients. PRFK was associated with a lower risk of surgical wound complications, and ORIF with better post-operative function, angle of Gissane, calcaneal height, and calcaneal width. There were no statistically significant differences between the techniques with regards to post-operative Böhler's angle. PRFK does not provide a substantive advantage over ORIF for the treatment of calcaneal fractures in adults. PRFK may, however, yield comparable functional outcomes to ORIF for closed Sanders type II calcaneal fractures but with less complication related to surgical wound healing. PMID:27457262

  10. The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    WANG Hong; ZHANG Qingsong; DUAN Deyu; YAN Lijun

    2006-01-01

    To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months (range 12-30 months). The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation (P<0.01), the total excellent and fine rate was 91.86 %. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

  11. Extended lateral approach for intra-articular calcaneal fractures: an inverse relationship between surgeon experience and wound complications.

    Science.gov (United States)

    Schepers, Tim; Den Hartog, Dennis; Vogels, Lucas M M; Van Lieshout, Esther M M

    2013-01-01

    The current reference standard for the treatment of displaced intra-articular calcaneal fractures is open reduction and internal fixation using an extended lateral approach. In the present retrospective study, we evaluated the results of a consecutive series of patients treated in the same fashion from June 2005 to September 2011 using a subcuticular single-layer closure technique. We also determined the risk factors for the development of wound complications and the rate of wound complications. Also, we assessed which patient, fracture, and surgical characteristics affected these complications. During the 75-month study period, we operated on 53 displaced intra-articular calcaneal fractures in 50 patients using the extended lateral approach. The incision was closed using the subcuticular technique in 49 cases (92.45%). In the subcuticular closure group 2 (4.1%) deep infections and 2 (4.1%) superficial wound complications (1 dehiscence and 1 infection) occurred. Wound edge or flap necrosis was not encountered. The use of bone-void filler and the experience of the surgical team were significantly (p rate combined with the extended lateral approach. The effect of bone void fillers on the incidence of complications should receive more attention in future research. The association between wound complications and the experience level of the surgical team supports the need for centralization of this complex injury. PMID:23318101

  12. Traitement chirurgical des fractures articulaires du calcanéum par plaque vissée

    OpenAIRE

    Hammou, Nassreddine; Abid, Hatim; Shimi, Mohammed; El Ibrahimi, Abdelhalim; El Mrini, Abdelmajid

    2015-01-01

    Les fractures du calcanéum sont peu fréquentes mais le plus souvent graves. Le traitement chirurgical par plaque vissée est ardemment défendu. L'objectif de notre travail rétrospectif est d’évaluer les résultats du traitement chirurgical des fractures articulaires du calcanéum à travers une série de 12 patients opérée aux service d'orthopédie du CHU Hassan II de Fès sur une durée de 3 ans, et les comparer aux données de la littérature. L’âge moyen dans notre série était de 34 ans, le geste op...

  13. Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    Wang Xianhui; Mei Jiong; Li Shanzhu; Ni Ming; Shang Hongjing

    2009-01-01

    Objective: To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods: Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases (16 sides) with intra-articular calcaneal fractures including 13 males (14 feet) and 2 females (2 feet) ,with average age of 36. 6 years (24-61 years). All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ (3 type Ⅱ a, 3 type Ⅱ b and 8 type Ⅱ c)and 2 feet of type lilac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results: All patients were followed up for an average of 18.4 months (ranged, 12 to 34 months). No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group (86.5+4.4) was better than in joint depression type group (81.2±1.7, P<0.05). Radiography showed basic restoration of Bohler's angle, Gissane's angle and calcaneal shape. Conclusion: The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders 11 and III type

  14. Ligamentotaxis for complex calcaneal fractures using Joshi's external stabilization system

    OpenAIRE

    Singh, Ajai; Srivastava, RN; Jah, M; Kumar, Ashish

    2008-01-01

    Background: Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi's external stabilization system (JESS) for its efficacy. Materials and Methods: Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition) fractures of the calcaneum, who were treated by external fixator (JESS) based on the princip...

  15. Case report:Calcaneal fractures in a cat

    OpenAIRE

    Longley, Mark J; Hannes, Bergmann,; Langley-Hobbs, Sorrel J.

    2016-01-01

    A one year four month old male neutered domestic shorthair cat was presented for sudden onset, left pelvic limb lameness. Upon clinical examination, pain was localised to the hock region and the cat was found to have persistent deciduous teeth. No evidence of trauma was apparent. Radiographs revealed a transverse fracture at the base of the calcaneus. The fracture was stabilised with a Steinmann pin and tension band wire. Eleven weeks after fixation of the fracture, the cat presented with lam...

  16. Soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures%软组织评估及干预策略对预防跟骨骨折术后伤口并发症的临床意义

    Institute of Scientific and Technical Information of China (English)

    王焱; 李公; 潘恒; 何矫; 路玉峰

    2012-01-01

    Objective To evaluate the clinical significance of soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures. Methods A prospeclive study over a 6-year period was conducted on 207 closed calcaneal fractures in 168 patients who had sought medical treatment in our department from February 2005 through July 2011 for closed calcaneal fractures.There were 152 men with 190 feet involved and 16 women with 17 feet involved.They were aged from 17 to 68 years (average,38.1 years).By Sanders classification,58 feet were of type Ⅱ,124 feet of type Ⅲ and 25 feet of type Ⅳ.A self-developed system of soft tissue assessment was adopted to evaluate the patients.including initial assessment and preoperative assessment, before clinical interventions were adopted accordingly. All patients were randomized into 3 groups who were taken care of by doctors with similar competence according to the same specified protocol.The associations were analyzed between initial soft tissue assessment and time interval from injury to operation, and between initial and preoperative soft tissue assessments and wound complications as well.The postoperative wound complications were compared between groups. Results The incidence of wound complications was 9.2% in this series.The initial soft tissue assessment was positively correlated with the time interval from injury to operation ( r =2.474,P =0.000),closely associated with the severity of the fracture (x2 =109.829,P =0.000),and significantly associated with the wound prognosis ( P < 0.05).Preoperative soft tissue assessment (including wrinkle test,capillary reaction test and percutaneous partial pressure of oxygen) had significant effects on the incidence of wound complications (x2 =440.961,P =0.000).There was no significant difference between the 3 groups in incidence of wound complications ( P > 0.05). Conclusion It is important to conduct perioperative soft tissue

  17. 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.

  18. Treatment of ipsilateral high energy tibial plateau and calcaneal fractures by a circular wire fixator: a case report

    OpenAIRE

    Dhar, Shabir Ahmed; Butt, Mohammed Farooq; Ali, Murtaza Fazal; Mir, Mohammed Ramzan; Kawoosa, Altaf Ahmed

    2009-01-01

    Introduction High energy tibial plateau fractures along with calcaneal fractures individually produce several challenges for the orthopaedic surgeon. The principles of bony reconstruction include anatomic reduction and rigid internal fixation of intra-articular fractures and accurate restoration of the coronal, sagittal and transverse mechanical axes. Due to the tenuous nature of the soft tissue and devitalisation of the comminuted fragments with open reduction, external fixation of type 6 ti...

  19. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    Science.gov (United States)

    Labronici, Pedro José; Reder, Vitor Rodrigues; de Araujo Marins Filho, Guilherme Ferreira; Pires, Robinson Esteves Santos; Fernandes, Hélio Jorge Alvachian; Mercadante, Marcelo Tomanik

    2016-01-01

    Objective To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. Method 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. Results All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. Conclusion The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk. PMID:27069891

  20. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2016-04-01

    Full Text Available OBJECTIVE: To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. METHOD: 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. RESULTS: All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2 were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. CONCLUSION: The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

  1. Ligamentotaxis for complex calcaneal fractures using Joshi′s external stabilization system

    Directory of Open Access Journals (Sweden)

    Singh Ajai

    2008-01-01

    Full Text Available Background: Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi′s external stabilization system (JESS for its efficacy. Materials and Methods: Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition fractures of the calcaneum, who were treated by external fixator (JESS based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9% patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months. Results: Forty-two (93.4% of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4% complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8% patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients. On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity. Conclusion: We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures.

  2. The surgical dilemma of the malunited calcaneal joint depression fracture: the VAMC Miami experience.

    Science.gov (United States)

    Cohen, M

    1996-01-01

    During the period of October 1985 through March 1995, 25 patients presented to the Veterans Affairs Medical Center, Miami with a chief complaint of chronic pain status post calcaneal joint depression fracture. Their acute injury was treated conservatively at this and various other institutions. Nine patients were managed conservatively with orthotics, University of California Biomechanics Laboratory braces (UCBLs), shoe modification, or prosthetics. Sixteen patients underwent hindfoot fusions. Good to excellent results were obtained in 15 of the 16 fusions. The remaining patient, having an isolated subtalar fusion, was later diagnosed with multiple sclerosis. Proper evaluation of the chronic pain patient is critical when mapping out an appropriate treatment plan. Hindfoot arthrodesis with soft tissue decompression is a successful tool in eliminating chronic pain due to malunited depression fractures. PMID:8722881

  3. Non-union of calcaneum - A rare complication of calcaneal fracture - A case report with brief review of literature.

    Science.gov (United States)

    Kumar, Narinder

    2015-09-01

    Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literature available on calcaneal non-union is also briefly reviewed. Role of subtalar arthrodesis with internal fixation of fracture and bone grafting for successful management of this rare complication is highlighted along with the possibility of under-reporting of this relatively unknown complication. PMID:26155055

  4. BOHLER'S ANGLE: CORRELATION WITH OUTCOME IN DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES TREATED WITH LOCKING COMPRESSION PLATE FIXATION WITH AND WITHOUT BONE GRAFTING

    OpenAIRE

    Deepak P; Eknath D; Vijayanand; Satish

    2014-01-01

    BOHLER'S ANGLE: correlation with outcome in displaced intra-articular calcaneal fractures Treated with locking compression Plate Fixation with and without bone grafting. AIMS: The aim is an accurate reduction of the fracture with reconstruction of Bohler’s angle, length and axis and sub talar joint surface. To determine whether autologous bone graft supplementation is beneficial in achieving and maintaining restoration of Calcaneal height and anatomic reduction. SETTINGS AND ...

  5. 跟骨关节内骨折--手术治疗%Intraarticular calcaneal fractures Operative management

    Institute of Scientific and Technical Information of China (English)

    Tim Pohlemann; David Ring; Hartmut R.Siebert

    2004-01-01

    Evidence is lacking from these trials concerning the optimal procedure for treatment of displaced intraarticular calcaneal fractures. Clinical trials comparing different treatment , especially as they relate to potential risk fractors such as fracture classification, should be explored.%这些研究没有证明何种方法是治疗跟骨关节内移位骨折的最佳手术方法.应该对比较性临床研究进行探讨,尤其是不同治疗方法与潜在的风险因素如骨折类型的相关性.

  6. 跟骨内固定法治疗粉碎性跟骨骨折的临床效果分析%Analysis of clinical effect of internal calcaneal fixation treatment for comminuted calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    陈星

    2011-01-01

    目的:探讨跟骨内固定治疗粉碎性跟骨骨折的疗效.方法:选取我院2005年12月~2008年12月行切开复位可塑形钛质钢板固定加植骨术治疗粉碎性跟骨骨折患者41例52足,所有跟骨骨折患者均采用L型大切口跟骨钢板固定,保护腓肠神经,钢板外侧固定,术后评价骨折复位效果.结果:采用Marglang足部评分标准,优24足,良16足,中7足,差5足,优良率为76.9%.切口一期愈合47足,切口延迟愈合3足,钢板外露伴浅感染2足.结论:跟骨内固定法治疗粉碎性跟骨骨折疗效较好.%Objective: To investigate the effect of internal calcaneal fixation treatment for comminuted calcaneal fractures.Methods: 41 cases with 52 calcaneal fractures of patients with comminuted calcaneal fratures in the treatment of open reduction with plastic titanic steel plate fired and bone graft operation were selected.All were fixed with L-shaped calcaneal steel plates for large incision, with the sural nerve protected and the lateral side of the plate fixed.Postoperative effects of fracture reduction were evaluated.Results: The Marglang foot scoring standards were used to evaluate the postoperative effect, with 24 feet excellent, 16 feet good, 7 feet fair and 5 feet poor.The excellent and good rate was 76.9%.47 feet were primary wound healing, 3 patients had delayed wound healing and 2 feet appeared steel plate exposion with superficial infection.Conclusion: The effect of internal calcaneal fixation treatment for comminuted calcaneal fractures is preferably.

  7. Study of occurrence, demography and pathomorphology of ankle and foot fractures and evaluation of the treatment outcome of calcaneal fractures

    International Nuclear Information System (INIS)

    This study highlights which injury has greatest burden, how frequent are the injuries of foot and ankle areas, which is an extremely neglected specialty in orthopedics and also the importance of proper diagnosis, classification of fractures, appropriate pre-operative planning and timely conservative as well as surgical intervention of ankle and foot fractures that resulted in a satisfactory outcome Despite the fact, foot and ankle is the most important locomotor unit of our lower limb, there have been few studies addressing the problem and treatment outcome of such fractures. Objective: To determine the occurrence, demography and pathomorphology of ankle and foot fractures, also evaluation of treatment outcome of calcaneal fractures. Methodology: This was a longitudinal interventional study which dealt with acute traumatic ankle and foot fracture patients coming to Accident and Emergency Department of MHL, DOST unit 1, with inclusion and exclusion criteria clearly defined. Results: Total 100 patients were included in the study. Mean age of patients was 35.71+-13.60 years. Minimum age of patients was 14 and maximum age of patients was 70 years respectively. Gender distribution of patients shows that 15 patients were female and the remaining 85 patients were male. Male patients were greater in number as compared to female patients ie. M: F, 6:1. Mechanism of the injury showed that there were 48 patients who suffered from RTA , 37 patients had trauma due to fall from height, 6 patients had industrial injuries, 5 patients had Fire Arm Injury, and 2 patients had injuries due to domestic activity, 1 had trauma due to sports activity and 1 had injury due to agricultural work. There were 41 patients with fractures of calcaneum and out of which 5 had bilateral fracture calcaneum. They were classified according to CT based Sanders classification. Out of these 22 patients were of Sanders type III, 12 patients were of Sander type II, 5 patients were of Sander type IV, 2

  8. Effect of Intraoperative Three-Dimensional Imaging During the Reduction and Fixation of Displaced Calcaneal Fractures on Articular Congruence and Implant Fixation

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Marianne

    2015-01-01

    , resulting in improved articular congruence and implant positioning. METHOD: Sixty-two displaced calcaneal fractures were operated on using standard fluoroscopic views. When the surgeon had achieved a satisfactory reduction, an intraoperative 3D scan was conducted, malreductions or implant imperfections were...

  9. BOHLER'S ANGLE: CORRELATION WITH OUTCOME IN DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES TREATED WITH LOCKING COMPRESSION PLATE FIXATION WITH AND WITHOUT BONE GRAFTING

    Directory of Open Access Journals (Sweden)

    Deepak P

    2014-09-01

    Full Text Available BOHLER'S ANGLE: correlation with outcome in displaced intra-articular calcaneal fractures Treated with locking compression Plate Fixation with and without bone grafting. AIMS: The aim is an accurate reduction of the fracture with reconstruction of Bohler’s angle, length and axis and sub talar joint surface. To determine whether autologous bone graft supplementation is beneficial in achieving and maintaining restoration of Calcaneal height and anatomic reduction. SETTINGS AND DESIGN: Level 1 trauma center, Prospective, randomized. METHODS AND MATERIAL: Consecutive 46 patients who had fracture calcaneum were treated by open reduction and internal fixation by locking plate with and without bone graft during the period from November 2009 to April 2012. STATISTICAL ANALYSIS USED: AOFAS-Ankle-Hind foot Scale, t Test. RESULTS: Fewer complications and statistically significant better results related to treatment with locking plates with bone grafting confirmed in comparison to without bone grafting ones were noted for intra-articular calcaneal fractures. In Group A the mean time for union was 10.39wks. The results were good and excellent in 86.95%, 8.69 % had fair result and 4.34% had poor results. In Group B the mean time for union was 11.95 wks. The overall results were good and excellent in 73.91%, 13.04 % had fair result and 13.04 % had poor results. CONCLUSIONS: The operative treatment of intra-articular calcaneal fractures could restore Böhler's angle better and the patient could return to full weight bearing earlier. We confirmed that autologous bone graft supplementation is beneficial in achieving and maintaining restoration of calcaneal height and anatomic reduction.

  10. Non-union of calcaneum – A rare complication of calcaneal fracture – A case report with brief review of literature

    OpenAIRE

    Kumar, Narinder

    2015-01-01

    Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literatur...

  11. Ligamentotaxis for complex calcaneal fractures using Joshi′s external stabilization system

    OpenAIRE

    Singh Ajai; Srivastava R; Jah M; Kumar Ashish

    2008-01-01

    Background: Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi′s external stabilization system (JESS) for its efficacy. Materials and Methods: Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition) fractures of the calcaneum, who were treated by external fixator (JESS) based on t...

  12. Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture

    Science.gov (United States)

    Li, Lian-hua; Guo, Yong-zhi; Wang, Hao; Sang, Qing-hua; Zhang, Jian-zheng; Liu, Zhi; Sun, Tian-sheng

    2016-01-01

    Abstract Background: We conducted a prospective randomized clinical trial to compare the clinical and radiological outcomes of the sinus tarsi and extended lateral approaches for the surgical treatment of displaced intraarticular calcaneal fractures. Methods: Between January 2009 and January 2014, patients with displaced intraarticular calcaneal fracture were randomly assigned to receive surgical treatment by the sinus tarsi approach or the extended lateral approach using block randomization. We recorded and analyzed data on demographics, time to surgery, wound complications, Böhler angles pre- and postoperatively, and American Orthopedic Foot & Ankle Society score. Results: Sixty-four patients met the inclusion criteria and were randomly assigned to the 2 groups: 32 patients underwent sinus tarsi approach, and 32 patients the extended lateral approach. Baseline characteristics of both groups were similar. The time to surgery in the sinus tarsi approach group was significantly shorter than in the extended lateral approach group (P = 0.04). The wound complication rates were 6.3% and 31.2% in the sinus tarsi approach and extended lateral approach groups, respectively, which was significantly different (P = 0.01). Regarding the clinical outcomes, the groups did not differ significantly on walking visual analogue scale or American Orthopedic Foot & Ankle Society scores at 6 months and 1 year postoperatively. No significant differences existed between groups regarding the Böhler angle at different times and reduction quality of the articular surface and the medial wall. Conclusion: Compared with the extended lateral approach, the sinus tarsi approach decreased wound complications and preoperative waiting time, and achieved similar functional and radiological outcomes for displaced intraarticular calcaneal fractures. PMID:27603354

  13. Operative treatment of calcaneal fractures%跟骨骨折的手术治疗策略及疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈滨; 黎润光; 王钢

    2010-01-01

    目的 探讨跟骨骨折的受伤机制、临床分型、手术治疗方法及其疗效.方法 2005年6月至2009年5月共收治70例(83足)闭合性新鲜跟骨骨折患者,男45例,女25例;年龄18~62岁,平均38.3岁.骨折根据Essex-Lopresti分类:关节外骨折20足(前突骨折5足,体部骨折9足,结节部骨折3足,内外侧突骨折3足),关节内骨折63足(舌状骨折25足,关节压缩型骨折38足).63足关节内骨折根据Sanders分型:Ⅱ型30足,Ⅲ型21足,Ⅳ型12足.采用常规足外侧"L"形切开复位普通钢板或锁定钢板内固定50足,微创切开复位螺钉固定20足,撬拨复位克氏针(或加螺钉)固定13足.20足骨缺损>2 cm3,行骨移植治疗.术后采用美国足踝外科协会(AOFAS)踝与后足评分评价患者足部功能恢复情况. 结果 70例患者术后获12~30个月(平均18个月)随访.末次随访时70例患者83足AOFAS踝与后足评分平均为(90.3±11.0)分(48~100分).20足关节外骨折患者AOFAS踝与后足评分平均为(98.1±2.6)分(90~100分),无并发症发生.63足关节内骨折患者AOFAS踝与后足评分平均为(87.8±11.4)分(48~100分).并发症包括:切口皮缘坏死2足,经换药后创面闭合;腓肠神经损伤4足;距下关节创伤性关节炎10足. 结论 对于不同类型的跟骨骨折,术前慎重评估软组织损伤和骨折类型、程度,采用适当的治疗方法,可以获得较好疗效.关节外骨折的疗效明显优于关节内骨折.%Objective To investigate the injury mechanism, clinical classification, treatment methods and clinical results of calcaneal fractures. Methods From June 2005 to May 2009, 83 feet in 70 patients with calcaneal fractures were treated. According to Sanders and Essex-Lopresti classifications, 63 feet had intra-articular fractures (30 feet of type Ⅱ, 21 type Ⅲ, and 12 type Ⅳ ) and 20 feet had extra-articular fractures (3 feet of lateral condylar fracture, 5 anterior process fracture, 9 calcaneal body fracture

  14. 开放性跟骨关节内骨折的手术治疗%Surgical treatment of open intraarticular calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    孙洋; 曲家富; 曹利海; 闫荣亮

    2013-01-01

    Objective To investigate effect of surgical treatment for open intraarticular calcaneal fracture.Methods A total of 128 patients (141 feet) with open intraarticular calcaneal fracture combined with severe soft tissue injury were treated,in the early stage of treatment,the primary purposes were to achieve soft tissue coverage for wound healing,and to reduce calcaneal fracture for avoiding increase of skin tension and contracture of Achilles tendon.In the first stage operation,the fractures were reduced by drawing,prying or manual reduction to restore the width,height and length of calcaneus,and then fixed with screws or Kirschner wires.Finally vacuum sealing drainage(VSD) was used to cover wound according to degree of injury.In the second stage operation,open reduction and internal fixation or reconstruction of calcaneal thalamus combined with subtalar arthrodesis were used according to Sanders classification.Results All patients werefollowed up for 18 months to 6 years (average,40 months).The average wound healing time was 16 days,and the first rate healing rate was 90.8%.The total infection rate was 9.2%,including superficial infection rate of 7.8% and deep infection rate of 1.4%.According to AOFAS classification,functional recovery was excellent in 58 feet,good in 70 feet,fair in 10 feet and poor in 3 feet,the excellent and good rate was 90.8%.Conclusion For open intraarticular calcaneal fracture combined with severe soft tissue injury,different methods should be used according to degree of injury and fracture style.Usually,the VSD should be used for patients with severe soft tissue injury,which can significantly reduce infection rate and improve effect.%目的 探讨开放性跟骨关节内骨折手术治疗的有效方法.方法 对Gustilo Ⅱ型以上128例(141足)跟骨关节内骨折,早期解决软组织覆盖及伤口愈合问题,尽量恢复跟骨正常骨性结构,用螺钉或克氏针临时固定骨折,均采用VSD技术治疗为后期处理

  15. 手术治疗96例跟骨骨折的体会%Experience of surgical treatment for 96 cases with calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    徐健; 董涛

    2015-01-01

    Objective:To discuss the curative effect and the precautions of the treatment for patients with calcaneal fracture. Methods:96 patients with calcaneal fracture were selected,all patients were treated with open reduction and internal fixation. Results:In 96 patients,84 patients healed by first intention,12 cases of skin necrosis of incision and exposed plate.All patients were followed up,and all of them with fractures healed for long-term follow up.The clinical effect was excellent and good in 86 cases,the excellent and good rate was 89.65%.Conclusion:Patients with calcaneus fracture involving the articular surface treated by reasonable open reduction and internal fixation can obtain satisfactory clinical curative effect.%目的:探讨跟骨骨折手术的疗效与注意事项。方法:收治跟骨骨折患者96例,均采用切开复位内固定治疗。结果:术后切口Ⅰ期愈合84例,12例出现切口皮肤部分坏死、钢板外露。患者均获随访,远期随访骨折均愈合。临床疗效优良86例,优良率89.58%。结论:累及关节面的跟骨骨折合理进行切开复位内固定手术治疗可获得满意的临床疗效。

  16. 钢板内固定与外固定架治疗跟骨骨折效果比较%PLATE INTERNAL FIXATION VERSUS EXTERNAL FIXATOR IN THE TREATMENT OF CALCANEAL FRACTURES

    Institute of Scientific and Technical Information of China (English)

    李玉椿; 杨斌; 王振宇

    2012-01-01

    目的 分析比较切开复位钢板内固定和闭合复位外固定架治疗跟骨骨折的效果.方法 钢板内固定组43侧,采用切开复位钢板内固定治疗;外固定架组19侧,采用闭合复位外固定治疗,术后测量Bohler角,按Marry Land评分系统进行效果评定.结果 钢板内固定组优34侧,良6侧,可3侧,优良率93%;外固定架组优14侧,良5侧,优良率100%.两种治疗方法疗效比较差异无显著性(P>0.05).钢板内固定组术后2例出现切口拐角处感染不愈合,1例深部感染.结论 两种方法治疗跟骨关节内骨折均取得满意的疗效,但外固定架治疗跟骨骨折简单易行,降低了手术切口不愈合及神经肌腱损伤的风险,是一种可靠的治疗办法.%Objective To compare the effectiveness between open reduction plus plate internal fixation and closed reduction plus external fixator in the treatment of calcaneal fractures. Methods Forty-three patients with calcaneal fractures were treated with open reduction and internal plate fixation, and 19 received closed reduction plus external fixation. Postoperatively, the Bohler Angle was measured, and the efficacy was assessed according to Marry Land scoring system. Results In plate fixation group: 34 were excellent, six were good, and three were improved, the excellent and good rate being 93%. In external fixation group, 14 were excellent and five were good, the excellent and good rate being 100%. The difference between the two groups was no significant in regard to the two methods of therapy (P>0. 05). In plate fixation group, postoperative infection occurred in two cases and did not heal, one with deep-part infection. Conclusion Both therapies can obtain satisfactory for intra-articular fracture of calcis, but external fixation is simple and easy to perform, being a reliable therapy, which decreases the risk of wound disunion, and injury of nerve and tendon.

  17. Treatment of plastic Titanium plate on fixation of calcaneal fractures%可塑钛板内固定治疗跟骨骨折

    Institute of Scientific and Technical Information of China (English)

    崔庆元

    2011-01-01

    Objective To investigate the plastic plate fixation of calcaneal fractures. Methods Totally 22 patients, 18 males, 10 cases of left foot, right foot 7 cases in which both feet 1 female 4 cases , 3 cases of left foot right foot in 1 case. The average age of 22 -44 years old 33 years old. Are fall injuries. Are blunt trauma, the use of L - shaped lateral calcaneal incision subperiosteal dissection to expose the subtalar and calcaneocuboid joints, so Bohler recovery to 30° angle or so, with a plastic titanium plate. Results After 2 feet skin flap with partial necrosis of subcutaneous infection in which a foot, some exposed steel, dressing healed. Patients were followed up using Maryland foot score excellent joint function rate of 88%. Conclusions Plastic plate fixation of calcaneal fractures, if done correctly, results are quite satisfactory.%目的 探讨可塑钛板内固定治疗跟骨骨折.方法 本组22例,男性18例,左足10例,右足7例,其中双足1例,女性4例,左足3例,右足1例.年龄22 ~44岁,平均33岁.均为坠落伤.均为闭合性损伤,采用跟骨外侧L型切口骨膜下剥离,显露距下关节及跟骰关节,使B(o)hler角恢复至30°左右,用可塑钛合金钢板固定.结果 术后两足切口皮缘有部分坏死其中1足出现皮下感染,钢板部分外露,换药愈合.术后随访采用Maryland足部评分法关节功能优良率达88%.结论 可塑钛板内固定治疗跟骨骨折,只要方法得当,效果十分理想.

  18. Operative Treatment of Sanders Ⅲ,Ⅳ Type Calcaneal Fracture%Sanders Ⅲ、Ⅳ型跟骨骨折的手术治疗

    Institute of Scientific and Technical Information of China (English)

    赵快平; 王朝晖; 李春艳

    2016-01-01

    Objective:To explore the clinical outcomes of the Sanders Ⅲ ,Ⅳ type calcaneal fracture treated by opetat‐ing .Methods:31 cases(35 feet) being severe calcaneal fracture were analyzed retrospetively from Jun 2011 to Jun 2014 . These cases were treated by operating with L‐shaped lateral approach of calcaneum ,fixing with locking plate and graft‐ing with allogeneic bone .Results:There were 3 cases with approach complication after opetation and the incidence was 8 .6% .The postopetative outcome of the height ,width ,Bohler angle ane Gissane angle of calcaneun was more perfectly than the preoperation .Maryland foot score system was using to evaluate the postoperative fuction when the cases were followed up .The results showed 11 excellent ,18 good ,5 fair and 1 poor .The excellent and good rate was 82 .9% .Con‐clusion:It is a effective method to treat the Sanders Ⅲ ,Ⅳ type calcaneal fracture with L‐shaped lateral approach of cal‐caneum ,locking plate internal fixation and allogeneic bone graft .It is both importance to recover the posterior talocalca‐neal jiont surface and the whole calcaneal anatomic form .%目的:探讨手术治疗SandersⅢ、Ⅳ型跟骨骨折的临床疗效。方法:回顾分析2011年6月-2014年6月采用跟骨外侧“L”型切口手术入路、锁定钢板内固定和同种异体骨植骨治疗31例(35足)的严重跟骨骨折。结果:术后出现切口并发症3例,发生率为8.6%;术后跟骨高度、宽度、Bohler角、Gissane角较手术前明显改善(P<0.05)。随访采用M aryland足部评分,优11足、良18足、可5足、差1足,优良率82.9%。结论:跟骨外侧“L”型切口手术入路、锁定钢板内固定和同种异体骨植骨是治疗Sanders Ⅲ、Ⅳ型跟骨骨折的有效方法,术中在复位跟骨后关节面的同时,注意跟骨整个解剖形态的恢复。

  19. 开放性跟骨骨折的早期规范化治疗%Early and standard treatment of open calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    龚晓峰; 武勇; 王岩; 王满宜; 贺良

    2008-01-01

    目的 探讨开放性跟骨骨折的早期规范化治疗,以期降低骨髓炎、下肢截肢的发生率.方法 2005年10月-2006年10月收治开放性跟骨骨折16例17处,其男12例13处,女4例4处;平均年龄31岁.应用规范化治疗:伤后急诊手术清创,大量等渗盐水、过氧化氢、碘伏冲洗.根据全身情况及骨折类型分别进行Ⅰ期手法整复石膏托外固定和Ⅰ期多克氏针经皮固定.待软组织消肿后,经外侧切口行切开复位内固定.术后平均随访6个月,采用美国足踝外科协会(AOFAS)踝-后足功能评分评估并发症发生率.结果 本组患者未截肢;伤口浅表感染、深部感染及骨髓炎各1例;伤口延迟愈合及足底皮肤坏死各1例.结论 早期规范化治疗能够显著降低伤口感染率,从而预防骨髓炎的发生,并为Ⅱ期手术处理骨折提供良好的软组织条件.%Objective To discuss early and standard treatment of open calcaneal fractures so as to lower incidence of amputation and osteomyelitis. Methods From October 2005 to October 2006,16 cases of 17 open calcaneal fractures were treated in our department.There were 12 males(13 fractures)and 4 females at a mean age of 31 years.All cases were treated with the sanle early treatment protocol,including emergent debridement,and lavaging with normal saline,H2O2 and iodide solutions.All cases were immobilized with plaster or multiple K-wires according to systemic condition and fracture type.With detumescence of the soft tissues.open reduction and internal fixation was done via lateral incision.The patients were followed up for mean six months and the incidence rate of complications evaluated bv American Orthopaedic Foot and Ankle Society(AOFAS)scale. Resuits No amputation was found.but there was one case with osteomyelitis.one with superficial infection and one with deep infection.Delayed skin union was found in one case and plantar skin necrosis in one. Conclusion Early and standard treatment of open

  20. Operative results of closed tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    Mathur Hitin

    2005-01-01

    Full Text Available Background: Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. Comparison of operative results in recent reports has been difficult due to a lack of standard fracture classification scheme and uniform standardized objective criteria for evaluating results. Methods: Between August 1998 to December 2002, 27 closed tibial plateau fractures were treated operatively using methods and principles advocated by AO/ASIF and followed up for an average of 35.74 months (range 24-68 months. Fractures were classified according to Schatzker′s staging system and results evaluated using Rasmussen′s 30-point clinical grading system and Rasmussen′s radiological evaluation of the knee at a minimum follow up of 2 years. Results: Type II was the most common fracture type (9 cases followed by type I (6 cases. There were 37% excellent and 51.85% good functional results with only 3 patients having unacceptable results. The mean Rasmussen′s functional score was 25.062 (range 15-30. Minimal fixation in comminuted or depressed fractures as compared to rigid fixation was the cause of unacceptable results. Loss of knee range of motion in a few cases was attributed to delayed knee mobilization in these cases. Using Rasmussen′s radiological grading, 2 patients had excellent results and 81.48 % patients had good results. Only 3 patients had poor radiological results. The mean Rasmussen′s radiological score was 15.33 (range 10-18. Moreover, clinical evaluation did not correlate with the follow up radiograph. Conclusion: Anatomic reduction and rigid internal fixation followed by early knee motion and partial weight bearing during bone healing are the cornerstones in the treatment of tibial plateau fractures. Standard fracture classification, uniform reporting and evaluating criteria, along with detailed analysis of uniform treatment methods, has helped us

  1. 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.

  2. Calcaneal Ossoscopy.

    Science.gov (United States)

    Toepfer, Andreas; Lenze, Ulrich; Harrasser, Norbert

    2016-06-01

    Both unicameral bone cysts and intraosseous lipoma of the calcaneus are rare entities that are mostly diagnosed because of unspecific heel pain, pathologic fracture, or as incidental finding. Minimally invasive ossoscopy with endoscopic resection of the tumor followed by grafting can potentially minimize risks of open surgery and speed up convalescence. We present our modifications to previously described techniques of endoscopic curettage with a particular focus on intraosseous lipoma and allogenic grafting. The key point for grafting is the use of a funnel-shaped ear speculum facilitating the plombage with allogenic cancellous bone chips. Compared with its alternatives, grafting with allogenic cancellous bone might prove favorable in this localization for several reasons: osteointegration, handling, availability, and costs. The objective of this technical note is to present a simple, safe, and cost-effective surgical technique for endoscopic surgical treatment of benign osteolytic lesions of the calcaneus. PMID:27656388

  3. 软组织损伤评估处理对跟骨骨折术后感染的意义%Classified Treatments of Soft-tissue Injury in Preventing Postoperative Infection in Patients with Calca-neal Fracture

    Institute of Scientific and Technical Information of China (English)

    徐生根; 肖坚; 吴维剑

    2016-01-01

    Objective To study the clinical significance of soft tissue assessment and classification treat⁃ment for the prevention of postoperative infection in the patients with calcaneal fractures. Methods We re⁃cruited 91 patients who underwent open reduction and reconstruction plate internal fixation operation for closed calcaneal fractures (103 feet). All patients were randomly divided into a control group and an evaluation group. In the control group, there were 36 men (40 feet) and 7 women (8 feet). They aged from 18 to 72 years (average 38.5 years). By Sanders classification, 11 feet were of type Ⅱ, 21 feet of type Ⅲ and 8 feet of type IV. All con⁃trol patients with preoperative soft tissue injury underwent the conventional preparation processing, and preopera⁃tive assessment of soft tissue and classification treatment was not carried out. In the evaluation group, there were 39 men (44 feet) and 9 women (11 feet). They aged from 19 to 71 years(average 39.6 years). By Sanders classifi⁃cation,12 feet were of type Ⅱ, 23 feet of type Ⅲ, and 9 feet of type IV. They underwent soft tissue assessment using criteria for preoperative assessment and also underwent classification treatment. Results The control group of 43 patients were followed up for 13~17 months (average 14.5 months). There were 5 cases of postopera⁃tive wound infection, and the infection rate was 16.3%. In the evaluation group, 48 cases were followed up for 14-22 months (average 16.1 months), and only 2 cases had wound infection after surgery, and the infection rate was 4.17%. The infection rates in the two groups were different significantly (P<0.05). Conclusion It is im⁃portant to conduct preoperative skin and soft tissue assessments and classification treatment, as an intervention strategy for calcaneal fractures. It can significantly reduce the rate of wound infection after fracture of calcaneus.%目的:探讨皮肤软组织损伤评估及分级处理对预防跟骨骨折术后切

  4. Delayed presentation of pseudoaneurysm complicating closed humeral fracture: MR diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Harris, O. [Dept. of Radiology, Whiston Hospital, Liverpool (United Kingdom); Roche, C.J.; Torreggiani, W.C.; Munk, P.L. [Dept. of Radiology, Vancouver General Hospital (Canada); Ritchie, D.A.; McWilliams, R. [Dept. of Radiology, Royal Liverpool University Hospital (United Kingdom); Jane, M. [Dept. of Orthopaedic Surgery, Royal Liverpool University Hospital (United Kingdom)

    2001-11-01

    Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging. (orig.)

  5. Delayed presentation of pseudoaneurysm complicating closed humeral fracture: MR diagnosis

    International Nuclear Information System (INIS)

    Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging. (orig.)

  6. The Current Situation on Treatment of Calcaneal Bone Fractures%跟骨骨折治疗现状

    Institute of Scientific and Technical Information of China (English)

    赵津刚

    2011-01-01

    由于跟骨结构的特异性和复杂性,治疗不当易造成跟骨疼痛、行走困难等严重后遗症,因此追求解剖复位并可靠固定是治疗的目的.近年来,跟骨骨折的治疗,如切开复位锁定板固定、经皮撬拨、关节镜、植骨等取得了较大进展,手术方法多样,在并发症的预防方面也有长足的进步.由于跟骨骨折致残率高,并发症多,多年来对其治疗一直争论很大.%Due to the specificity and the complexity of the calcaneum structure,it's easy to cause calcaneum ache,difficulty walking and other serious sequela if not treated well, therefore the pursuit of anatomical reduction and reliable fixing is the treatment goal.In recent years, the calcaneum bone fracture's treatment,such as the incision replacement lockplate fixing, percutaneous by leverage, the arthroscope, bone grafting and so on, has made great progress, the surgery method was diversified, and it also makes considerable progress in the complication prevention aspect.Because the disability rate of calcaneum bone fracture is high, and many complication are easily caused, it caused big argument for the treatment in many years.

  7. Clinical analysis of internal fixation with plastic titanium plate in the treatment of calcaneal fractures%可塑性钛钢板内固定治疗跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    杨新宇; 吴海华

    2012-01-01

    目的 探讨切开复位可塑性跟骨钛钢板内固定治疗跟骨骨折的疗效.方法 SandersⅡ、Ⅲ、Ⅳ型跟骨关节内骨折患者29例共32足,采用手术切开复位并予可塑性跟骨钛钢板进行内固定,观察临床疗效.结果 29例患者均获随访,按照Msryland Foot Score系统进行术后功能评价,其中优21足、良9足、可2足,优良率93.7%.结论 手术切开复位、可塑性钛钢板内固定治疗跟骨关节内骨折是一种有效可靠的治疗方法.%Objective To study the application of open reduction and plasticity titanium plate in the treatment of calcaneal fracture.Methods 29 patients with sanders Ⅱ、Ⅲ、V calcaneal fracture were treated by surgery with open reduction and titanium plate fixation.The clinical effects were observed.Results All patients were followed by Maryland Foot score postoperative functional evaluation system,the group of 29 cases of fracture,excellent 21 cases,good 9 cases,acceptable 2 cases,excellent rate was 93.7%.Condtusion The open reduction and internat fixation with plastic titanic plate was reliable to treat displaced intra-articular fracture of calcaneus.

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

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2015-01-01

    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.

  9. The new bi - directional compression fracture malunion of calcaneal nail care%新型双向加压钉治疗跟骨骨折畸形愈合的护理

    Institute of Scientific and Technical Information of China (English)

    郑慧琳; 余旭辉; 段清萍; 张弘; 饶绮

    2015-01-01

    目的::探讨新型双向加压钉治疗跟骨骨折畸形愈合的护理方法。方法:选择陈旧性跟骨骨折畸形愈合患者30例,采集患者症状、体征及 X 线摄片或 CT 检查的相关数据,根据畸形的类型、程度、临床表现,实施新型双向加压钉矫形手术治疗,在围术期进行系统的护理。结果:30例患者33足手术时间15~45 min,平均时间(28.3±6.7)min;术中失血16~52 ml。术后 X 线片及螺旋 CT 扫描复查,均显示跟骨外侧突出骨块及跟骨横径已恢复正常。所有患者均顺利出院,术后随访时间12~30个月,平均17.5个月。 X 线片显示跟骨高度、宽度、Bohler 角基本恢复正常。根据美国骨科足踝外科学会的踝后足评分标准评分,60~70分1例,71~80分5例,81~90分18例,91~100分6例。结论:对陈旧性跟骨骨折患者行新型双向加压钉治疗,在围术期进行精心的护理,可有效减少并发症,提高手术成功率。%Objective:To explore the new bi - directional compression fracture malunion of calcaneal nail care. Methods:30 cases of calcaneal fracture mal-union cases,collecting patient symptoms,signs and X - ray or CT examination of the relevant data,according to the clinical types,degrees,deformity,the im-plementation of the new bi - directional compression nail for treatment of orthopedic operation,in the perioperative period nursing system. Results:30 cases of 33 foot operation time 15 - 45 min,average time was (28. 3 ± 6. 7)min;intraoperative blood loss was 16 - 52 ml. after X - ray and spiral CT scans showed prominent,lateral calcaneus bone block and calcaneal diameter has returned to normal. All patients were successfully discharged,postoperative follow - up, patients were followed up for 12 - 30 months,average 17. 5 months. X - ray showed the calcaneal height,width,the angle of Bohler returned to normal. Ac-cording to the Institute of USA Department of orthopedics of foot and ankle surgery ankle hindfoot score

  10. Closed reduction of a fractured bone - aftercare

    Science.gov (United States)

    ... 53. Nettina SM. Musculoskeletal health. Lippincott Manual of Nursing Practice . 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010;chap 32. General principles of fracture care. In: Eiff MP, Hatch R, ...

  11. Anatomy Titanium Plate and Bone Graft for Treatment of Calcaneal Fractures Rating%解剖钛钢板加植骨术对跟骨骨折的治疗效果评价

    Institute of Scientific and Technical Information of China (English)

    杨国涛

    2015-01-01

    Objective To evaluate the anatomy of the titanium plate and bone graft for the treatment of calcaneal fractures. Methods 30 patients in our hospital 33 patients with fractures of the heel joint for the study were given anatomical titanium plate and bone graft treatment, analyze its therapeutic effect. Results Al patients were fol owed up foot in 1-2 years after treatment, postoperative complication rate 6.1%; Maryland Foot Score draw its excel ent rate was 90.9%. Conclusion he Anatomy of titanium plate and bone graft treatment of calcaneal fracture treatment significantly, the prognosis is good, worthy of promotion in clinical practice.%目的:评价解剖钛钢板加植骨术对跟骨骨折的治疗效果。方法选取我院收治的30例33足跟关节内骨折患者为研究对象,均给予解剖钛钢板加植骨术治疗,分析其治疗效果。结果所有患足在治疗后均随访1~2年,术后并发症发生率为6.1%;Maryland 足部评分标准得出其优良率为90.9%。结论解剖钛钢板加植骨术治疗跟骨骨折的治疗效果显著,预后效果好,值得在临床上推广。

  12. 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

  13. Biomechanics – Elastic Foundation Applied in Modelling of Calcaneal Nails

    Directory of Open Access Journals (Sweden)

    Sejda František

    2015-12-01

    Full Text Available This paper presents a strength analysis of a calcaneal nail (material Ti6Al4V and stainless steel which is used to treat complex heel fractures. The application focuses on a unique calcaneal nail, the C-NAIL, produced by Medin a.s. (Nové Město na Moravě, Czech Republic. The paper first presents an analysis of fracture types, treatment methods and loading of the calcaneus. It then presents an analysis of limit conditions and loading. Calculations (displacement and stress are performed for 6 and 7 fixing screws using FEM (Ansys Workbench 14 software. The calculation involves a new, original application of an elastic foundation, which effectively replaces the complex interaction of the calcaneal nail and the heel bone.

  14. 经皮撬拨复位空心钉内固定治疗跟骨关节内骨折%Percutaneous Reduction and Internal Fixation in the Treatment of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    王先辉; 陈舰; 胡孙君; 应正然

    2013-01-01

    Objective:To sum up the experience of percutaneous and internal fixation of intra-articular calcaneal fracture.Methods:Fom June 2007 to June 2010,Percutaneous reduction and internal fixtion was performed on 24 cases with intra-articular calcaneal fractures.According to Sanders classification,there were 19 feet of type Ⅱ (3 type Ⅱ a,5 type Ⅱ b and 11 type Ⅱ c) and 5 feet of type Ⅲac.Results:All patients were followed up for an average of 16 months (ranged from12 to 24 months).No complications such as wound infection,screw breakage and calcaneum varus were found postoperatively.The average time for bone healing was 14.5weeks.The results were excellent in 17 cases,good in 5 cases,average in 2 cases according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score.The rate of excellent and good clinical results was 91.6%.Radiography showed basic restoration of B(o)hler' s angle,Gissane' s angle and calcaneal shape.Conclusions:Percutaneous reduction and internal fixation is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures,with advantages of simple operation,fewer complications and good clinical results.%目的:总结经皮撬拨复位空心钉内固定治疗跟骨关节内骨折的手术经验.方法:2007年6月~2010年6月,采用经皮撬拨复位空心钉内固定治疗跟骨骨折24例,其中SandersⅡ型19例(Ⅱ a型3例,Ⅱ b型5例,Ⅱ c11例),Sanders Ⅲ ac型5例.结果:所有患者术后随访12 ~24个月(平均16个月).术后均未发生切口感染、螺钉断裂及跟骨内翻等并发症.术后平均骨折愈合时间为14.5周.按美国足踝外科协会(AOFAS)后足评分系统评价疗效,优17例,良5例,一般2例,优良率91.6%.X线片检查示B(o)hler角、Gissane角、跟骨外形基本恢复正常.结论:经皮撬拨复位空心钉内固定适用于治疗Sanders Ⅱ,Ⅲ型跟骨骨折,具有操作简单、并发症少和临床疗效好等优点.

  15. An anatomic study and clinical application of sustentaculum talus for displaced intraarticular calcaneal fractures%载距突的解剖学研究及其在跟骨关节内移位骨折手术中的应用

    Institute of Scientific and Technical Information of China (English)

    王志杰; 邹云雯; 钟世镇; 丁自海

    2009-01-01

    Objective To study the anatomy and clinical application of sustentaculum talus for displaced intraarticular calcancal fractures. Methods The anterior tilt angles of the sustentaculum talus and the anterior part of posterior calcaneal facet, the maximal width of the middle calcaneum and the maximal and minimal thicknesses of the sustentaculum talus base were measured in 40 pieces of adult calcaneal spec-imens. The intraarticular structures of normal calcaneum were observed, including anatomical relations of the sustentaculum talus. The internal screw fixation of middle calcaneum was simulated to measure the positions and angles of screws. Follow-ups were conducted in 27 patients with displaced intraarticular calcaneal fractures treated by ORIF through an extensile right-angled lateral incision. The accuracy of screw insertion and func-tional outcome were assessed. Results The anterior tilt angle of the sustentaculum talus is 50°±5°, the anterior tilt angle of anterior part of posterior calcaneal facet is 69°±5°, the width of the middle calcaneum is (41.75±1.76) mm, and the maximal and minimal thicknesses of sustentaculum tali base are (12.14±1.60) mm and (4.81±1.07) mm respectively. The compact structure of bone trabecula beneath the sus-tentaculum talus progresses to the inferior part of the posterior calcaneal facet. The sustentaculum talus is closely connected with the tendons and vessels running along medially. The best 3 positions for screw insertion measured on coronal plane from the posterior facet to the sustentaculum talus are as follows: the lowest position is 25°±5° upwards, the highest point is 3°±3° downwards and the middle position is 13°±3°. The excellent and good rate of functional outcome was 88.9%. Conclusions ORIF through an extensile right-angled lateral incision is effective for displaced intraarticular calcaneal fractures. The sustentaculum talus is a good place for screw insertion. The length of screws can be determined by

  16. To Investigate the Application of Spiral CT Three-dimensional Reconstruction of the Value of Calcaneal Fractures%跟骨骨折应用螺旋 CT 三维重建的价值探讨

    Institute of Scientific and Technical Information of China (English)

    李海源; 李小满; 高莉丽; 林秀琼; 蔡映红; 梁玉英

    2015-01-01

    Objective Analysis of spiral CT three-dimensional reconstruction imaging in the diagnosis of trauma in the clinical value of calcaneus .Methods Collection the patients with calcaneal injury to our hospital for diagnosis and treatment in November 2 0 1 2 to November 2 0 1 4 ,selection of image data w hich patients had X-ray examination and three-dimensional reconstruction of spiral CT examination ,comparison of X -ray and spiral CT 3 D reconstruction ,by using the SPSS1 9 .0 statistical software using chi square test analysis of the dif-ference between X-ray and spiral CT 3 D reconstruction in diagnosis ,classification of calcaneal fracture .Results X-ray examination and CT 3 D reconstruction for diagnosis if there is no statistical significance of calcaneal fracture(P=0 .371 >0 .05 ) ,the fracture type classification (comminuted ,intra-articular) are highly statisti-cally significant( P<0 .0 1 ) .Conclusion X-ray and spiral CT 3 D reconstruction is the basic way to check the calcaneum bone fracture ,but the spiral CT three-dimensional reconstruction can specifically form more intu-itive ,comprehensive ,clear observation of fracture ,bring convenience for Department of orthopedics diagnosis and treatment .%目的:分析螺旋CT三维重建成像技术在诊断跟骨外伤中临床价值。方法收集2012年11月至2014年11月间到我院接受诊治的跟骨外伤患者,挑选其中患者均有进行X线平片检查及螺旋CT三维重建检查的影像资料,比较X线平片检查及螺旋CT三维重建,采用SPSS 19.0统计软件应用卡方检验分析X线平片检查及螺旋CT三维重建对跟骨骨折诊断、分类的差异。结果 X线平片检查与CT三维重建对于诊断是否有跟骨骨折无统计学意义(P=0.371>0.05),对于骨折类型分类(粉碎性、关节内)有高度统计学意义( P<0.01)。结论 X线平片检查及螺旋CT三维重建都是跟骨骨折检查的基本方式,但螺旋CT三维重

  17. Landing on your own two feet: a case report of bilateral calcaneus and open pilon fractures.

    Science.gov (United States)

    Tiedeken, Nathan C; Hampton, David; Shaffer, Gene

    2014-01-01

    High energy fractures of the distal tibial plafond and calcaneus have been associated with high functional morbidity and wound complications. Although both of these fractures result from a similar mechanism, they have rarely been reported to occur on an ipsilateral extremity. The combination of these 2 injuries on the same extremity would increase the likelihood of an adverse surgical or functional outcome. We present the case and management strategy of a 43-year-old male with bilateral open pilon fractures and closed calcaneal fractures after falling from a height. A staged protocol was used for the bilateral pilon fractures, with external fixation until operative fixation on day 9. Nonoperative management of the calcaneal fractures resulted in a successful functional outcome at 10 months of follow-up. Treatment of this fracture pattern must incorporate the condition of the soft tissues, an understanding of the fractures, and minimize patient risk factors to optimize the functional and surgical outcomes. PMID:24856663

  18. Three-dimensional finite element analysis of calcaneal fractures%跟骨三维有限元模型的建立及其骨折发生机制

    Institute of Scientific and Technical Information of China (English)

    黄诸侯; 李俊; 陈日齐; 杜景文; 张建新

    2012-01-01

    目的:建立跟骨三维有限元模型,探讨跟骨骨折发生机制.方法:通过扫描正常人跟骨螺旋CT,精确模拟边界条件,并运用Sap 93计算软件运算建立跟骨有限元模型,模型由1 959个节点,1 496个单元组成.在跟骨有限元模型上模拟踝关节在中立位和背伸20°时的状况后对模型施以500N的垂直轴向载荷,观察模型应力分布和位移情况.结果:跟骨在踝关节中立位时通过跟距外侧的关节面,并且由内后斜向前外方向的跟骨处遭受应力最大.背伸20°受力时除上述位置遭受应力最大外,从跟骨体部走向后距关节面与跟腱之间的部位遭受应力也比较大.结论:高处坠落踝关节中立位时跟骨骨折的发生将从跟距关节面的外侧向内后方向走行;当坠落时踝关节处于背伸位时除产生上述骨折线外,跟骨体部走向后距关节面方向也将发生骨折,同时跟腱附着点附近也会形成撕脱性骨折.%Objective :To establish the three-dimensional finite element model of calcaneus,and to discuss mechanism of calcaneal fracture. Methods:The calcaneus of normal person was scanned with spinal CT.and the finite element model was established with the Sap 93 software. The node and element number of this model was 1 959 and 1 496 respectively. After establishing the finite element model of the calcaneus, the axial load of 500 N was applied on the model in neutral position and back stretches 20° position. The stress distribution and the displacement of the models were observed. Results:The fracture line passed through the lateral articular facet of talocalcaneal joint when the ankle joint was in neutral position,and the stress distribution was maximal at calcaneus from posteromedial to anterolateral aspect. In addition, the stress distribution was maximal from calcaneus to position between posterior talar articular surface and calcaneal tendon when the ankle joint was in back stretch position of 20 degree

  19. Supracondylar fractures in children-closed reduction vs open reduction

    Directory of Open Access Journals (Sweden)

    Boparai RPS

    2006-01-01

    Full Text Available Back ground: Supracondylar fracture is the most common fracture around the elbow in children of the age group 5-10 yrs. The issue of open reduction in such fractures is always a matter of debate as even closed reduction gives satisfactory results. However the present study of 50 cases aims to highlight the benefits of open reduction over closed reduction in such cases. Methods: Patients were divided into two groups, 25 cases (group I were treated by ORIF using K-wires while 25 cases (group II were treated by closed reduction and P.O.P. splint in pronation. Group I patients were treated under G/A by two mini incisions medial and lateral and fragments fixed with K-wires. Post-operatively P.O.P. back splint was given. In both groups, the back splint was discarded after three weeks and active exercises encouraged. Results: Minor complications as superficial infections and pin tract infection were observed in group I patients. However variation of carrying angle (cubitus varus was more in group II. Limitation of movement was more in group II due to mal-rotation and anterior ledge formation, not seen with open reduction group. Conclusion: We conclude from above series that ORIF of supracondylar fracture is better than closed reduction as incidence of malunion is less and range of motion near normal as compared to closed reduction.

  20. The relationship between restoring Gissane angle and prognosis in calcaneal fracture surgery%跟骨骨折手术Gissane角的恢复与预后的关系

    Institute of Scientific and Technical Information of China (English)

    郑磊; 秦书俭

    2015-01-01

    Objective To explore the relationship between restoring Gissane angle and prognosis in calcaneal fracture surgery. Methods Forty patients with single side calcaneal fracture (SandersⅡ-Ⅲ), Gissane angle changed more than 15°and having performed open reduction and internal fixation with steel plate were enrolled. In them, 25 patients (experimental group) recovered Gissane angle in surgery referencing the healthy side with X-rays. Another 15 patients (control group) didn't recover Gissane angle. The ratio of calcaneum height and length was measured at 1 week after surgery. At 6 and 12 months after surgery, the function were valued by Maryland score. Results The ratio of calcaneum height and length in experimental group was significantly higher than that in control group:0.60± 0.04 vs. 0.55±0.05, and there was statistical difference (P<0.05). All the patients were followed up. At 6 and 12 months after surgery, the Maryland score in experimental group were significantly higher than those in control group:(88.9± 5.7) scores vs. (80.5±7.3) scores and (89.5 ±5.5) scores vs. (82.5 ±6.4) scores, and there were statistical differences (P<0.05). Conclusions Restoring Gissane angle is benefitial for prognosis. So in calcaneal fracture surgery, the Gissane angle should be recovered as much as possible referencing the healthy side.%目的 探讨跟骨骨折手术Gissane角的恢复与预后之间的关系. 方法 选择住院手术治疗的SandersⅡ~Ⅲ型单侧跟骨骨折、Gissane角改变大于15°的患者40例,均进行跟骨骨折切开复位钢板内固定手术治疗.其中25例(试验组)参考健侧足跟骨X线片,术中将Gissane角恢复.另15例(对照组)术中未将Gissane角恢复.在术后1周通过X线片测量两组跟骨高长比,术后6和12个月分别对两组患者进行Maryland评分. 结果 试验组术后跟骨高长比高于对照组(0.60±0.04比0.55±0.05),差异有统计学意义(P<0.05).40例患者均获得随访.术后6和12个月,

  1. QUANTITATIVE EVALUATION OF POSTOPERATIVE EFFECT OF CALCANEAL FRACTURES USING FOOTSCAN SYSTEM%Footscan足底压力分析系统对跟骨骨折术后疗效的定量评价

    Institute of Scientific and Technical Information of China (English)

    陈占法; 张英泽; 郑占乐; 郭明珂

    2009-01-01

    Objective To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures. Methods From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwent minimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type Ⅱ, 11 of type Ⅲ, and 2 of type Ⅳaccording to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type Ⅱ, 11 of type Ⅲ and 23 of type Ⅳ according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P > 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed. Results All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P 0.05).Significant differences

  2. The Use of the String of Pearls Locking Plate System in the Stabilisation of a Comminuted Calcaneal Fracture in a Giant Breed Dog

    Directory of Open Access Journals (Sweden)

    A. B. Scrimgeour

    2011-01-01

    Full Text Available An eight-year-old male Pyrenean mountain dog was presented with a comminuted fracture of the right calcaneus following motor vehicle trauma. The fracture was stabilised with a plate-rod construct, using the String of Pearls locking plate system and an intramedullary pin. Healing was uncomplicated.

  3. Acute haematogenous infection of a closed vertebral fracture.

    Science.gov (United States)

    Marshman, Laurence A G; Allison, Dale; Molloy, Cynthia J

    2009-12-01

    Acute haematogenous infection of a closed fractures is rare. A 68-year-old diabetic male sustained a burst fracture of a lumbar vertebra (L2) after a fall onto his back. After 5 days of conservative management, he developed a chest infection and amoxicillin was commenced empirically. However, after 6 days his previously moderate focal L2 back pain had become more severe. Pyrexia and systemic inflammatory markers continued to rise despite administration of antibiotics. Blood cultures and a CT-guided biopsy of L2 both revealed Staphylococcus aureus which was sensitive to flucloxacillin. The patient's symptoms and signs gradually normalised following administration of flucloxacillin for 6 weeks, and the use of a cast brace. We conclude that haematogenous infection can be successfully managed non-operatively.

  4. 钢板与克氏针内固定修复跟骨骨折:Gissane角及Bohler角与跟骨高度比较%Internal fixation with plate and Kirschner wire to repair calcaneal fractures:comparison of Gissane angle, Bohler angle and calcaneus height

    Institute of Scientific and Technical Information of China (English)

    马东弟; 杨振建; 宋锦旭; 高志峰; 孙立恒; 潘学文

    2015-01-01

      结果与结论:切开复位重建钢板内固定组治疗后的Gissane角、Bohler角及跟骨高度显著大于经皮撬拨复位克氏针固定组(P 0.05);切开复位重建钢板内固定组治疗后1年随访的足踝功能AOFAS评分显著高于经皮撬拨复位克氏针固定组(P OBJECTIVE:To compare and analyze the prognosis effect of open reduction and internal fixation and percutaneous poking fixation with Kirschner wire for calcaneal fractures. METHODS:A total of 62 patients with calcaneal fractures, who were treated in Tangshan Fengnan District Hospital from March 2012 to September 2013, were selected for this study. The patients were divided into two groups according to the therapy strategy:open reduction and internal fixation group (n=29) and percutaneous poking fixation with Kirschner wire group (n=33). Gissane angle, Bohler angle, calcaneus height, incidence of postoperative complication and AOFAS score (1-year fol ow-up) were compared between the two groups. RESULTS AND CONCLUSION:The Gissane angle, Bohler angle and calcaneus height in open reduction and internal fixation group were higher than percutaneous poking fixation with Kirschner wire group (P0.05). The AOFAS score during 1-year fol ow-up was significantly higher in open reduction and internal fixation group than in the percutaneous poking fixation with Kirschner wire group (P<0.05). Results indicated that open reduction and internal fixation could recover the regular structure of calcaneus and subtalar joint. Surgeon with skil ed operation skil s could ensure the safety of surgery. Open reduction and internal fixation can promote the prognosis of calcaneal fractures, and is better than percutaneous poking fixation with Kirschner wire.

  5. PERCUTANEOUS BIPLANAR EXTERNAL FIXATOR METHOD FOR TREATMENT OF CALCONEAL FRACTURES

    OpenAIRE

    Jagadeesh Kumar; Parthasaradhy M.; Subramanian,; Thiyageswaran; Abinandharajha; Adhiyamaan; Shivakumar

    2015-01-01

    Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patient s. We have used a biplanar percutaneous external fixator for treating calcaneal fractures per operative visualization of the fractures. We have treated 20 ca...

  6. Surgical treatment of displaced intraarticular calcaneal fractures in children%应用跗骨窦有限切口克氏针内固定加植骨治疗儿童跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    李凡; 勘武生; 刘郁东; 徐剑; 李明静

    2015-01-01

    Objective To retrospectively evaluate the surgical outcomes of displaced intraarticular calcaneal fractures in children after open reduction,internal fixation with Kirschner wire and bone grafting via limited tarsal sinus incision.Methods The clinical data of 26 boys (77 sides) with displaced intraarticular calcaneal fractures from June 2010 to February 2014 were collected for respective analyses.Limited open reduction,internal fixation and bone grafting via limited tarsal sinus incision with k-wire were performed.Their average age was 9.6 (2-15) years.Preoperative radiographs and computed tomographic scans were used to classify the fractures.According to the Sanders classification,there were 6 feet of type Ⅱ (4 type Ⅱa,2 type Ⅱb),14 feet of type Ⅲ (6 type Ⅲab,5 type Ⅲac & 3 type Ⅲbc) and 7 feet of type Ⅳ.The functional outcomes were assessed by the modified American Orthopedic Foot & Ankle Society (AOFAS) ankle and hindfoot score.Results The mean follow-up period was 21 (8-30) months.All fractures healed clinically after 4 weeks postoperation.In patients with type Ⅱ fractures,B hler angle was restored from 16.8 ± 12.9 to 36.8 ±7.5 (P<0.05)and Gissane angle from 104.8°± 12.8° to 124.3°± 9.6°(P<0.05); In type Ⅲ fractures,B? hler angle improved from 15.4°± 14.1° to 34.4°± 9.1°(P<0.000 1) and Gissane angle from 100.6° ± 10.1° to 119.8° ± 11.7°(P<0.05) ; In type Ⅳ fractures,B? hler angle was restored from 8.6° ± 10.5° to 34.7° ± 5.3°(P<0.05) and Gissane angle from 105.4° ± 4.0° to 121.4° ± 8.9°(P<0.05).The mean modified AOFAS scores were 65.2 ± 2.5,67.0 ± 1.6 and 65.0 ± 2.8 in patients with type Ⅱ,type Ⅲ and type Ⅳ respectively.The differences of AOFAS scores were not statistically significant among three groups (P<0.05).Pin hole infection occurred in one foot.There was on onset of wound infection,tissue necrosis,osteomyelitis or traumatic arthritis.Conclusions Limited open reduction

  7. Comparison of clinical effects between external fixator combined with limited internal fixation and plates for treatment of intraarticular calcaneal fractures%外固定架结合有限内固定与钢板内固定治疗跟骨关节内骨折比较

    Institute of Scientific and Technical Information of China (English)

    柴雷子; 薛锋; 丁亮; 沈玉春; 赵勇

    2013-01-01

    Objective To investigate the clinical effects of the external fixator combined with the limited internal fixation for the treatment of intrarticular calcaneal fractures.Methods According to different ways of treatment of intraarticular calcaneal fractures,78 patients(86 feet) were divided into two groups:42 patients(48 feet) were treated with the external fixator combined with the limited internal fixation as group A; 36 patients (38 feet) were treated with plates as group B.Fracture healing time,recovery of the calcaneal,clinical outcomes and the rate of incision complications were compared.Results A total of 78 cases were followed up for 8~34 months (average 16.8 months).Both group A and B all had acceptable reduction in calcaneal length,height,width,Bohler angle,and Gissane angle,there was significant difference between preoperative and postoperative results(P <0.05),and there was no signicant difference in postoperative results between group A and group B(P >0.05).Based on the Maryland grading system,excellent rate was 89.6% in the group A,excellent rate was 86.8% in the group B,there were no significant difference between them(P >0.05).The rate of incision complications in the group A was lower than in the group B,there was significant difference between them (4.2% vs 21.1%,P <0.05).Conclusion External fixator combined with limited internal fixation for intraarticular calcaneal fractures is satisfactory and minimally invasive.%目的 探讨外固定架结合有限内固定治疗跟骨关节内骨折的临床疗效.方法 78例(86足)跟骨关节内骨折分为2组:A组42例(48足)采用外固定架结合有限内固定治疗;B组36例(38足)采用钢板内固定治疗.对两组骨折愈合时间、跟骨恢复情况、临床疗效、切口并发症发生率等指标进行比较.结果 78例均获得平均16.8(8~34)个月随访.两组术后跟骨的长度、宽度、高度、Bohler角及Gissane角均得到了良好的恢复,与术前比较

  8. Complications of close interlock nailing in the management of close tibial fracture

    International Nuclear Information System (INIS)

    Objective: The objective of this study is to find out the frequency of complications of locally made interlock nailing in tibia after nine months of surgery. Material and Method:. This case series study was done from March 2004 to February 14 in the Department of Orthopedic and Trauma Postgraduate Medical Institute Hayatabad Medical Complex Peshawar. A total of 58 adults ( after the closure of epiphysis) patients were randomly selected provided that they have; Close diaphysial fracture of tibia which is located 7 cm below the knee joint and 4 cm above the ankle joint and fracture less than one week old. Results: Total numbers of patients were 58. Anterior Knee pain was observed in 14(24.1%), delayed union in 10(17.2%), external of 100 rotation in 4(6.9%) and internal rotation of 50 in 1(1.7%), non union in 4(6.9%), intramedullay infection in 3(5.2%), shortening of 1 centimeter (cm) in 2(3.4), 2 cm in 1(1.7%) and 1.5 cm in 3(5.2%) cases, distal screw broken in 2(3.4%), proximal screw broken in 1(1.7%), Nail broken in 2(3.4), infection at proximal screw in 2(3.4%) and at distal screw was 2(3.4%), Restriction of knee flexion in 1(1.7%), Restricted ankle movements in 1(1.7%), varus angulation of 100 in 1(1.7%), valgus angulation of 100 in 1(1.7%), Ankle pain in 1(1.7%) and deep vein thrombosis in 1(1.7%). Conclusion: interlocking nail is considered to be the gold standard for management of tibial fracture but it is not free of complication especially knee pain and angular rotation. (author)

  9. False positive indium-111 white blood cell scan in a closed clavicle fracture

    International Nuclear Information System (INIS)

    Aggressive treatment of the multiply injured patient often requires early fixation of many fractures, some of which may be open. Often, patients develop postoperative fevers requiring a thorough workup to rule out infection. Recently, indium-111 white blood cell (WBC) imaging has become a valuable adjunct in the diagnosis of acute infection. The patient described had a simple, closed clavicle fracture with markedly increased activity on an indium-111 WBC scan obtained for fever workup. This subsequently proved to be a normal, healing, noninfected fracture by other diagnostic techniques. Noninfected, simple closed fractures should be added to the list of causes for a false-positive indium-111 WBC scan

  10. Treatment of the avulsion fractures of calcaneal tuberosity in elderly osteoporotic patients with fixation of shaped locking plate%锁定钢板塑形固定治疗老年骨质疏松性跟骨后结节撕脱骨折

    Institute of Scientific and Technical Information of China (English)

    王旭; 王晨; 张超; 黄加张; 马昕

    2014-01-01

    Objective To investigate the clinical results after treatment of the avulsion fractures of calcaneal tuberosity in elderly patients using shaped locking plate. Methods We retrospectively reviewed the elderly patients with the avulsion fractures of calcaneal tuberosity who received ORIF (open reduction internal fixation) with shaped locking plate from January 2006 to December 2011. Only the patients aged more than 60 were included. The AOFAS hindfoot scale was used for clinical evaluation at the last follow-up.Results Seventeen patients were identified with a mean age of 67.2. The follow-up durations was ranged from 1.2-7.1 years, 4.3 years in average. All the fractures achieved bony union and one patient associated with wound delayed healing was finally recovered by dress changing. The mean AOFAS hindfoot score at the last follow-up was 91.2. Discussion The avulsion fractures of calcaneal tuberosity were prone to happen in elderly patients. The peak occurrence age was around 70. The osteoporotic calcaneaus was avulsed by the Achilles tendon due to reduced biomechanical strength. It could be comsed by the strongly dorsiflexed ankle, the isometric contraction of gastrocnemius or the direct stress. Such mechanism was different from the fractures of calcaneal medial tuberosity in young patients which was caused by longitudinal forces. Most studies were recommended for surgical intervention of the calcaneal avulsion fractures. However, due to the risk factors of diabetes, hyperlipidemia or lower limb vascular dysfunction, the occurrence of wound problems was increased. Meanwhile, the results of clinical reports varied due to different choice of internal fixations. The present study found that satisfied stability and clinical result could be achieved by fixed the avulsion fragment to the inferior medial side of the calcaneaus with shaped locking plate. Conclusion The treatment of avulsion fractures of calcaneal tuberosity in elderly patients using shaped locking plate

  11. Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures

    Directory of Open Access Journals (Sweden)

    Halvorson Jason J

    2012-02-01

    Full Text Available Abstract Background One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique. Methods All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee. Results No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%. Conclusions Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant. Funding There was no outside source of funding from either industry or other organization for this study.

  12. 外踝后穿支皮瓣修复跟骨骨折钢板内固定术后皮肤缺损%Lateral retrom alleo larperforator flap for repairing soft tissue defects after internal fixation of calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    张建华; 吴学建

    2014-01-01

    Objective To investigate the clinical effect of the lateral retrom alleo larperforator flap (sural nerve nutritional vessel axial flap) on repairing soft tissue defects after internal fixation of calcaneal fractures.Methods From March 2008 to September 2013,eight cases of the soft tissue defects were repaired by using lateral retrom alleo larperforator flap.Results All of the eight flaps survived.Specifically,the patients were follow-up for 6 to 30 month.It turned out that the appearance and function of the flaps had good recovery.No chronic infection developed during the period.Conclusions Lateral retrom alleo larperforator flap has good repair effect on the reconstruction of the soft tissue defects after internal fixation of calcaneal fractures.%目的 探讨外踝后穿支皮瓣(腓动脉终末穿支蒂腓肠神经营养血管皮瓣)修复跟骨骨折钢板内固定术后皮肤缺损的临床效果.方法 2008年3月至2013年9月对8例跟骨骨折钢板内固定患者术后的皮肤缺损采用外踝后穿支皮瓣修复.结果 术后8例皮瓣全部成活,术后随访时间6~30个月,皮瓣外观及功能恢复良好,无创面再坏死、裂开、感染等情况出现.结论 外踝后穿支皮瓣修复跟骨骨折钢板内固定术后皮肤缺损获得良好的修复效果.

  13. Risk factors for failed closed reduction of pediatric supracondylar humerus fractures.

    Science.gov (United States)

    Beck, John D; Riehl, John T; Moore, Blake E; Deegan, John H; Sartorius, Jennifer; Graham, John; Mirenda, William M

    2012-10-01

    The purpose of this retrospective study was to examine pediatric supracondylar humerus fractures at a Level I trauma center. Data were analyzed to identify risk factors associated with closed reduction failure. Closed pediatric supracondylar humerus fractures that were treated at the authors' trauma center between October 1997 and January 2009 were reviewed. The main outcome variable was necessity of open reduction. To determine which factors were independently associated with a failed closed reduction, a multivariate logistic model was fit predicting open reduction status.A total of 174 patients required operative treatment. Of these, 23 underwent open reduction and 151 underwent with closed reduction and percutaneous pinning. For patients who required open reduction, 39.1% had an associated injury compared with 14.6% of patients treated with closed reduction (P=.008). Average time from presentation to surgery was 4.1 hours in the open reduction and 6.3 hours in the closed reduction group (P=.049). Risk factors that significantly predicted failure of closed reduction were the presence of an associated injury, initial fracture displacement, and Gartland type III fracture (P=.008, .03, and .023, respectively).Associated injury, large initial fracture displacement, and Gartland type III factures were statistically significant independent risk factors for closed reduction failure. Increased time from injury to presentation demonstrated a trend toward open reduction. Consideration should be given to the expedient transfer of patients with type III supracondylar humerus fractures with associated injuries when definitive care will be provided at another institution. PMID:23027486

  14. X-ray picture of unstable bone fractures and closed comporession-distraction osteosynthesis

    International Nuclear Information System (INIS)

    Roentgenologic pictures of unstable bone fractures and the consolidation dynamics after closed compression-distraction osteosynthesis are analyzed. It is established that studying roentgenologic pictures of fractured bones in the early terms after the trauma permit to state unfavourable consolidation conditions and to predict the result of the treatment

  15. Quality of life after open versus closed treatment for mandibular condyle fractures: a review of literature

    NARCIS (Netherlands)

    S.C. Kommers; B. van den Bergh; T. Forouzanfar

    2013-01-01

    Introduction Many studies have compared treatment outcomes after open reduction and internal fixation (ORIF) and closed reduction (CR) of mandibular condylar fractures. Despite this the optimal treatment for these fractures remains a controversy. The purpose of this review is to compare the influenc

  16. “/\\”形小切口钢板螺栓加压内固定治疗跟骨关节内骨折%The treatment of displaced intra-articular calcaneal fractures by "/\\" shape incision with compression fixation and stud bolts

    Institute of Scientific and Technical Information of China (English)

    曲家富; 闫荣亮; 李生旺; 曹立海; 赵国志; 彭义; 刘洪达; 张英泽

    2013-01-01

    目的 探讨跟部外侧“/\\”形小切口钢板螺栓加压内固定治疗跟骨关节内骨折的方法及疗效.方法 回顾性分析2010年8月至2011年11月手术治疗并获得随访的130例(140足)跟骨关节内骨折患者资料,男117例(127足),女13例(13足);年龄17~73岁,平均42.3岁.按Sanders分型:Ⅱ型49足,Ⅲ型75足,Ⅳ型16足.手术采用跟部外侧“/\\”形小切口,即跟腱前缘直切口和跗骨窦斜切口,使用跟骨解剖钢板螺栓加压固定治疗跟骨关节内骨折.手术前、后摄跟骨轴位、侧位X线片和跟骨CT扫描,测量跟骨B(o)hler角、Gissane角、内翻角、距下关节面骨折移位距离、跟骨高度、中点宽度、长度.根据Maryland足部评分及AOFAS踝-后足评分评价疗效.结果 130例患者均获得随访,随访时间15~31个月,平均20个月;术后平均出血量(194.24±104.17) ml,无一例发生切口皮缘坏死及伤口感染.骨折愈合时间45~86 d,平均(54.51±20.38)d.手术前、后B(o)hler角分别为6.27°±11.81°、27.21°±8.28°,Gissane角分别为108.36°±21.77°、117.47°±12.93°,跟骨中点宽度为(47.35±5.85) mm、(35.96±4.14) mm,高度为(39.79±5.85) mm、(47.64±3.83) mm,长度为(78.30±5.81) mm、(79.41±5.30) mm.Maryland足部评分为42~100分,优71足,良59足,可7足,差3足,优良率92.86%(130/140).AOFAS踝-后足评分为45~100分,优76足,良58足,可5足,差1足,优良率95.71%.术后12足踝关节内外翻活动较健侧受限5°~8°,其中3足于术后1年发生距下关节创伤性关节炎.结论 外侧“/\\”形小切口钢板螺栓加压内固定治疗跟骨关节内骨折可显著减少伤口并发症,恢复跟骨解剖形态和距下关节面平整,促进骨折早期愈合.%Objective To explore the method and efficacy of the treatment for displaced intra-articular calcaneal fractures by lateral "/\\" shape incision with compression fixation and stud bolts.Methods From August 2010 to November 2011,used

  17. C-arm guided closed reduction of zygomatic arch fracture

    Energy Technology Data Exchange (ETDEWEB)

    Eo, Yoon Ki; Lee, Dong Kun [College of Medicine, Wonkwang Univ., Iksan (Korea, Republic of); Kim, Jeong Sam; Jang, Young Il [Kwangyang College, Kwangyang (Korea, Republic of)

    1999-04-01

    The zygomatic arch is structurally protruded and is easily fractured. The classic management of zygomatic arch fracture has been mentioned the Keen, Lothrop, Dingman and Alling and threaded K-wire. All of the above methods have advantages and disadvantages. To minimize the disadvantages, we performed threaded K-wire for the first time using C-arm image intensifier. The subjects were 16 patients with Knight North group II (Zygomatic arch fracture). Among them the C-arm was used in 12 patients and the operator used sensitivity general method in 4 patients and confirmed the operation by mobile X-ray equipment. In conclusion, both groups were satisfied surgically and cosmetically. Using the C-arm, actual image at the time operation was clear and satisfied, the surrounding tissue damage was minimized and at was more accurately completed. The operation time was shortened by 30 to 60 minutes proving it to be an efficient method. We suggest though that further studies be needed to evaluate the radiation effect on these patients.

  18. Long-term outcome assessment of closed treatment of mandibular fractures.

    Science.gov (United States)

    Fayazi, Sara; Bayat, Mohammad; Bayat-Movahed, Saeed; Sadr-Eshkevari, Pooyan; Rashad, Ashkan

    2013-05-01

    Mandibular fractures are among the most common trauma injuries of the craniomaxillofacial region. This study evaluated the late results of mandibles fractures treated with arch bar. Forty-nine patients were examined clinically and by questionnaires for late results of arch bar treatment. Demographic data (age, sex, etc), trigeminal nerve sensation (Weber test), temporomandibular joint evaluation, masticatory muscle function, and occlusion were recorded. The data were analyzed by χ test using Sigma Stat 2.0 software. Fifty-one percent of the patients with angular fractures complained of sensory disturbances. Condylar and angular fractures demonstrated higher levels of pain. According to Pearson χ test, a statistically significant relation between angular fracture and tenderness of the internal pterygoid muscles (P = 0.047), angular fracture and cross-bite (P = 0.021), parasymphysial fracture and pain upon wind blowing (P = 0.026), and body fracture and mastication discomfort (P = 0.038) was found. In closed reduction therapy, fracture location of the mandible seems to be more likely correlated in producing particular long-term complications. Regular follow-ups for functional treatments and physiotherapy of chewing muscles and temporomandibular joint, along with removal of occlusal abnormalities, should be considered following arch bar reduction of mandibular fractures. PMID:23714869

  19. Radiodiagnosis of closed fractures of 2-5 metacarpal bones

    International Nuclear Information System (INIS)

    A unified method of radiodiagnosis of angular deformities in subcapital fractures of 2-5 metacarpal bones was proposed. It was based on the standardization of the wrist laying for roentgenography of the oblique view strictly at the angle of 45 deg. The projection angle of deformity of the metacarpal bone was measured on a radiogram obtained and then a true value of the angular displacement of the bone fragments to the palm was determined on a nomogram (i.e. on a chart of the ratio of values of the true and projection angles). The healthy metacarpal bone heads were inclined to the palm at the angle of 13-33 deg. It was found that in subcapital fractures of 2-5 metacarpal bones certain self-correction (varying from 10 to 15 deg) of angular deformities was possible in children and adolescents only. Owing to such radiodiagnosis and a differentiated choice of therapeutic methods (in 48.8% of the patients indications for reposition were determined) good anatomical and functional results were obtained in most of the patients (96.9%)

  20. Calcaneal tendon: imaging findings; Tendao calcaneo: avaliacao por imagem

    Energy Technology Data Exchange (ETDEWEB)

    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio [Colegio Brasileiro de Radiologia e Diagnostico por Imagem, Sao Paulo, SP (Brazil)]. E-mail: crismontandon@hotmail.com; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos [Goias Univ., Goiania, GO (Brazil). Hospital de Clinicas. Dept. de Diagnostico por Imagem e Anatomia Patologica

    2003-12-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  1. Closed patella fracture combined with cruciate ligament injury:a case control study

    Institute of Scientific and Technical Information of China (English)

    LI Han; WANG Wei; LIU Yue-ju; CHEN Wei; ZHANG Qi; LI Xu; ZHU Lian

    2013-01-01

    Background Patellar fracture and cruciate ligament injury are a common consequence of traumatic knee injury.Patellar fracture combined with cruciate ligament injury is rarely reported,although the mechanisms of two things are similar.This study aimed to evaluate the incidence of closed patella fracture combined with cruciate ligament injury.Methods From 2012 March 1 to June 30,magnetic resonance images of 60 patients with unilateral closed patellar fracture were studied in our institution.The mean age of the patients at presentation was 40.2 years (range,13-64 years) and 48 patients were men.First,patients were divided according to the cause of injury.Twenty-eight patients had highenergy trauma from a falling injury or motor vehicle accident,and 32 patients had low-energy trauma resulting from a tumbling injury.Second,according to the fracture pattern,31 patients had a transverse fracture and 29 patients had a comminuted fracture.Results We found seven cases of closed patellar fracture combined with cruciate ligament injury among 60 patients,including two cases of a completely ruptured posterior cruciate ligament,two with a partially torn posterior cruciate ligament,and three with a partially torn anterior cruciate ligament.The percentage of this combined injury was 11.6% (7/60).The incidence of a combined injury of the cruciate ligament with a comminuted fracture (6/29,20.7%) was significantly higher than that with a transverse fracture (1/31,3.2%,P <0.05).The most common mechanism of injury in patellar fracture combined with cruciate ligament injury was high-energy trauma from road traffic accidents (94%),whereas in the patellar fracture alone,it was tumbling (62%).The incidence of combined injury with high-energy trauma (6/28,21.4%) was significantly higher than that with low-energy trauma (1/32,3.1%,P <0.05).Conclusions These data suggest that high-energy trauma often results in a comminuted patellar fracture,which is often combined with

  2. Close Intramedullary Interlocking Nailing Versus Locking Compression Plating In the Treatment of Closed Fracture Shaft of the Tibia.

    Science.gov (United States)

    Kundu, I K; Datta, N K; Chowdhury, A Z; Das, K P; Tarik, M M; Faisal, M A

    2016-07-01

    Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al. Patients were assessed for pain on full weight bearing and kneeling, shortening and range of motion of knee and ankle joints. Radiological assessment for union of fracture, alignment of fracture and angulations and position of nail and screws and infection were observed during follow up. A total number of 32 patients were selected but only 27 patients were available for follow up for a period of 6 months. They were grouped into Group A, consisting of 15 patients who took the treatment in the form of closed intramedullary interlocking nailing and Group B, consisting of 12 patients those underwent ORIF with locking compression plating. In both of the groups Motor Vehicle Accident was the main mechanism of trauma. Fracture involving the middle 3rd of the tibia is common in both the groups. During post-operative follow up, four patients in Group A complained anterior knee pain, one patient in Group B had superficial infection, most of the patients had no restriction of movement in the ankle and knee joints and a single patient in Group B showed 1.5cm shortening of the lower limb. Period of hospital stay and fracture union time were less in Group A, which was statistically significant. Both groups showed excellent result with minimum complications. So this study permits to conclude that close IM interlocking nailing and open reduction and internal fixation by locking compression plating is equally effective for the management of close

  3. Closed Talar Dislocation without Associated Fracture a Very Rare Injury, a Case Report

    OpenAIRE

    Kumar, Yashavntha C; Reddy, Sandeep; Golla, Dinesh Kumar; Ganesh, Niranthara

    2014-01-01

    Introduction: Total talar dislocations are uncommon injuries and usually seen following high velocity injuries. Total talar dislocations (missing talus) without fractures around the ankle are extremely rare. There are no consensuses on the best treatment of such injuries. To best of our knowledge very few cases have been reported in literature. We hereby report a closed total talar dislocation in a 25 year old male without an associated fracture around ankle. He was managed with emergency clo...

  4. A PROSPECTIVE STUDY OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN TREATED BY CLOSED REDUCTION

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    Ch. Imobi

    2015-08-01

    Full Text Available There is no universal agreement regarding the management of displaced supracondylar fracture of the humerous in children. According to some orthopaedic surgeon almost all supracondylar humeral fractures should be treated operatively by reduction and pinning. While according to others closed reduction and pinning should be used for Gartland type II and some type III fractures. We present 50 cases of displaced supracondylar fracture treated by closed manipulative reduction under G.A. and immobilization with a posterior plaster of paris slab and collar and cuff. OBJECTIVE : T o assess the functional results of the injured elbow and to study the incidence of change in the carrying angle of the elbow. MATERIALS AND METHODS: This prospective study was conducted in 50 patients with extension type of displaced supracondylar fractures of humerus in children (Gartland type II and type III treated by closed manipulative reduction and immobilization in flexion of the elbow with a posterior plaster of paris slab and collar and cuff. Patients were followed up for 6 months. Flexion type of supracondylar fracture and those fractures which are absolutely indicated for operative intervention, Viz an open fracture and severe vascular compromise were excluded from the study. The range of movement and carrying angle was measured with the help of a Goniometer and Flynn criteria were used for functional assessment. RESULTS: At the end of follow up period, the end results were graded as excellent in 40%, good in 42%, fair in 12% and poor in 6%. A satisfactory result was therefore obtained in 94% and unsatisfactory result in 6% of the 50 patients who were followed and evaluated. CONCLUSION: This closed method of treatment for all practical proposes produces least complications, shorter hospital stay, can be expected to yield reproducible consistent satisfactory results not surpassed by any other method of treatment.

  5. CLOSED REDUCTION AND PERCUTANEOUS K-WIRES FIXATION OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To observe the effects of closed reduction and pereutaneous K-wires fixation of displacd supracondylar humnerus fracture in children. Methods. Retrospective review of fourteen patients who sustained displaced supmcondylar fracture of distal humerus treated by closed reduction and percutaneous K-wires fixation. Results. All patients' K-wires were removed at 4 weeks post-operation. Their elbow function regained at 8weeks. The average period of followed up was 10 month (varies from 6 to 18 month), all fractmes healed very well without any permanent complications. Two transient nerves palsy, ulnar and radial nerve each, recovered completely at12 weeks and 16 weeks post-operation respectively. Conclusion. Closed reduction and percutaneous K-wires fixation is a safe and efficient treatment for displaced humerus surpracondylar fracture in children.

  6. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation

    Institute of Scientific and Technical Information of China (English)

    Aman Dua; Krishna Kiran Eachempati; Rajesh Malhotra; Lalit Sharma; Mallinath Gidaganti

    2011-01-01

    Objective: Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury.Methods: We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type Ⅲ) with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours.Results: Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann's angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn's criteria,38 patients (95%) had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus.Conclusion: Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.

  7. 微创锁定板内固定和切开复位内固定治疗跟骨关节内骨折效果分析%Analysis Efficacy of Minimally Invasive Locking Plate Fixation and Open Reduction Internal Fixation in the Treatment of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    张番; 郑淑媛

    2014-01-01

    Objective:To investigate the clinical treatment efficacy of minimally invasive locking plate fixation and open reduction internal fixation in the treatment of intra-articular calcaneal fractures.Method:76 patients with calcaneal fracture in orthopedic department for elective surgery in our hospital from June 2012 to July 2013 were selected.All cases were randomly divided into the minimally invasive fixation group and the open reduction internal fixation group according to the admission number parity,38 cases in each group.The surgical time,intraoperative and postoperative bleeding, hospitalization time,healing time of the two groups were compared.The postoperative treatment efficacies of the two groups were evaluated by AOFAS ankle and hindfoot scoring system,visual analog scale(VAS method)and condensed Health Status Scale(SF-36).Postoperative complications of the two groups were recorded.Result:The surgical time and intraoperative and postoperative bleeding volume of the minimally invasive fixation group were significantly less than the open reduction internal fixation group,the differences were statistically significant(P0.05).The total complication rate of the minimally invasive fixation group was 7.9%,it was significantly lower than 36.8% of the open reduction internal fixation group,the difference was statistically significant(P0.05);微创内固定组总并发症发生率7.9%明显低于切口内固定组的36.8%,差异有统计学意义(P<0.05)。结论:微创锁定板内固定治疗跟骨关节内骨折临床效果优于切开复位内固定,有助于减少术后并发症的发生,促进跟骨术后功能恢复,提高患者生活质量,值得在临床推广使用。

  8. The Pathomechanics Of Calcaneal Gait

    Science.gov (United States)

    Sutherland, David H.; Cooper, Les

    1980-07-01

    The data acquisition system employed in our laboratory includes optical, electronic and computer subsystems. Three movie camera freeze the motion for analysis. The film is displayed on a motion analyzer, and the body segment positions are recorded in a three dimensional coordinate system with Graf/pen sonic digitizer. The angular rotations are calculated by computer and automatically plotted. The force plate provides measurements of vertical force, foreaft shear, medial-lateral shear, torque, and center of pressure. Electromyograms are superimposed upon gait movies to permit measurement of muscle phasic activity. The Hycam movie camera si-multaneously films (through separate lens) the subject and oscilloscope. Movement measurements, electromyograms, and floor reaction forces provide the data base for analysis. From a study of the gait changes in five normal subjects following tibial nerve block, and from additional studies of patients with paralysis of the ankle plantar flexors, the pathomechanics of calcaneal gait can be described. Inability to transfer weight to the forward part of the foot produces ankle instability and reduction of contralateral step length. Excessive drop of the center of mass necessitates com-pensatory increased lift energy output through the sound limb to restore the height of the center of mass. Excessive stance phase ankle dorsiflexion produces knee instability requiring prolonged quadriceps muscle phasic activity.

  9. Surgical Treatment of Calcaneal Spur.

    Directory of Open Access Journals (Sweden)

    Eduardo Sarmiento Sánchez

    2007-12-01

    Full Text Available Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level, antibiotic prophylaxis, final outcomes, and patient's satisfaction with the treatment were the set of variables selected. Results: High morbidity of the heel pain syndrome was evidenced in this studied. The most frequent cause was the calcaneal spur. There is predominance in female Indian race. The high influenced of the socio-cultural factor in the genesis of this disease is proved as well as the impossibility of carrying out the conservative treatment due to high cost of medications. Conclusions: The efficacy achieved with combined treatment technique allowed the results obtained. All this contributed to achieve high satisfaction levels.

  10. Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia

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    Kapoor Sudhir

    2009-01-01

    Full Text Available Background : Intramedullary fixation is the treatment of choice for closed diaphyseal fractures of femur and tibia. The axial and rotational stability of conventional interlocking nails depends primarily on locking screws. This method uses increased operating time and increased radiation exposure. An intramedullary implant that can minimize these disadvantages is obviously better. Expandable intramedullary nail does not rely on interlocking screws and achieves axial and rotational stability on hydraulic expansion of the nail. We analyzed 32 simple fractures of shaft of femur and tibia treated by self-locking expandable nail. Materials and Methods: Intramedullary fixation was done by using self-locking, expandable nail in 32 patients of closed diaphyseal fractures of tibia (n = 10 and femur (n = 22. The various modes of injury were road traffic accidents (n = 21, fall from height (n = 8, simple fall (n = 2, and pathological fracture (n = 1. Among femoral diaphyseal fractures 16 were males and six females, average age being 33 yrs (range, 18- 62 yrs. Seventeen patients had AO type A (A1 (n = 3, A2 (n = 4, A3 (n = 10 and 5 patients had AO type B (B1 (n = 2, B2 (n = 2, B3 (n = 1 fractures. Eight patients having tibial diaphyseal fractures were males and two were females; average age was 29.2 (range, 18- 55 yrs. Seven were AO type A (A1 (n = 2, A2 (n = 3, A3 (n = 2 and three were AO type B (B1 (n = 1, B2 (n = 1, and B3 (n = 1. We performed closed (n = 27 or open reduction (n = 5 and internal fixation with expandable nail to stabilize these fractures. The total radiation exposure during surgery was less as no locking screws were required. Early mobilisation and weight-bearing was started depending on fracture personality and evidences of healing. Absence of localised tenderness and pain on walking was considered clinical criteria for union, radiographic criteria of union being continuity in at least in three cortices in both AP and lateral views

  11. Alloxan-induced diabetes delays repair in a rat model of closed tibial fracture

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    S.F. Diniz

    2008-05-01

    Full Text Available A closed fracture was performed on the left tibia of 3-month-old Wistar rats weighing 250 to 350 g that were either healthy (N = 24 or made diabetic with alloxan (N = 24 to investigate the effect of alloxan-induced diabetes on the course of bone fracture healing. Histomorphometric analysis of the fracture site was performed at 7, 14, 25, and 35 days. After 7 days, diabetic rats had significantly less cartilage (P = 0.045 and greater fibrous connective (P = 0.006 tissue formation at the fracture site compared to controls. In contrast, marked callus formation was seen in diabetic rats with significant osteogenesis (P = 0.011, P = 0.010, P = 0.010, respectively, for 14, 25, and 35 days and chondrogenesis (P = 0.028, P = 0.033, P = 0.019 compared to controls. Radiographic analysis revealed a displaced fracture with poor bone fragment alignment and delayed consolidation at these times in the diabetic group. The levels of alkaline phosphatase were significantly higher in diabetic rats at 25 days (P = 0.009. These results suggest that the initial excessive formation of fibrous connective tissue associated with delay in chondrogenesis and osteogenesis may not provide suitable stability of the fractured site, contributing to the inappropriate alignment of fragments and an increase in the volume of callus in later stages of repair. The resulting displaced fracture in diabetic rats requires long periods for remodeling and complete bone consolidation.

  12. Missed ulnar nerve injury and closed forearm fracture in a child

    Institute of Scientific and Technical Information of China (English)

    Batra Amit; Devgan Ashish; Verma Vinit; Singh Raj; Batra Shivani; Magu Narender; Singla Rohit

    2013-01-01

    Ulnar nerve injury in closed fracture of forearm in children is uncommon.Commonly,neurapraxia is the reason for this palsy but other severe injuries or nerve entrapment has been reported in some cases.The importance of diagnosis concerning the types of the nerve injury lies in the fact that they have totally different management.We present a case of ulnar nerve deficit in a child following a closed fracture of the forearm bones.It is imperative to diagnose exact cause of palsy as it forms the basis for treatment.MRI scan can help diagnosis and accordingly guide the management.Simple nerve contusion should be treated conservatively,and exploration with fixation of the fracture should be done in lacerations and entrapments of the nerve.Surgery is not the treatment of choice in cases that could be managed conservatively.

  13. 经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效%An analysis of the clinical effects of percutaneous fracture reduction followed by internal fixation with multiple axial and horizontal cannulated screws in the treatment of Sanders type II and III calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    林文琛; 许耀明; 颜峻; 李超颖; 郑烽礼

    2014-01-01

    ObjectiveTo explore and compare the curative effects of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of Sanders typeⅡ andⅢ calcaneal fracture at early stage.Methods 60 patients with calcaneal fracture from February 2010 to September 2013 were selected. They all belonged to Sanders typeⅡ andⅢ fracture, in which 34 patients were typeⅡ and 26 typeⅢ. All patients were randomly assigned to two groups and received surgeries of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate. They were observed in the follow-ups, and functional evaluation was carried out via Marryland evaluation system. Excellent and good rate of the two methods was calculated, and differences between the two groups were analyzed through statistics. Results Follow-ups were carried out for 60 patients, and the follow-up time was 4-38 months (average 18 months). Clinical effects: among 31 patients who received percutaneous fracture reduction followed by internal fixation with cannulated screws, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 83.8%; among 29 patients who received open reduction followed by internal fixation with titanium plate, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 82.8%. The differences of the excellent and good rate between the two methods were not statistically significant (x2=0.617,P =0.971>0.05).Conclusion Percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of calcaneal fracture can both achieve favorable effects. Percutaneous fracture reduction followed by internal fixation with

  14. 切开复位内固定术治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效观察%The open reduction and internal fixation treatment of Sanders type Ⅱ、Ⅲ calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    李海峰; 季伟; 白雪东; 贾治伟

    2011-01-01

    目的 分析切开复位内固定术用于Sanders Ⅱ、Ⅲ型跟骨骨折患者的治疗效果.方法 回顾分析2008年6月至2010年6月我科同一组医生实施切开复位、钛板螺钉治疗的21例(23足)Sanders Ⅱ、Ⅲ型跟骨骨折患者.术前、术后在X线片上测量跟骨宽度、Bohler's角以及Gissane's角.伤后5-7 d局部消肿后实施手术,单侧骨折患者采用侧卧位,双侧患者采用俯卧位,选择跟骨外侧切口,采用"不接触技术"保护局部皮瓣,术中直视下用斯氏针辅助将后关节面复位,必要时取髂骨植于骨缺损部位,用钦钛螺钉固定.术后3、6、12个月复查X线及CT检查观察跟骨宽度、Bohler's角以及Gissane's角以及骨折愈合情况.结果 本组21例跟骨骨折切口均愈合良好,术后复查X线和(或)CT显示骨折愈合良好,测量跟骨宽度、Bohler' s角以及Gissane's角均恢复良好,患者下地活动后足跟均无明显不适.结论 加强围手术期管理、选择合适手术时机,掌握必要的手术技巧,切开复位内固定治疗Sanders Ⅱ、Ⅲ跟骨骨折可获得满意效果.%Objective To evaluate the open reduction and internal fixation operation effect of the Sanders type Ⅱ 、 Ⅲ calcaneous fracture. Methods A total 21 cases(23 foots) with Sanders type Ⅱ , Ⅲ calcaneal fracture from Jun 2008 to Jun 2010 underwent surgical treatment of the open reduction and fixation with titanium plates. The Bohler's and Gissane's angle as well as the width of the calcaneum were measured on pre-and postoperative X-ray films. The operation were done by one group experienced trauma surgeon under tourniquet control at 5 days to 7 days after injury. The patient is placed in the lateral decubitus position to treat unilateral fracture. The prone position is selected to treat bilateral fractures, no touch technique were used to protect the skins around incisions through lateral approch. During operation, one or two 3.5 mm Steinmann pins are introduced to

  15. Muscular tendinous junction rupture of the posterior tibial tendon after closed bimalleolar ankle fracture.

    Science.gov (United States)

    Jasqui-Remba, Salomon; Rodriguez-Corlay, Ruy Ernesto

    2016-01-01

    In this case report, we present an acute rupture in the muscular tendinous junction of a posterior tibialis muscle in a bimalleolar closed ankle fracture after a high-energy trauma in a 30-year-old patient with no significant medical history. Fracture was confirmed by simple X-rays, and was treated with an open reduction in which both of the fractures were treated with osteosynthesis material and reparation of the syndesmosis. If left untreated, this uncommon finding can result in a bad postsurgical outcome; we believe this injury is more common but under-reported in the literature. The surgeon should be aware and look specifically for this type of lesion during the procedure. Finding and treating this injury requires special postoperative care, non-weight-bearing instructions and balanced physiotherapy. PMID:26843223

  16. Computational and physical consequences of interaction of closely located simultaneous hydraulic fractures

    CERN Document Server

    Rejwer, Ewa

    2015-01-01

    Strong interaction of closely located, nearly parallel hydraulic fractures and its influence on their propagation are studied. Both computational and physical aspects of the problem are considered. It is shown that from the computational point of view, when a distance between cracks is small as compared with their sizes, the system becomes ill-conditioned and numerical results deteriorate. The physical consequence of the interaction consists in decreasing of the crack opening and even greater decrease of conductivity. Then the resistance to fluid flow grows what results in the propagation of only those fractures, the distance between which is large enough. The research aims to suggests a means to overcome the computational difficulty and to improve numerical simulation of hydraulic fractures in shales. Numerical experiments are carried out for a 2D problem by using the complex variable hypersingular boundary element method of higher order accuracy. The condition number of the main matrix of a system, the open...

  17. Open vs. closed reduction combined with minimally invasive plate osteosynthesis in humeral fractures.

    Science.gov (United States)

    Liu, Yin-Wen; Wei, Xiao-En; Kuang, Yong; Zheng, Yu-Xin; Gu, Xin-Feng; Zhan, Hong-Sheng; Shi, Yin-Yu

    2016-08-01

    Aim To explore a more effective surgical procedure, the outcomes of closed manipulative reduction (CMR) combined with minimally invasive plate osteosynthesis (MIPO) and conventional open reduction and internal fixation (ORIF) for treating proximal humeral fractures were compared. Material and methods In a retrospective study of patients operated for humerus shaft fractures from April 2008 to July 2011, the outcomes of 33 patients treated with CMR/MIPO were compared with the outcomes of 42 patients treated with ORIF. The fractures were classified, and the incision length, blood transfusion, operating time, as well as the VAS (Visual Analog Scale) pain scores were analyzed. The neck-shaft angles of the proximal humerus were detected, and the postoperative function of the shoulder was evaluated. Results The mean values of incision length, blood transfusion, and VAS pain scores at the 1st and 3rd day after CMR/MIPO and operation time were lower than that of ORIF. The postoperative radiographs verified good position of all screws and satisfactory bone fracture reduction in both groups. Meanwhile, in the ORIF group, nonunion (three cases) and humeral head necrosis (four cases) were detected. Conclusions The MR/MIPO technique showed smaller incisions, easier operation, less blood transfusion and more effective recovery of shoulder joint function for treating proximal humeral fractures than ORIF. PMID:27266386

  18. Avaliação biomecânica das fraturas intra-articulares do calcâneo e sua correlação clínica radiográfica Biomechanical evaluation of intra articular calcaneal fracture and clinical radiographic correlation

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2004-06-01

    Full Text Available O presente estudo teve o objetivo de oferecer uma avaliação clínica, radiográfica e biomecânica de pacientes com fratura intraarticular de calcâneo, submetidos à redução aberta e fixação interna. A amostra consistiu em 22 pacientes, 20 do sexo masculino e dois do sexo feminino, com idade média de 40,95 (± 11,63 anos. Os autores realizaram avaliações radiográficas do ângulo de Böhler e Gissane, no pré e no pós-operatório, além de utilizarem a tomografia computadorizada para avaliação da classificação de Sanders. A avaliação da Distribuição da Pressão Plantar foi realizada pelo sistema F-scan. Os resultados clínicos encontrados foram satisfatórios apresentando, pontuação média de 75,5 no critério da AOFAS.. A redução cirúrgica resultou em uma melhora dos ângulos de Böhler e Gissane. O estudo mostrou diferenças estatisticamente significantes entre o antepé o retropé fraturados no que tange sobre a área de contato, pressão e força de reação do solo. Os valores encontrados para estes parâmetros foram maiores no retropé que no antepé fraturados. A trajetória de Pressão (COP foi menor no pé fraturado que no pé normal. Encontrou-se correlação entre o Ângulo de Gissane após a redução e o Segundo Pico de Força, indicando que quanto melhor a redução deste ângulo , melhor a impulsão. Também encontrou-se a correlação entre a pontuação AOFAS e o Primeiro Pico de Força, mostrando que quanto melhor o resultado clínico melhor o apoio do retropé.The present study had an objective to perfom a clinical, radiographic and biomechanical evaluation in patients with calcaneal fractures submitted to open reduction with internal fixation. The sample consisted of 22 patients - 20 male and 2 female with an average age of 40,95 (±11,63 years old. The authors have done radiographic evaluation of the pre and post operatory of Böchler and Gissane angles; furthermore, they used a CT scanning for Sander

  19. MANAGEMENT OF DISPLACED SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN BY CLOSED REDUCTION AND PERCUTANEOUS PINNING

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    Srinivas

    2015-06-01

    Full Text Available INTRODUCTION: Supracondylar fracture of the humerus is common injury in children between the ages of 5 to 10 years. With males are affected twice high than females . The average age incidence was 8.3 years. Proper clinical and radiological examination is necessary for type of displacement and type of treatment. Percutaneous pinning of supracondylar fracture is certainly not a new technique ( 5 , but it had excellent results in various series , compar atively with other techniques. Closed reduction and crossed percutaneous pinning is a reliable method of treatment for severely displaced supracondylar fractures of the humerus in children . MATERIALS: In our study 25 patients were treated with closed reduction and percutaneous pinning between 2009 - 2014 . All 25 fractures were extension type III and closed variety. Left s ide was involved in 20 patients and Right side in 5 patients. The commonest mode of injury was by fall while playing and fall from bicy le. The displacement of the fracture was posteromedial in 19 patients and posterolateral in 6 patients. RESULTS: In our study we had 84% excellent or good results and 16% fair or poor results. Results were assessed according to the flynn’s criteria. W e had following complications after percutaneous pinning . In one patient ulnar neuropraxia developed because of the medial pin. After 1 week medial pin was removed and following that patient recovered completely. In our study one patient had radial and median n erve injury and developed myositis ossificans . Mild degree of volkmann’s ischaemia and restriction of elbow movements. All these were because of the patient had massage and manipulation elsewhere before the treatment. Another patient had mild degree of cub itus varus deformity. DISCUSSION: Closed reduction with immobilization in cast and Dunlop’s traction , skeletal traction necessitates either longer duration of hospitalization or supervision of the patient constantly . Open

  20. Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    Cao Liehu; Wang Bin; Li Ming; Song Shaojun; Weng Weizong; Li Haihang; Su Jiacan

    2014-01-01

    Objective:To compare the clinical effects between closed reduction and internal fixation (CRIF) and total hip arthroplasty (THA) for displaced femoral neck fracture.Methods:In this prospective randomized study,285 patients aged above 65 years with hip fractures (Garden Ⅲ or Ⅳ) were included from January 2001 to December 2005.The cases were randomly allocated to either the CRIF group or THA group.Patients with pathological fractures (bone tumors or metabolic bone disease),preoperative avascular necrosis of the femoral head,osteoarthritis,rheumatoid arthritis,hemiplegia,long-term bed rest and complications affecting hip functions were excluded.Results:During the 5-year follow-up,CRIF group had significantly higher rates of complication in hip joint,general complication and reoperation than THA group (38.3% vs.12.7%,P<0.01; 45.3% vs.21.7%,P<0.01; 33.6% vs.10.2%,P<0.05 respectively).There was no difference in mortality between the two groups.Postoperative function of the hip joint in THA group recovered favorably with higher Harris scores.Conclusion:For displaced fractures of the femoral neck in elderly patients,THA can achieve a lower rate of complication and reoperation,as well as better postoperative recovery of hip joint function compared with CRIF.

  1. Calcaneal loading during walking and running

    Science.gov (United States)

    Giddings, V. L.; Beaupre, G. S.; Whalen, R. T.; Carter, D. R.

    2000-01-01

    PURPOSE: This study of the foot uses experimentally measured kinematic and kinetic data with a numerical model to evaluate in vivo calcaneal stresses during walking and running. METHODS: External ground reaction forces (GRF) and kinematic data were measured during walking and running using cineradiography and force plate measurements. A contact-coupled finite element model of the foot was developed to assess the forces acting on the calcaneus during gait. RESULTS: We found that the calculated force-time profiles of the joint contact, ligament, and Achilles tendon forces varied with the time-history curve of the moment about the ankle joint. The model predicted peak talocalcaneal and calcaneocuboid joint loads of 5.4 and 4.2 body weights (BW) during walking and 11.1 and 7.9 BW during running. The maximum predicted Achilles tendon forces were 3.9 and 7.7 BW for walking and running. CONCLUSIONS: Large magnitude forces and calcaneal stresses are generated late in the stance phase, with maximum loads occurring at approximately 70% of the stance phase during walking and at approximately 60% of the stance phase during running, for the gait velocities analyzed. The trajectories of the principal stresses, during both walking and running, corresponded to each other and qualitatively to the calcaneal trabecular architecture.

  2. The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

    Directory of Open Access Journals (Sweden)

    Gulseren Kayalar

    2009-01-01

    Full Text Available OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA. MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO, dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT, covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05. A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001, body mass index (BMI (r=0.223, p=0.001, number of live births (r=-0.229, p=0.001, breast feeding time (r=-0.064, p=0.001, and age at menarche (r=-0.050, p=0.008. The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001 and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001 at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001 and calcaneal

  3. Closed medial total subtalar joint dislocation without ankle fracture: a case report

    Science.gov (United States)

    2014-01-01

    Introduction Total subtalar dislocation without fracture of the ankle is a rare clinical entity; it is usually due to a traumatic high-energy mechanism. Standard treatment is successful closed reduction under general anesthesia followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks. Case presentation We present the case of a 30-year-old Moroccan woman who was involved in a road traffic accident. She subsequently received a radiological assessment that objectified a total subtalar dislocation without fracture of her ankle. She was immediately admitted to the operating theater where an immediate reduction was performed under sedation, and immobilization in a plaster boot was adopted for 8 weeks. The management of this traumatic lesion is discussed in the light of the literature. Conclusions Medial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain. PMID:25240955

  4. Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

    Energy Technology Data Exchange (ETDEWEB)

    Tresley, Jonathan [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States); University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States)

    2016-07-15

    To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

  5. Closed subtalar dislocation with non-displaced fractures of talus and navicular: a case report and review of the literature

    OpenAIRE

    Fotiadis, Elias; Lyrtzis, Christos; Svarnas, Theodoros; Koimtzis, Miltos; Akritopoulou, Kiriaki; Chalidis, Byron

    2009-01-01

    Closed subtalar dislocations associated with talus and navicular fractures are rare injuries. We report on a case of a 43-year-old builder man with medial subtalar dislocation that was further complicated by minimally displaced talar and navicular fractures. Successful closed reduction under general anesthesia was followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 ;weeks. At 3 years post-injury, the subtalar joint was stable, the foot and ankle mobility was i...

  6. Estimation of deformation and stiffness of fractures close to tunnels using data from single-hole hydraulic testing and grouting

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, A.; Tsang, C.-F.; Rutqvist, J.; Gustafson, G.

    2010-05-01

    Sealing of tunnels in fractured rocks is commonly performed by pre- or post-excavation grouting. The grouting boreholes are frequently drilled close to the tunnel wall, an area where rock stresses can be low and fractures can more easily open up during grout pressurization. In this paper we suggest that data from hydraulic testing and grouting can be used to identify grout-induced fracture opening, to estimate fracture stiffness of such fractures, and to evaluate its impact on the grout performance. A conceptual model and a method are presented for estimating fracture stiffness. The method is demonstrated using grouting data from four pre-excavation grouting boreholes at a shallow tunnel (50 m) in Nygard, Sweden, and two post-excavation grouting boreholes at a deep tunnel (450 m) in Aespoe HRL, Sweden. The estimated stiffness of intersecting fractures for the boreholes at the shallow Nygard tunnel are low (2-5 GPa/m) and in agreement with literature data from field experiments at other fractured rock sites. Higher stiffness was obtained for the deeper tunnel boreholes at Aespoe which is reasonable considering that generally higher rock stresses are expected at greater depths. Our method of identifying and evaluating the properties and impact of deforming fractures might be most applicable when grouting takes place in boreholes adjacent to the tunnel wall, where local stresses might be low and where deforming (opening) fractures may take most of the grout.

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

    Science.gov (United States)

    Kim, J H; Nam, D H

    2015-10-01

    Most surgeons agree that closed treatment provides the best results for condylar fractures in children. Nevertheless, treatment of the paediatric mandibular condyle fracture that is severely displaced or dislocated is controversial. The purpose of this study was to investigate the long-term clinical and radiological outcomes following the treatment of displaced or dislocated condylar fractures in children using threaded Kirschner wire and external rubber traction. This procedure can strengthen the advantage of closed reduction and make up for the shortcomings of open reduction. From March 1, 2005 to December 25, 2011, 11 children aged between 4 and 12 years with displaced or dislocated mandibular condyle fractures were treated using threaded Kirschner wire and external rubber traction under portable C-arm fluoroscopy. All patients had unilateral displaced or dislocated condylar fractures. The follow-up period ranged from 24 to 42 months (mean 29.3 months). Normal occlusion and pain-free function of the temporomandibular joint, without deviation or limitation of jaw opening, was achieved in all patients. This closed reduction technique in displaced or dislocated condylar fractures in children offers a reliable solution in preventing the unfavourable sequelae of closed treatment and the open technique, such as altered morphology, functional disturbances, and facial nerve damage. PMID:26117724

  8. Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible.

    Science.gov (United States)

    Hlawitschka, M; Loukota, R; Eckelt, U

    2005-09-01

    The study was performed to evaluate and compare the results of open and closed treatments of diacapitular fractures of the mandible. Following open reduction and internal fixation (ORIF) 14 patients with 15 displaced condylar fractures, which had caused a shortening of the mandibular ramus, were examined clinically (Helkimo index), radiologically (Orthopantomogram, Clementschitsch [reversed Towne's] view, Submentovertex view) and axiographically (CARDIAX). These findings were compared to a group of 29 patients with 34 similar condylar fractures which had been treated using closed techniques. Following ORIF patients showed better radiological results with regard to the mandibular ramus height, resorption and pathological changes to the condyle, compared to the patient group after closed functional treatment. In both groups some signs of dysfunction persisted, although there were slightly better results in the ORIF group. In 30% of the closed treatment group, lateral deviation during mouth opening, crepitus and occlusal disturbances were noted. No cases of occlusal disturbance were observed in the ORIF group. The axiographic examinations revealed a significant limitation of movement of the fractured condyle in both groups. However, after open treatment, the temporomandibular joint displayed significantly less irregularities in the condylar paths. In cases of complex reconstruction of the mandibular condyle, ORIF appears to improve the function of fractured condyles, when combined with a postoperative therapeutic exercise regime. PMID:16053886

  9. Fractures of the calcaneum. A review of 70 patients

    OpenAIRE

    Paul, M.; Peter, Robin; Hoffmeyer, Pierre

    2004-01-01

    We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced calcaneal fractures. At a mean of 6.5 years, we reviewed 70 patients with a calcaneal fracture who were divided into four groups: group 1, 18 patients with undisplaced fractures and a normal Böhler's angle (BA) who had been treated non-operatively; group 2, 23 with intra-articular fractures and a BA < 10 degrees who had been treated non-operatively; group 3, 13 with intra-articular ...

  10. Delayed recognition of pediatric calcaneal osteomyelitis: a case report

    OpenAIRE

    Mallia, Alvin James; Ashwood, Neil; Arealis, Georgios; Bindi, Frank; Zamfir, Georgiana; Galanopoulos, Ilias

    2015-01-01

    Introduction The diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient. Case presentation A 9-year-old white boy presented to our in...

  11. Closed reduction external fixator fixation versus open reduction internal fixation in the patients with Bennett fracture dislocation

    Institute of Scientific and Technical Information of China (English)

    Li Zhongzhe; Guo Yang; Tian Wen; Tian Guanglei

    2014-01-01

    Background The Bennett fracture is either a common or a challenging problem to hand surgeons.It is still debated whether closed or open reduction gives optimal results.This study aimed to describe and assess a closed reduction and mini-external fixator fixation technique for the treatment of Bennett's fracture dislocation and to compare this technique versus open reduction and internal fixation.Methods From October 2002 to December 2012,56 patients with Bennett's fracture dislocation were treated by closed reduction and mini-external fixator fixation and 32 patients were treated by open reduction and internal fixation in Jishuitan Hospital.Patients with an articular step-off of more than 1 mm were excluded.All patients were assessed at a mean followup of 7 years (range 2-10 years) and the two groups were compared with pain levels,active range of trapeziometacarpal motion,grip strength and pinch strength,arthritic changes,and adduction deformity.Results Based on primary closed reduction maintained,the rate of anatomic reduction is 63.6%.Radiographic fracture union was achieved in all patients at a mean time of 5 weeks.At the final follow-up,there was no difference between the two groups in mean union time and pain levels (P=-0.2).There was also no difference between the two groups regarding the active range of trapeziometacarpal motion (P=0.3),grip stength (P=0.6),pinch strength (P=0.2),arthritic change and loss of reduction (P=0.2).There was a significant correlation between adduction deformity and the development of arthritis (P=0.02).Conclusion Closed reduction mini-external fixator fixation should be first tried to apply in the treatment of Bennett's fracture dislocation,and open reduction internal fixation should only be performed for irreducible fractures.

  12. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Ignacio [Musculoskeletal Research Fellow at NYU Langone Medical Center, New York, NY (United States); Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires (Argentina); Rosenberg, Zehava [NYU Langone Medical Center, New York, NY (United States); Zember, Jonathan [Albert Einstein College of Medicine Jacobi Medical Center, Bronx, NY (United States)

    2016-04-15

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  13. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    International Nuclear Information System (INIS)

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  14. Treatment of Severely Displaced Radial Neck Fractures in Children With Percutaneous K-wire Leverage and Closed Intramedullary Pinning

    Science.gov (United States)

    Zhang, Fu-Yong; Wang, Xiao-Dong; Zhen, Yun-Fang; Guo, Zhi-Xiong; Dai, Jin; Zhu, Lun-Qing

    2016-01-01

    Abstract To evaluate the efficacy and safety of percutaneous K-wire leverage (PKWL) reduction and closed intramedullary pinning (CIMP) for the treatment of pediatric radial neck fractures. From June 2010 to December 2013, a total of 50 children with Judet III and IV radial neck fractures were treated at our hospital. Manual closed reduction was first attempted to reduce the radial neck fractures. Upon successful closed reduction or the radial neck–shaft angle was reduced to  0.05), but were significantly larger than group A in the radial neck–shaft angle and fracture displacement (P < 0.05). Group A and B had significantly shorter operation time than group C (58.4 ± 14.5 minutes, 55.2 ± 11.2 minutes, versus 81.4 ± 7.5 minutes, P < 0.05). Forty-five patients were followed up for a mean of 2 years. Bone union was achieved in all patients within a mean time of 4.1 months. The patients treated with manual reduction or percutaneous leverage reduction showed excellent results. Three patients, however, treated with open reduction showed 10 to 20° limitation in range of motion of the elbow. No other complications were seen. Percutaneous K-wire leverage and CIMP are safe and effective for the treatment of pediatric Judet III and IV radial neck fractures. PMID:26735536

  15. Closed head experimental traumatic brain injury increases size and bone volume of callus in mice with concomitant tibial fracture

    Science.gov (United States)

    Brady, Rhys D; Grills, Brian L; Church, Jarrod E; Walsh, Nicole C; McDonald, Aaron C; Agoston, Denes V; Sun, Mujun; O’Brien, Terence J; Shultz, Sandy R; McDonald, Stuart J

    2016-01-01

    Concomitant traumatic brain injury (TBI) and long bone fracture are commonly observed in multitrauma and polytrauma. Despite clinical observations of enhanced bone healing in patients with TBI, the relationship between TBI and fracture healing remains poorly understood, with clinical data limited by the presence of several confounding variables. Here we developed a novel trauma model featuring closed-skull weight-drop TBI and concomitant tibial fracture in order to investigate the effect of TBI on fracture healing. Male mice were assigned into Fracture + Sham TBI (FX) or Fracture + TBI (MULTI) groups and sacrificed at 21 and 35 days post-injury for analysis of healing fractures by micro computed tomography (μCT) and histomorphometry. μCT analysis revealed calluses from MULTI mice had a greater bone and total tissue volume, and displayed higher mean polar moment of inertia when compared to calluses from FX mice at 21 days post-injury. Histomorphometric results demonstrated an increased amount of trabecular bone in MULTI calluses at 21 days post-injury. These findings indicate that closed head TBI results in calluses that are larger in size and have an increased bone volume, which is consistent with the notion that TBI induces the formation of a more robust callus. PMID:27682431

  16. Simulating the pervasive fracture and fragmentation of materials and structures using randomly close-packed Voronoi tessellations.

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, Joseph E.

    2008-09-01

    Under extreme loading conditions most often the extent of material and structural fracture is pervasive in the sense that a multitude of cracks are nucleating, propagating in arbitrary directions, coalescing, and branching. Pervasive fracture is a highly nonlinear process involving complex material constitutive behavior, material softening, localization, surface generation, and ubiquitous contact. Two primary applications in which pervasive fracture is encountered are (1) weapons effects on structures and (2) geomechanics of highly jointed and faulted reservoirs. A pure Lagrangian computational method based on randomly close-packed Voronoi tessellations is proposed as a rational approach for simulating the pervasive fracture of materials and structures. Each Voronoi cell is formulated as a finite element using the reproducing kernel method. Fracture surfaces are allowed to nucleate only at the intercell faces. The randomly seeded Voronoi cells provide an unbiased network for representing cracks. In this initial study two approaches for allowing the new surfaces to initiate are studied: (1) dynamic mesh connectivity and the instantaneous insertion of a cohesive traction when localization is detected, and (2) a discontinuous Galerkin approach in which the interelement tractions are an integral part of the variational formulation, but only become active once localization is detected. Pervasive fracture problems are extremely sensitive to initial conditions and system parameters. Dynamic problems exhibit a form of transient chaos. The primary numerical challenge for this class of problems is the demonstration of model objectivity and, in particular, the identification and demonstration of a measure of convergence for engineering quantities of interest.

  17. Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet

    Science.gov (United States)

    Martinkevich, P.; Rahbek, O.; Møller-Madsen, B.; Søballe, K.; Stilling, M.

    2015-01-01

    Objectives Lengthening osteotomies of the calcaneus in children are in general grafted with bone from the iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and precise method for measurements of rigid body movements including the evaluation of joint implant and fracture stability, however, RSA has not previously been used in clinical studies of calcaneal osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal lengthening osteotomy (LCLO). Methods LCLO was performed in six fixed adult cadaver feet. Tantalum markers were inserted on each side of the osteotomy and in the cuboideum. Lengthening was done with a plexiglas wedge. A total of 24 radiological double examinations were obtained. Two feet were excluded due to loose and poorly dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits. Results Systematic bias was generally below 0.10 mm for translations. Precision of migration measurements was below 0.2 mm for translations in the osteotomy. Conclusion RSA is a precise tool for the evaluation of stability in LCLO. Cite this article: Bone Joint Res 2015;4:78–83. PMID:25957380

  18. 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

  19. 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

  20. A COMPARATIVE STU DY BETWEEN “CLOSED REDUCTION, CAST IMMOBILISATION “AND “CLOSED REDUCTION, PERCUTANEOUS K - WIRE FIXATION, CAST IMMOBILISATION” IN DISTAL RADIUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Subramaniam

    2015-08-01

    Full Text Available BACKGROUND DATA: D istal radius fracture is a common fracture encountered by an orthopaedic surgeon. V arious treatment modalities exist for the same. K - wire fixation being one among them. T he traditional closed reduction and cast immobilization also provides fair results. H e nce the need to know which among the two provides cost effective treatment for the patient. MATERIALS AND METHODS: prospective study done between the periods J uly 2005 to J une 2007. D orsally displaced distal radius fractures with or without intra articular involvement were included in the study. 42 patients were involved in the study. T hey were randomly divided into two groups of 21 each. C losed reduction and below elbow immobilization were done in 21 patients, and closed reduction, percutaneous k - wire fixa tion were done in another 21 patients. 6 patients were lost to follow up in both the groups. Parameters assessed at the end of one year are - clinical: pain, any evidence for pin tract infection, evidence for nerve lesion, evidence of reflex sympathetic dystrophy, evidence of tendon rupture, mobility of wrist joint – palmar flexion, dorsiflexion, pronation, supination, grip strength assessment using jamar dynamometer. RADIOLOGICAL: dorsal angle of radius and radial shortening were assessed. RESULTS: statistical analysis was computed using mean and standard deviation, between the two groups. ‘t’ test was used to compare the mean values. p<0.05 was considered statistically significant. C losed reduction, percutaneous k - wire fixation showed statistically significant value p<0.05 with postoperative grip strength. I ntra articular fractures showed significantly higher mean pain scale score compared to extra articular freactues. E xtra articular fractures showed significantly higher mean values in range of motion – palmar flexion, dorsiflexion, rotations and in grip strength. CONCLUSION: C losed reduction and percu tnaeus k - wire fix ation showed superior

  1. A STUDY OF CLOSED INTERLOCKING NAILING FOR FRACTURES OF SHAFT OF FEMUR IN ADULTS

    Directory of Open Access Journals (Sweden)

    Ashwin

    2013-06-01

    Full Text Available ABSTRACT: BACKGROUND:-This study is to determine the clinical course and results after interlocking nailing for femoral shaft fractures , merits and demerits of interlocking nailing, achieving the final goals of femoral shaft fracture management with special references to time for radiological union, knee stiffness, limb length discrepancy, ambulation and return to work. Femur is the strongest and heaviest bone in the human skeleton. It is also the longest bone contributing 26% to height of an individual. Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice, can cause prolong morbidity and extensive disability unless treatment is appropriate. Many treatment modalities were described; with many surgeons advocating different methods of treatment .At present Interlocking nailing of the femur seems to be the ideal method of treatment for complex femoral fractures.

  2. Operative management of closed intra-articular fractures of distal end of humerus in adults.

    Science.gov (United States)

    Bhattacharyya, Arunangsu; Jha, Amrish Kumar; Chatterjee, Debdutta; Ghosh, Bappaditya; Roy, Sandip Kumar; Banerjee, Debabrata

    2011-06-01

    This is a study of 60 patients with mean age of 30 years having intra-articular fracture of distal humerus of type C (AO classification). We treated these fractures by open reduction and internal fixation through transolecranon approach. Mean duration of operative time with that of injury was 10 days. In all the cases 1st the intracondylar fracture was fixed followed by reconstruction and stabilisation of medial and lateral pillar by 1/3 tubular plate and 3.5 mm dynamic compressent plate (DCP) or recon plate respectively. Minimum follow-up was of 1 year duration with average follow-up of 3 years. We could achieve 100% union with mean range of movement at the and of 1 year was 20 degree to 110 degree. Two fractures had delayed union, 5 patients had skin complications for which extended dressing was required. None of these patients required SSG or secondary suture.

  3. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards

    OpenAIRE

    Morris, R.; Sonibare, A.; Green, D.; Masud, T.

    2000-01-01

    OBJECTIVE—To investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards.
METHODS—All patients admitted to medical and geriatric wards with a pelvic fracture over a four year period were identified using the hospital clinical coding database. Data were collected from casenotes, hospital and Family Health Services Authority databases. Where available, pelvic radiographs were graded according to the Singh index.
RESULTS—The casenot...

  4. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma

    OpenAIRE

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-01-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date.

  5. ROLE OF LOW PROFILE PRECONTOURED DISTAL TIBIAL LOCKING PLATE USING MIPPO TECHNIQUE IN PILON FRACTURE

    Directory of Open Access Journals (Sweden)

    Isaac Sunder

    2015-10-01

    Full Text Available : Tibial pilon fracture – Spectrum of injury ranging from fractures caused by low energy rotational foces to fractures caused by high energy axial compression forces due to RTA/ fall from height with significant metaphyseal communition articular communition with diaphyseal extension. Almost 80% patients will have fibula fracture. The aim of the study is study the efficacy of LP PD DTP in the management of closed pilon fractures (OTA type A Type B and Type C 1 and open pilon fractures (Grade 1 Grade II Grade III A (Gustilo Anterson grading. 1. I have studied 21 patients of pilon fracture classified using AO/OTA classification Type A-metaphyseal; Type B–Partially articular; Type C Metaphyseal fracture with articular involvement. 2. Used LP/ PC/ Distal tibial plate using MIPPO technique in OTA–A, B and C 1 closed & grade I II Grade III A compound fractures. OBSERVATIONS: 1. In contrary to stages protocol (Ist external fixation with fibular plating after 2-3 Weeks ORIF/MIPPO with/Without bone grafting, it is done percutaneously or minimally invasive and it can be done on day 1 without any major soft tissue problem & post-operative infection. 2. Duration of stay in the hospital can be reduced. 3. Since it is done through calcaneal traction or femoral distractor – fibula length restored & plating may not be necessary all the time and fibula plating can be avoid if the soft tissue condition is not favorable for plating laterally. 4. Since it is done through calcaneal traction/femoral distractor inspite of ground glass communition–good reduction is almost always possible. 5. Since MIPPO–need for bone grafting in less. 6. As in staged protocol more time is spent in soft tissue healing and after 2–3 weeks, fractures reduction if difficult and almost impossible with indirect reduction and may warrant open reduction. I conclude that LP PC distal tibial plate using MIPPO technique offers several advantages over two staged protocol and improved

  6. Closed reduction of mandibular condyle fractures using C-arm fluoroscopy: a technical note.

    Science.gov (United States)

    Imai, Tomoaki; Michizawa, Masahiro; Yamamoto, Naofumi; Kai, Tatsuro

    2013-01-01

    We describe a C-arm technique for mandibular condylar fractures in an anatomic study using a model skull and show its feasibility in a clinical case. The C-arm allowed posterior-anterior visualization of the condylar process. The X-ray axis was canted ∼15 degrees cranially to the Frankfort horizontal line. The skull's sagittal plane was rotated ∼15 degrees ipsilaterally to the X-ray axis. This technique facilitates clear visualization of the condylar neck with easy, flexible, and timely adjustments. In selected cases, this method would convert the clinical settings of the condylar fracture pattern to that which would not be amenable to an open approach, making possible minimally invasive surgical procedures.

  7. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

    OpenAIRE

    Landorf Karl B; Zammit Gerard V; Menz Hylton B; Munteanu Shannon E

    2008-01-01

    Abstract Background Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Methods Weightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, SD 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiogra...

  8. Minimally invasive technologies in the treatment of closed fractures of the intercondylar elevation of the knee: a clinical case

    Directory of Open Access Journals (Sweden)

    Евгений Владимирович Ворончихин

    2015-12-01

    Full Text Available Тhis article presents a clinical case of the surgical treatment of a fracture in the intercondylar eminences of the knee joint in a 7-year-old child. Closed fractures of the intercondylar exaltation are mainly a characteristic of childhood. This type of damage occurs by dysfunction of the knee resulting from instability. Because the fracture of the intercondylar eminences of the knee joint in children is similar to the damage of the anterior cruciate ligament in adults, the current course of knee surgery is a minimally invasive technique. These include fixation of the intercondylar exaltation using video stroboscopy as well as the assistance of various implants (e.g., screw, wire, and Dacron. In the children's Department of Traumatology and Orthopedics of the Federal Center of Traumatology, Orthopedics and Endoprosthesis Replacement in Barnaul, various surgeries are performed, including arthroscopy of the right knee joint, intercondylar exaltation reposition, and fixation of the intercondylar exaltation latch Lupine (De PuyMitek.

  9. Efficacy Evaluation for the Treatment of Subcapital Femoral Neck Fracture in Young Adults by Capsulotomy Reduction and Closed Reduction

    Institute of Scientific and Technical Information of China (English)

    Cong Liu; Meng-Ting Liu; Peng Li; Hong-Hai Xu

    2015-01-01

    Background:Subcapital femoral neck fracture in young adults has many complications,and the incidence is increasing year-by-year.The selection of the proper operation method to avoid them is an ambiguous matter.This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and intemal fixation in young adults.Methods:From March 2003 to February 2010,65 young patients with subcapital femoral neck fractures were treated,including 39 males and 26 females with average age of 34.5 years (range,19-50 years); 29 cases of the left side and 36 cases of the right side.They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting.The two groups had no significant differences in sex,age,body mass index and preoperative Harris Hip Score.The observation criteria involved the length of the incision,blood loss,operation time,nonunion rate,avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.Results:Four of 65 patients were lost follow-up,and the follow-up rate was 93.8%,the average follow-up time was 38.7 months (range,33-47 months).In Group A,the incision length was 5.1 ± 2.2 cm,blood loss was 84.0 ± 13.2 ml,and operation time was 52.9 ± 10.2 min.In Group B,the incision length was 15.4 ± 4.6 cm,blood loss was 396.0 ± 21.3 ml,and operation time was 1 16.5 ± 15.3 min.Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B.ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B.Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B.The above index of two groups was considered statistically significant (P < 0.05).Conclusions:Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing,reduce ANFH

  10. A Thermo-Hydro-Mechanical modeling of fracture opening and closing due heat extraction from geothermal reservoir

    Science.gov (United States)

    Nand Pandey, Sachchida; Chaudhuri, Abhijit; Kelkar, Sharad

    2015-04-01

    -water injection. The initial fracture aperture was taken 1mm. The Young's modulus of rock matrix and joint stiffness were taken as 15GPa and 15GPa/m respectively. Our results show that the contraction of rock due to cooling causes the opening of the fracture near injection well. However in some regions where temperature drop is insignificant the compressive stress develops and fracture closes. As the heat extraction continues with time, further contraction of rock causes more aperture growth between the wells. For the above-mentioned computational domain, due to cold-water (20 °C) at mass flow rate 4kg/s, the aperture in the vicinity of the injection well increases by 75%. Our simulation for joint stiffness equal to 50GPa/m, show that the magnitudes of normal tensile and compressive stresses in the fracture/joint are almost same but the aperture alteration is proportionally reduced. Since the joint stiffness is a nonlinear function of opening, it is important to include a suitable nonlinear model for joint opening/closing while simulating the fracture transmissivity alter during heat extraction.

  11. Characteristics of calcaneal bone infarction: an MR imaging investigation

    Energy Technology Data Exchange (ETDEWEB)

    Abrahim-Zadeh, R.; Klein, R.M.; Leslie, D.; Norman, A. [Department of Radiology, New York Medical College, Macy Pavillion, Valhalla, NY 10595 (United States)

    1998-06-01

    Objective. Bone infarction (BI) of the calcaneus is an uncommon entity which has received little mention in the recent literature. In this paper, we review the MR images of six calcanei with BI, which demonstrate a pattern of presentation that may explain the etiology of BI at this unusual location. Design. A retrospective review was performed of the transcribed reports of the foot or ankle MR examinations at our institution. MR images of examinations with any marrow signal abnormality were reviewed for presence of BI and its distribution. Patients. Based on MRI criteria, four patients had calcaneal BI (none biopsy proven); they ranged in age from 37 to 51 years old. Two patients were diagnosed with systemic lupus erythematosus, one with fibrositis, and another with polymyositis. All were treated with corticosteroids. Results. Six calcanei (in four patients) contained a region of calcaneal BI. In five of the six, the lesions were entirely or predominantly located in the posterior half of the calcaneus. Conclusion. Two theories are proposed which may explain why BI predominantly occurs in the posterior half of the calcaneus. First, the convergence of the recurrent intraosseous calcaneal vessels may occasionally produce the equivalent of a single dominant vessel that is more prone to vascular accidents. Secondly, the region between the recurrent and the epiphyseal vessels may act as a watershed zone, increasing its susceptibility to ischemia. (orig.) With 4 figs., 1 tab., 8 refs.

  12. Displaced Intra-articular Fractures of the Calcaneus: with an emphasis on minimally invasive surgery

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2009-01-01

    textabstractDisplaced intra-articular calcaneal fractures are complex injuries. Classically these fractures are treated with open reduction and internal fixation (ORIF) or conservatively. When comparing these two treatment modalities, ORIF has a significantly higher rate of wound complications and c

  13. Traumatic pathologies of the calcaneal peroneal tubercle.

    Science.gov (United States)

    Heller, Eyal; Robinson, Dror

    2010-01-01

    The peroneal tubercle occurs in about one half of human feet. It size varies from a small nodule of less than 1mm height to a prominent spur up to 1cm in size. It had been noted to cause stenosing tenosynovitis of the peroneal tendons, especially in association with an accessory peroneal bone. The current manuscript describes two cases of symptomatic tenosynovitis developing after an ankle sprain with fracture of the peroneal tubercle. The tenosynovitis caused dysfunction of the peroneal tendons unresponsive to prolonged conservative therapy. Symptoms were resolved following surgical resection. PMID:20655732

  14. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2008-08-01

    Full Text Available Abstract Background Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Methods Weightbearing lateral foot radiographs of 216 people (140 women and 76 men aged 62 to 94 years (mean age 75.9, SD 6.6 were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. Results Of the 216 participants, 119 (55% had at least one plantar calcaneal spur and 103 (48% had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5. Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0, report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8 and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4. No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. Conclusion Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.

  15. PERCUTANEOUS BIPLANAR EXTERNAL FIXATOR METHOD FOR TREATMENT OF CALCONEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar

    2015-07-01

    Full Text Available Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patient s. We have used a biplanar percutaneous external fixator for treating calcaneal fractures per operative visualization of the fractures. We have treated 20 calcaneal fractures in 18 patients, 12 intra articular and five extra articular, with our percutaneou s external fixator system with under image intensifier and achieving the fracture reduction. Functional outcome was measured using the American Orthopaedic Foot and ankle society Hind foot score. All fractures united with a mean of 55 days. Partial weight bearing was possible in a mean of 1.8 days and full bearing was possible in a mean of 11.6 days. All the patients were returned to their original work within six weeks. Minor infectious complications occurred in 17.6 percent of cases. The average AOFAS sco re at six months follow up was 83.8. We conclude that our percutaneous external fixator technique for fracture calcaneum is an effective alternative to the currently available – surgical and conservative treatment modalities especially in lower socio econo mic labor population who need to return to their job as early as possible. Level of Evidence – IV Case series

  16. Stress Fracture of the Sacrum.

    Science.gov (United States)

    Hearn, Darren W; Humphrey, David W

    2015-11-01

    A physical therapist evaluated a 25-year-old male military trainee, who reported 1 week of left hip pain exacerbated by running and sitting cross-legged. At follow-up, the patient reported unchanged hip pain and new left knee pain. Due to potential for multifocal stress injuries outside the visual field of a single MRI, bone scan and single-photon emission computerized tomography were chosen as imaging modalities. Imaging revealed a nondisplaced lateral left-sided sacral stress fracture and left calcaneal stress fracture. J Orthop Sports Phys Ther 2015;45(11):965. doi:10.2519/jospt.2015.0411. PMID:27136290

  17. The conundrum of calcaneal spurs: do they matter?

    LENUS (Irish Health Repository)

    Moroney, Paul J

    2013-12-30

    Background: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. Methods: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). Results: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Conclusion: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant.

  18. [Dislocated intra-articular calcaneus fractures. Long-term follow-up after open reposition and osteosynthesis].

    Science.gov (United States)

    Funk, E M; Wiedemann, M; Bickel, R; Rüter, A

    1995-10-01

    A series of 98 patients with a total of 105 intra-articular fractures of the os calcis were operated on during a 10-year period between 1983 and 1992. We were able to follow up 60 patients with 64 fractures an average of 44 months (range, 18-105 months) postoperatively. At the time of follow up, 83.9% of patients had been back to work, 78.6% with the same employer as before. Five of the patients followed up had had to retire from work; each of these had one or more severe coexisting injuries. A compromising nerve injury occurred postoperatively in 3 out of 58 patients with closed fractures, in all cases following surgery with a medial or bilateral approach. In only 1 of the 58 patients followed up after closed fractures did a deep infection requiring arthrodesis occur. One patient had sympathetic reflex dystrophy (Sudeck). A good functional result in the lower ankle joint correlated with a good outcome. In contrast, postoperative improvement of the tuber angle and the degree of arthrosis seen radiographically did not. We conclude that operative repair of intraarticular calcaneal fractures is a procedure that can safely be procedure used to restore the ability to work in the majority of patients. The medial approach should preferably not be used, nor should the metal be extracted from the medial approach if this can be avoided. PMID:7502082

  19. Increased mast cell numbers in a calcaneal tendon overuse model

    DEFF Research Database (Denmark)

    Pingel, Jessica; Wienecke, Jacob; Kongsgaard Madsen, Mads;

    2013-01-01

    , immunohistochemistry, and second harmonic generation microscopy (SHGM). The left tendon was used for quantitative polymerase chain reaction (qPCR) analysis. An increased tendon cell density in the runners were observed compared to the controls (P = 0.05). Further, the intensity of immunostaining of protein kinase B, P...... (P = 0.03). IL-3 mRNA levels were correlated with mast cell number in sedentary animals. The qPCR analysis showed no significant differences between the groups in the other analyzed targets. The current study demonstrates that 7-week HIUR causes structural changes in the calcaneal tendon, and further...

  20. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

    OpenAIRE

    Pendse Aniruddha; Daveshwar R; Bhatt Jay; Shivkumar

    2006-01-01

    Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean peri...

  1. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma.

    Science.gov (United States)

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-06-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma. PMID:27504302

  2. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma.

    Science.gov (United States)

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-06-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma.

  3. Closed Medial Malleolar Multifragment Fracture With a Posterior Tibialis Tendon Rupture: A Case Report and Review of the Literature.

    Science.gov (United States)

    Formica, Matteo; Santolini, Federico; Alessio-Mazzola, Mattia; Repetto, Ilaria; Andretta, Angelo; Stella, Marco

    2016-01-01

    Ankle fractures represent an exciting field of traumatology because of the wide variety of clinical presentations, injury mechanisms, and treatment options. Rupture of the posterior tibialis tendon (PTT) with ankle fracture can occur during trauma that involves pronation and external rotation of the foot or, less commonly, secondary to direct trauma to the ankle. This tendon injury is uncommon and probably misdiagnosed in many cases, because of the difficult clinical examination secondary to the pain and swelling. The identification and early treatment of PTT tears is essential for good functional outcomes to prevent the main mid- to long-term complication of disabling acquired flatfoot due to tendon failure. In the present report, we provide a review of the published data regarding ankle fractures associated with PTT rupture and describe our experience with a case of a multifragment medial malleolus fracture and complete rupture of the PTT diagnosed intraoperatively and surgically treated in a 34-year-old male, with 2.5 years of follow-up. PMID:25977150

  4. 髌骨骨折关节镜下闭合复位内固定术后的康复训练%Rehabilitation exercises after closed reduction internal fixation of fracture of patella under arthroscope

    Institute of Scientific and Technical Information of China (English)

    朴成哲; 李培; 阿良; 王敏

    2003-01-01

    @@ INTRODUCTION Closed reduction internal fixation under arthroscope is performed from August, 2000 to April, 2001 and advanced domestic and foreign rehabilitation programs are combined to treat fracture of patella comprehensively, satisfying effects are achieved.

  5. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

    Energy Technology Data Exchange (ETDEWEB)

    Chundru, Usha [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Liebeskind, Amy; Beltran, Javier [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Seidelmann, Frank; Franklin, Peter [Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Fogel, Joshua [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Brooklyn College, Department of Economics, Brooklyn, NY (United States)

    2008-06-15

    To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter's neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10-92 years. Pearson chi-square analyses and Fisher's exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p < 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P<0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P < 0.001), plantar fasciitis (52.5% vs 11.0%, P<0.001), and PTTD (32.0% vs 11.0%, P<0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter's neuropathy. (orig.)

  6. Calcaneal osteosarcoma: a rare cause of heel pain in the paediatric population.

    Science.gov (United States)

    Taslakian, Bedros; Issa, Ghada; Saab, Raya; Jabbour, Mark N; Khoury, Nabil J

    2013-02-04

    Osteosarcoma is the most common primary non-haemopoietic malignant bone tumour in children and adolescents. However, it rarely occurs in the calcaneus with only a few case reports in the literature. We report a case of a 14-year-old boy with calcaneal osteosarcoma, who presented with heel pain followed by swelling. The pain was initially thought to be related to a benign process and treated with analgesics, delaying the diagnosis. We discuss the clinical presentation, the differential diagnosis, multi-imaging and pathological findings of a calcaneal osteosarcoma, its clinical outcome and the importance of early diagnosis to improve outcome.

  7. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

    Directory of Open Access Journals (Sweden)

    Thulesius Hans

    2010-03-01

    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  8. 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...... was performed. In the remaining studies, a slightly elevated (but not significant) infection rate was found when compared with closed reduction. Altogether, an infection rate of 5.0% was found in the closed reduction group whereas 10.6% and 14.6% were found when open reduction was performed using either plates...... 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...

  9. The effect of age, weight, and lifestyle factors on calcaneal quantitative ultrasound: the ESOPO study.

    Science.gov (United States)

    Adami, Silvano; Giannini, Sandro; Giorgino, Ruben; Isaia, GianCarlo; Maggi, Stefania; Sinigaglia, Luigi; Filipponi, Paolo; Crepaldi, Gaetano; Di Munno, Ombretta

    2003-05-01

    Quantitative ultrasound (QUS) techniques have been shown to be as good as bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA), in predicting fracture risk: QUS technique could increase substantially the accessibility to a reliable bone osteoporosis risk evaluation, but little is know regarding the relationship of QUS to risk factors that have been found to predict DXA-BMD values and this is even more true in men. We studied 6,811 postmenopausal women 40 to 80 years of age and 4,981 men 60-80 years of age representative of the general population of all regions of Italy. All participants were questioned on lifestyle habits and on their medical history. After a physical examination "bone stiffness" (called here for simplicity, stiffness), which is derived from the values of broadband ultrasound attenuation (BUA) and speed of sounds (SoS) was measured by a heel QUS device (Achilles apparatus, Lunar, Madison, USA). The most common recognized determinants of bone mass (either categorical or continuous variables) were modeled with stiffness by multiple regression analysis or ANOVA. Stiffness was strongly related to age and weight. After adjusting for these variables, the women who had taken hormone replacement therapy for more than a year had significantly higher stiffness values. The difference versus nonusers remained significant for up to 20 years-since-menopause (YSM). This effect was so strong that for further analysis these women were excluded. By multivariate analysis, stiffness was then found to be significantly related to recalled body weight at 25 years of age, actual and past cigarettes smoked per day, and dairy calcium intake. Stiffness was also associated with a number of categorial factors adjusted for age, weight, and YSM: prior ovariectomy, history of more than 2 months confined to bed, outdoor physical activity, smoking, chronic use of any drug, and past corticosteroid use. All these categorial and continuous variables predicted

  10. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

    Energy Technology Data Exchange (ETDEWEB)

    Kose, Ozkan [Diyarbakir Education and Research Hospital, Orthopaedics and Traumatology Clinic, Diyarbakir (Turkey); Diclekent Bulvari, Ataslar Serhat Evleri, Diyarbakir (Turkey)

    2010-04-15

    Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot. A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study. Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen. Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified. (orig.)

  11. The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: A prospective study

    Directory of Open Access Journals (Sweden)

    S Muthukumar Balaji

    2016-01-01

    Conclusion: ITS fracture with intact fibula is a common occurrence, and they can be treated safely with reamed IM nailing that provides good union rates and the excellent functional result even in open fractures.

  12. A Study of Incidence of calcaneal spurs in North Indian population: A dry bone study

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    G. S. Ghindha

    2015-07-01

    Full Text Available The calcaneal spurs are the most common cause of pain in heel. The pain appears when patient stands on the foot for walking and pain disappears when patient walks some distance. The most common causes of spur formation is chronic fasciitis, wears and tears of ligaments and fascia present in the sole of foot. When the fasciitis heals, during the healing process the calcification of fascia or ligaments takes place, which results into the spur formation. The present study has been conducted on 325 dry human calcanei, irrespective of their sex, in the Department of Anatomy of M. M. Medical College and Hospital, Kumarhatti, District Solan (Himachal Pradesh. The objective of this study is to assess the rate of incidence of the presence of spurs in the calcanei and their types present in these calcanei. The photographs of all types of calcaneal spurs are taken and recorded and the study is compared with the standard literature and previous studies done by other authors. Out of 325 calcanei, 150 (35.38 % cases are having inferior, posterior calcaneal spurs. In 28 (8.62 % cases both types of spurs have been found. Other calcanei are having either inferior or posterior calcaneal spurs. The inferior spurs are more common on right and left side i.e out of 325 cases 75 (23.08 % cases, and posterior spurs found in 40 (12,31 % cases, respectively. In 2 (0.61 % cases a scale type of spurs was present which was attached in the middle of the inferior surface of the calcanei and their anterior ends are free, sharp and pointing forwards. These observations are definitely helpful to the orthopedician, traumatologist and surgeons in their diagnosis and treatment.

  13. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report.

    Science.gov (United States)

    Yi, Tae-Im; Ha, Seung-A; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-02-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

  14. [Anatomical variants of the medial calcaneal nerve and the Baxter nerve in the tarsal tunnel].

    Science.gov (United States)

    Martín-Oliva, X; Elgueta-Grillo, J; Veliz-Ayta, P; Orosco-Villaseñor, S; Elgueta-Grillo, M; Viladot-Perice, R

    2013-01-01

    The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel. PMID:24701749

  15. On Bone Mineral Density in Calcaneal Bone of Jump Trail Foot and Swinging Foot for Long Jump Athletes%跳远运动员起跳脚与摆动脚根骨的骨密度研究

    Institute of Scientific and Technical Information of China (English)

    李广宇

    2012-01-01

    The purpose of this study is to explore the influence of long jump training on bone mineral density (BMD) of calcaneal bone and to perform medical supervision for nutrition and diet. 24 male and 16 female athletes participated in this study by means of achcilles insight cryoscope BMD instrument. The calcaneal ultrasonic conduction velocity is preset and compared with jump foot and swinging foot in long jump athletes. The results are as follow: The difference of BMD in jump trail foot and swinging foot was not trivial, and the calcaneal BMD of long jump athletes is found higher then benchmark. Some indices of BMD in jump foot are found to be correlated with body mass index (BMI). The value of bone density in 12.5 percentage of male athletes is under 85% people of same age, suggesting that some jump athletes are subject to risk of fracture. The long jump exercise helps promoting calcaneal BMD, but the BMD are found lower than normal value among some male athletes, indicating the need of interfere.%为了揭示跳远运动员的根骨骨密度特点,探讨了跳远训练对起跳脚跟骨骨密度的影响.研究采用超声Achcilles Insight根骨骨密度测定仪,就跳远运动员(24名男子和16名女子)的起跳脚和摆动脚进行跟骨骨密度的测定和分析.结果表明:跳远运动员起跳脚与摆动脚的跟骨骨密度指标无显著差异,运动员的骨密度指标较同龄人高:起跳脚骨强度、根骨骨密度与BMI指数呈显著相关:男运动员中有12.5%起跳脚骨和摆动脚根骨骨密度在同龄人的85%以下,提示部分运动员有骨折风险,需要一定的干预.

  16. Clinical effect of two operation methods in treatment of Sanders II type calcaneus fractures

    Institute of Scientific and Technical Information of China (English)

    Dong Liu; Jun Hua; Yong-Ming Sun; Lu-Min Cao

    2015-01-01

    Objective:To explore the differences between percutaneous reduction hollow screw internal fixation and open reduction plate internal fixation in the treatment of Sanders II type calcaneal fracture.Method:68 patients with Sanders II type calcaneal fracture from January, 2012 to February, 2013 were divided into poking group and open reduction group, 34 cases in each group. They were treated with poking reduction and internal fixation, as well as open reduction and internal fixation, and then followed up for one year successfully. The operation time, hospitalization time, wound healing time and the amount of bleeding were compared. The Maryland foot score system was employed to assess the function recovery of two groups and the related complications were recorded.Result:The operation time, hospitalization time, incision healing time and the amount of bleeding in operation of poking group were significantly less than the open reduction group; The excellent rate of functional recovery of poking group and open reduction group were 79.41% and 82.35%. The difference between two groups had no statistical significance; the complication rate of poking group and open reduction group were 2.94% and 17.65%. The difference between two groups had statistical significance.Conclusion:Poking reduction combined with internal fixation for the treatment of Sanders II type calcaneal fracture can not only reduce the wound and intraoperative bleeding, shorten operation and hospitalization time, but also prevent the occurrence of complications.

  17. Calcaneal acrometastasis from urothelial carcinoma of the ureter: a case report and literature review

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    Ryder JH

    2013-04-01

    Full Text Available Jonathan H Ryder,1 Sean V McGarry,2 Jue Wang1  1Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA; 2Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA Purpose: Ureteral cancer is a rare entity. Typical symptoms are painless hematuria as well as flank pain. Bone metastasis of ureteral cancer can occur in nearby bone structures, such as the spine, pelvis, and hip bone. Distal bone metastasis, such as that in the calcaneus bone, however, is rare. Case report: An 82-year-old woman presented to the orthopedic clinic at the university hospital with a 3-month history of left heel pain. A magnetic resonance imaging (MRI of her foot demonstrated a calcaneal lytic lesion. A biopsy of the lytic lesion showed urothelial carcinoma with squamous differentiation. A computed tomography (CT scan of the abdomen and pelvis showed left hydronephrosis and an obstructive mass in the left ureter, at the iliac crossing. The patient received combined therapy that included local radiation, bisphosphonate, and chemotherapy, with complete resolution of her cancer-related symptoms. However, she eventually died from the progressive disease, 20 months after the initial diagnosis. Conclusion: This case highlights the rare presentation of ureter cancer with an initial presentation of foot pain, secondary to calcaneal metastasis. Multimodality therapy provides effective palliation of symptoms and improved quality of life. We also reviewed the literature and discuss the clinical benefits of multidisciplinary cancer care in elderly patients. Keywords: urothelial carcinoma, elderly, calcaneal acrometastasis, multimodality therapy, chemotherapy, radiation

  18. Double calcaneal osteotomy with percutaneous Steinmann pin fixation as part of treatment for flexible flatfoot deformity: a review of consecutive cases highlighting our experience with pin fixation.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2015-01-01

    Surgical correction of flexible flatfoot deformity and posterior tibial tendon dysfunction has been extensively reported in published studies. When appropriate, calcaneal osteotomies for flatfoot correction have been a favorite of foot and ankle surgeons because of the corrective power achieved without the need to fuse any rearfoot joints. The medial displacement calcaneal osteotomy and Evans calcaneal osteotomy, together termed the double calcaneal osteotomy, have been reported several times by various investigators with a wide variety of fixation options. We undertook an institutional review board-approved retrospective review of 9 consecutive patients (11 feet), who had undergone double calcaneal osteotomy with 2 percutaneous Steinmann pin fixation for the correction of flexible flatfoot deformity, with or without posterior tibial tendon dysfunction. All patients had radiographic evidence of bone healing of the posterior calcaneal osteotomy and incorporation of the Evans osteotomy bone graft at 6 weeks and demonstrated clinical healing at 6 weeks. All patients had 2 percutaneous Steinmann pins placed through both osteotomies, and these were removed an average of 6 weeks postoperatively. No patient developed pin site complications. The only complication noted was sural neuritis, which was likely incision related. No patients had delayed union or nonunion, and we did not identify any graft shifting postoperatively. The present retrospective series highlights our experience with 2 percutaneous Steinmann pin fixation, demonstrating equal or better results than many previous published fixation methods for double calcaneal osteotomy. It is cost-effective and minimizes the potential risk of iatrogenic Achilles pathologic features associated with screw fixation.

  19. Misdiagnosis of multiple fracture and dislocation complicated with closed abdominal injury%多发骨折脱位合并腹腔闭合伤漏诊的临床分析

    Institute of Scientific and Technical Information of China (English)

    马成利; 甄淑平

    2011-01-01

    目的:探讨多发骨折脱位合并腹腔闭合伤的漏诊原因,以减少其发生率.方法:对我院2007年1月~2009年12月收治的116例多发骨折脱位合并腹腔闭合伤患者进行回顾性分析,确定漏诊的发生率及引起漏诊的原因.结果:经手术证实多发骨折脱位合并腹腔闭合伤漏诊率为20.7%(24/116),同期单发骨折脱位合并腹腔闭合伤的漏诊率仅为7.4%(4/54).结论:多发骨折脱位合并腹腔闭合伤容易出现漏诊.拓宽诊断视野、全面系统检查、仔细观察病情变化,大多数漏诊是可以避免的,而反复腹腔穿刺是提高腹腔脏器损伤诊断率的重要手段.%Objective:To explore reasons that cause misdiagnosis of multiple fracture and dislocation complicated with closed abdominal injury in order to reduce its incidence. Methods: Data of 116 cases of multiple fracture and dislocation complicated with closed abdominal injury that admitted into our hospital from January 2007 to December 2009 were retrospectively analyzed in order to calculate the incidence and find out cause of misdiagnosis. Results:Incidence of confirmed misdiagnosis of multiple fracture and dislocation complicated with closed abdominal injury was 20. 7% (24/116), while the corresponding incidence for simple fracture and dislocation complicated with closed abdominal injury was 7.4 % (4/54 cases).Conclusions: Multiple fracture and dislocation complicated with closed abdominal injury can be easily misdiagnosed, but comprehensive examination, especially, peritoneo-puncture can screen out closed abdominal injury effectively

  20. A mechanical chest compressor closed-loop controller with an effective trade-off between blood flow improvement and ribs fracture reduction.

    Science.gov (United States)

    Zhang, Guang; Wu, Taihu; Song, Zhenxing; Wang, Haitao; Lu, Hengzhi; Wang, Yalin; Wang, Dan; Chen, Feng

    2015-06-01

    Chest compression (CC) is a significant emergency medical procedure for maintaining circulation during cardiac arrest. Although CC produces the necessary blood flow for patients with heart arrest, improperly deep CC will contribute significantly to the risk of chest injury. In this paper, an optimal CC closed-loop controller for a mechanical chest compressor (OCC-MCC) was developed to provide an effective trade-off between the benefit of improved blood perfusion and the risk of ribs fracture. The trade-off performance of the OCC-MCC during real automatic mechanical CCs was evaluated by comparing the OCC-MCC and the traditional mechanical CC method (TMCM) with a human circulation hardware model based on hardware simulations. A benefit factor (BF), risk factor (RF) and benefit versus risk index (BRI) were introduced in this paper for the comprehensive evaluation of risk and benefit. The OCC-MCC was developed using the LabVIEW control platform and the mechanical chest compressor (MCC) controller. PID control is also employed by MCC for effective compression depth regulation. In addition, the physiological parameters model for MCC was built based on a digital signal processor for hardware simulations. A comparison between the OCC-MCC and TMCM was then performed based on the simulation test platform which is composed of the MCC, LabVIEW control platform, physiological parameters model for MCC and the manikin. Compared with the TMCM, the OCC-MCC obtained a better trade-off and a higher BRI in seven out of a total of nine cases. With a higher mean value of cardiac output (1.35 L/min) and partial pressure of end-tidal CO2 (15.7 mmHg), the OCC-MCC obtained a larger blood flow and higher BF than TMCM (5.19 vs. 3.41) in six out of a total of nine cases. Although it is relatively difficult to maintain a stable CC depth when the chest is stiff, the OCC-MCC is still superior to the TMCM for performing safe and effective CC during CPR. The OCC-MCC is superior to the TMCM in

  1. Preliminary screening of osteoporosis and osteopenia in middle aged urban women from Hyderabad (INDIA using calcaneal QUS

    Directory of Open Access Journals (Sweden)

    Ashwin Kasturi

    2015-08-01

    Conclusions: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis. [Int J Res Med Sci 2015; 3(8.000: 2029-2033

  2. A CLINICAL STUDY ON FUNCTIONAL OUTCOME AFTER COMBINED ARTHROSCOPIC AND FLUOROSCOPIC ASSISTED REDUCTION AND INTERNAL FIXATION OF CLOSED TIBIAL PLATEAU FRACTURES IN ADULTS

    Directory of Open Access Journals (Sweden)

    Bhavani Prasad

    2015-06-01

    Full Text Available BACKGROUND AND INTRODUCTION: Management of tibial plateau fractures had witnessed tremendous improvement in surgical techniques over the past decades. Conservative treatment of these fractures results in consistently poor results. The present literature supports that absolute anatomi cal reduction and stable fixation of peri articular fractures followed by early post - operative rehabilitation is crucial for good results. And if this is achieved by minimal damage to soft tissue the results are much better. In this study it is achieved by arthroscopy and fluoroscopy. MATERIALS AND METHODS: We have conducted a prospective study between September 2009 to august 2013 including 9 patients with tibial plateau fractures treated with combined arthroscopic and fluoroscopic reduction and internal f ixation with or without bone grafting. And then the radiographic and functional evaluation done. RESULTS: According to Hohl’s clinical and radiographic scoring systems 4 patients were assessed excellent, 3 good, 2 fair. According to Rasmussen’s clinical sc oring system 4 patients excellent, 3 good and 2 fair results. CONCLUSION: The use of arthroscopy and fluoroscopy in the management of tibial plateau fractures results in good outcome. It also helped to simultaneously treat the meniscal injuries. But its use is mainly limited to Shatzkar type1, 2, 3, 4

  3. Application of CT Three Dimensional Reconstruction Technique for Closed Tibia Shaft Fracture%CT三维重建技术在闭合性胫骨骨折中的应用

    Institute of Scientific and Technical Information of China (English)

    曹渊武; 沈笛; 陈子贤; 姜晓幸; 施德源; 姜南春

    2015-01-01

    目的:探讨C T三维重建技术诊断闭合性胫骨骨折合并踝关节损伤的准确性。方法:对117例在复旦大学附属中山医院就诊的闭合性胫骨骨折患者术前常规行X线及三维CT检查。比较两种检查手段对胫骨骨折合并踝关节损伤的诊断价值。结果:术前X线检查发现19例胫骨骨折患者合并后踝骨折;而三维C T重建图像发现34例患者伴后踝骨折,比X线摄片多检查出15例。结论:对于胫骨骨折合并后踝关节损伤,三维C T重建技术较X线检查的诊断率更高,能降低漏诊率。%Objective:To explore the accuracy of CT three dimensional reconstruction technique for the diagnosis of tibia shaft fracture accompanied by ankle injury .Methods:Both X‐ray examination and three dimensional CT scanning were conducted for the 117 patients with closed tibia shaft fracture ,who went to Zhongshan Hospital of Fudan University ,before surgery .The numbers of patients ,who were diagnosed with tibia shaft fracture accompanied by ankle injury ,were compared between the two examination methods .Results:Nineteen patients with tibia shaft fracture were diagnosed with accompanied posterior malleolar fracture by X‐ray examination before surgery . However ,34 patients were diagnosed with accompanied posterior malleolar fracture by CT three dimensional reconstruction images . Thus , 15 more patients were diagnosed by CT three dimensional reconstruction technique than that by X‐ray imaging .Conclusions:Comparing with X‐ray examination , three dimensional CT reconstruction technique could increase the diagnosis accuracy for posterior malleolar fracture associated with tibia shaft fracture and reduce the rate of missed diagnosis .

  4. Open window for reduction and plate fixation under direct vision to treat the calcaneal frac-tures%开窗直视下联合复位内固定治疗跟骨骨折

    Institute of Scientific and Technical Information of China (English)

    陈小亮; 叶哲伟; 刘建湘; 张国磊; 安颖; 马秀才; 杨述华

    2014-01-01

    Objective To investigate the clinical efficacy of opening window from lateral calcaneous under direct vi-sion followed by reduction and internal fixation to treat the calcaneal fractures. Methods 36 cases (38 feet) of Sand-ersⅡ~Ⅳtypes of calcaneal fractures were treated by using the method of opening window from lateral calcaneous for reduction of collapse of articular surface and restoring the Gissane angle, Böhler angle under the direct vision as far as possible, and internal fixation after bone graft in the bone defect place. X-ray Böhler angle, Gissane angle and the length, width, height of calcaneal bone after operation were measured and compared with preoperative. According to the Maryland-foot score, the curative effect was assessed for postoperative function. Results 31 patients(32 feet) were followed up for 12~24 months,5 cases (6 feet) were lost. X-ray indicated all patients achieved bone healing after one year. Preoperative Böhler angle was -3. 6° ± 5. 8°, and postoperative was 29. 4° ± 4. 0°,there was statisti-cal significance(P<0. 05);preoperative angle of Gissane was 88. 9° ± 6. 3°,postoperative was 115. 9° ± 5. 6°, there was statistical significance(P<0. 05);the length, width and height of calcaneal bone between preoperative and post-operative,there was statistical significance(P<0. 05). The Maryland-foot score system for postoperative function was excellent in 11 feet, good in 13, fair in 5, and poor in 3. Conclusions Open window for reduction and plate fixa-tion under direct vision for sanders type Ⅱ,Ⅲ fracture curative effect is satisfied and for type Ⅳ fracture is good.%目的:探讨跟骨外侧开窗直视下联合复位钢板内固定治疗跟骨骨折的临床疗效。方法对36例(38足) SandersⅡ~Ⅳ型跟骨骨折患者采用跟骨外侧切口,在跟骨外侧皮质开窗后直视下复位塌陷的关节面,尽量恢复Gissane角、Böhler角;对有骨缺损者行自体髂骨及异体骨植骨后钢板内

  5. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

    Directory of Open Access Journals (Sweden)

    Pendse Aniruddha

    2006-01-01

    Full Text Available Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months. Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

  6. 桡骨远端骨折手法复位并石膏外固定临床疗效观察%Effect of manipulative reduction and cast immobilization in the treatment of closed distal radius fracture

    Institute of Scientific and Technical Information of China (English)

    牟朋林; 杨建惠; 吴武; 汪友平

    2014-01-01

    Objective To investigate the clinical efficacy of manipulative reduction and cast immobilization in the treatment of closed distal radius fracture.Methods 78 elderly patients with distal radial fractures were treated with closed reduction and cast immobilization,and received X-rays and regular assessment of wrist function after operation.We analyzed the effect at different time points.Results The postoperative X-ray examination showed,60 cases achieved desired effect of anatomic reduction,18 cases of functional reduction.At the final follow-up time point,Functional Assessment Scoring of 55 cases was excellent,23 cases of good.Conclusion Manual reduction combined with cast immobilization in the treatment of closed distal radius fractures can obtain satisfying outcome.%目的 观察手法复位并石膏外固定治疗闭合性桡骨远端骨折的临床疗效并探讨手法复位成功的关键因素.方法 对78例中老年桡骨远端骨折患者采用手法复位并石膏外固定治疗,术后定期进行X线和腕关节功能评估.结果 术后X线检查达到解剖复位60例,功能复位18例;末次随访时腕关节评分获优55例,良23例.结论 手法复位并石膏外固定治疗闭合性桡骨远端骨折可取得满意效果.

  7. 高弓马蹄内翻足术后复发与跟骨截骨%The recurring of varus and the lateral shift calcaneal osteotomy in the treatment of cavovarus foot

    Institute of Scientific and Technical Information of China (English)

    徐向阳; 刘津浩; 朱渊; 徐继平

    2009-01-01

    Objective To discuss the recurring of varus in the treatment of cavovarus foot and the relationship between correcting degree of lateral shift calcaneal osteotomy and the recurring rate.Methods Twenty-three patients (31 feet) with cavovarus foot were treated, which included 9 males and 14 females.According to the Coleman block test before the surgery, the manual passive correcting degree after the medial soft tissue release and/or the tendon lengthening and whether the calcaneal osteotomy were done, and the feet were divided into four groups.There were 0° and beyond 5° two levels of passive valgus for further differentiating and statistically analysis.The calcaneal osteotomy included lateralizing sliding osteotomy, posterior osteotomy and closing wedge osteotomy.Results In the effective following-up of 31 feet, hind foot varus recurred in 9 feet.Five varus were below 5° and 4 varus beyond 5°.The value is 4.23°±2.15°.The varus recurred in 3 feet without calcaneal osteotomy, whose Coleman block test before the surgery could correct the foot to neutral position.The varus did not recur in 4 feet without calcaneal osteotomy whose Coleman block test could correct the foot to more than 5° valgus.If the Coleman block test could not correct varus before the surgery, the varus recurred in 2 feet which could be corrected to neutral position after medial soft tissue release, while only one recurred varus in 3 feet which could be corrected to more than 5 valgus after medial soft tissue release.For the 19 feet with calcaneal osteotomy, one varus recurred in 9 feet which Coleman block test could correct the hind foot into neutral position, two varus recurred in 7 feet which Coleman block test could not correct the varus before the surgery but could correct to neutral position after the medial soft tissue release, no one varus recurred in 3 feet which Coleman block test could not correct the varus before the surgery but could correct to more than 5° valgus after the

  8. Previous physical exercise slows down the complications from experimental diabetes in the calcaneal tendon

    Science.gov (United States)

    Bezerra, Márcio Almeida; da Silva Nery, Cybelle; de Castro Silveira, Patrícia Verçoza; de Mesquita, Gabriel Nunes; de Gomes Figueiredo, Thainá; Teixeira, Magno Felipe Holanda Barboza Inácio; de Moraes, Silvia Regina Arruda

    2016-01-01

    Summary Background the complications caused by diabetes increase fragility in the muscle-tendon system, resulting in degeneration and easier rupture. To avoid this issue, therapies that increase the metabolism of glucose by the body, with physical activity, have been used after the confirmation of diabetes. We evaluate the biomechanical behavior of the calcaneal tendon and the metabolic parameters in rats induced to experimental diabetes and submitted to pre- and post-induction exercise. Methods 54-male-Wistar rats were randomly divided into four groups: Control Group (CG), Swimming Group (SG), Diabetic Group (DG), and Diabetic Swimming Group (DSG). The trained groups were submitted to swimming exercise, while unexercised groups remained restricted to the cages. Metabolic and biomechanical parameters were assessed. Results the clinical parameters of DSG showed no change due to exercise protocol. The tendon analysis of the DSG showed increased values for the elastic modulus (ptendinopathy process, but prevent the progress of degeneration. PMID:27331036

  9. Fracture mechanics safety approaches

    Energy Technology Data Exchange (ETDEWEB)

    Roos, E.; Schuler, X.; Eisele, U. [Materials Testing Inst. (MPA), Univ. of Stuttgart (Germany)

    2004-07-01

    Component integrity assessments require the knowledge of reliable fracture toughness parameters characterising the initiation of the failure process in the whole relevant temperature range. From a large number of fracture mechanics tests a statistically based procedure was derived allowing to quantify the initiation of fracture toughness as a function of temperature as a closed function as well as the temperature dependence of the cleavage instability parameters. Alternatively to the direct experimental determination one also can use a correlation between fracture toughness and notch impact energy. (orig.)

  10. 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.

  11. CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Walter W. Virkus

    2008-12-01

    displaced bimalleolar fracture in insulin dependant middle aged woman; Man-agement of calcaneal fractures; Fixation technic for a displaced talar neck fracture in a patient in ER; Indica-tions for surgical treatment of metatarsal fractures; Bone grafting in acute fractures; Management of a nonunion of plated midshaft tibia fracture; Management of a child with a twisted ankle and normal x-rays; Assessment of com-partment syndrome in foot.The Section III is about “GENERAL FRACTURE CARE” including: Management of multiple orthopedic injuries and damage control orthopedics; Bone stimula-tion in nonunion; Indications for locking plates; Fractures requiring anatomic reduction.AUDIENCE: Mainly trauma fellows and practicing or-thopedists are the targeted audience of the book, but not only the basic knowledge for the orthopedic residents but also the expert advices for complicated and controversial cases pointing experienced surgeons widen the spectrum of audience. Also non-physician personnel may benefit the basic knowledge from brief answers given in a casual format.ASSESMENT: “Curbside Consultation in Fracture Man-agement:49 Clinical Questions” offering practical, brief, evidence based answers to frequently asked questions especially those have been often left controversial related with the treatment of fractures of upper and lower extrem-ity, pelvic fractures is a useful resource mainly for resi-dents, fellows and junior orthopedists. Casual format that mimics a “curbside” dialog of colleagues and also the rich illustrations by images and diagrams makes the advanced knowledge in the text easier to understand and learn. Questions are carefully chosen from a wide spectrum of subjects related to fracture management to form a unique reference including high and low energy trauma fractures, pediatric fractures, fractures in elderly, multiple orthope-dic injury, and general fracture care. Assessment of frac-tures and diagnostic approach, postoperative care and

  12. Transphyseal Distal Humerus Fracture.

    Science.gov (United States)

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  13. Risk factors of failure in closed reduction for supracondylar fractures of humerus in children%儿童肱骨髁上骨折闭合复位失败的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杨杰; 孙辽军; 杜胜虎; 黄祥祥; 陈华; 郭晓山

    2013-01-01

    目的 探讨导致儿童肱骨髁上骨折闭合复位失败的危险因素,从而指导临床治疗.方法 回顾性分析2008年2月至2013年2月于本院治疗的138例肱骨髁上骨折患儿的临床资料,记录其年龄、BMI指数、受伤机制、骨折类型、受伤至手术时间、最大初始移位(对位及旋转).采用均值比较或卡方检验对以上因素进行单因素分析,再采用多因素logistic分析对可能的危险因素进行分析,以明确肱骨髁上骨折闭合复位失败的相关因素.结果 单因素分析显示BMI指数、骨折类型、受伤至手术时间、最大初始移位与儿童肱骨髁上骨折闭合复位失败有显著相关性,多因素Logistic回归分析显示,骨折类型、受伤至手术时间、最大初始移位是儿童肱骨髁上骨折闭合复位失败的独立危险因素.结论 伤后肿胀高峰期、GartlandⅢ型骨折、初始移位大的患儿闭合复位失败机率高,选择复位及固定方式时应仔细考虑这些危险因素.%Objective To investigate the risk factors of failure in closed reduction for supracondylar fracture of humerus in children and to guide clinical treatment.Methods Children with supracon dylar fractures who were treated in our hospital from February 2008 to February 2013 were studied.Age,BMI index,mechanism of injury,fracture type,duration from injury to surgery,the maximum initial displacement (right position and rotation) were analyzed.Mean comparison or chi-square test was used for univariate analysis and multivariate logistic regression analysis was used to identify possible risk factors.Results Univariate analysis showed that BMI index,fracture type,duration from injury to surgery and the maximum initial displacement were significantly correlated with the failure in closed reduction.Multivariate logistic regression analysis showed that the type of fracture,duration from injury to surgery and the maximum initial displacement were independent risk factors

  14. Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

    OpenAIRE

    Sendeht Ayuba J; Obadofin Michael O; VanderJagt Dorothy J; Laabes Emmanuel P; Glew Robert H

    2008-01-01

    Abstract Background Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) ...

  15. Normative calcaneal quantitative ultrasound data for the indigenous Shuar and non-Shuar Colonos of the Ecuadorian Amazon

    OpenAIRE

    Madimenos, FC; Snodgrass, JJ; Blackwell, AD; Liebert, MA; Cepon, TJ; Sugiyama, LS

    2011-01-01

    Summary Minimal data on bone mineral density changes are available from populations in developing countries. Using calcaneal quantitative ultrasound (QUS) techniques, the current study contributes to remedying this gap in the literature by establishing a normative data set on the indigenous Shuar and non-Shuar Colonos of the Ecuadorian Amazon. Purpose The paucity of bone mineral density (BMD) data from populations in developing countries partially reflects the lack of diagnostic resources in ...

  16. Urinary Mineral Concentrations in European Pre-Adolescent Children and Their Association with Calcaneal Bone Quantitative Ultrasound Measurements

    Directory of Open Access Journals (Sweden)

    Karen Van den Bussche

    2016-05-01

    Full Text Available This study investigates differences and associations between urinary mineral concentrations and calcaneal bone measures assessed by quantitative ultrasonography (QUS in 4322 children (3.1–11.9 years, 50.6% boys from seven European countries. Urinary mineral concentrations and calcaneal QUS parameters differed significantly across countries. Clustering revealed a lower stiffness index (SI in children with low and medium urinary mineral concentrations, and a higher SI in children with high urinary mineral concentrations. Urinary sodium (uNa was positively correlated with urinary calcium (uCa, and was positively associated with broadband ultrasound attenuation and SI after adjustment for age, sex and fat-free mass. Urinary potassium (uK was negatively correlated with uCa but positively associated with speed of sound after adjustment. No association was found between uCa and QUS parameters after adjustment, but when additionally adjusting for uNa, uCa was negatively associated with SI. Our findings suggest that urinary mineral concentrations are associated with calcaneal QUS parameters and may therefore implicate bone properties. These findings should be confirmed in longitudinal studies that include the food intake and repeated measurement of urinary mineral concentrations to better estimate usual intake and minimize bias.

  17. Urinary Mineral Concentrations in European Pre-Adolescent Children and Their Association with Calcaneal Bone Quantitative Ultrasound Measurements †

    Science.gov (United States)

    Van den Bussche, Karen; Herrmann, Diana; De Henauw, Stefaan; Kourides, Yiannis A.; Lauria, Fabio; Marild, Staffan; Molnár, Dénes; Moreno, Luis A.; Veidebaum, Toomas; Ahrens, Wolfgang; Sioen, Isabelle

    2016-01-01

    This study investigates differences and associations between urinary mineral concentrations and calcaneal bone measures assessed by quantitative ultrasonography (QUS) in 4322 children (3.1–11.9 years, 50.6% boys) from seven European countries. Urinary mineral concentrations and calcaneal QUS parameters differed significantly across countries. Clustering revealed a lower stiffness index (SI) in children with low and medium urinary mineral concentrations, and a higher SI in children with high urinary mineral concentrations. Urinary sodium (uNa) was positively correlated with urinary calcium (uCa), and was positively associated with broadband ultrasound attenuation and SI after adjustment for age, sex and fat-free mass. Urinary potassium (uK) was negatively correlated with uCa but positively associated with speed of sound after adjustment. No association was found between uCa and QUS parameters after adjustment, but when additionally adjusting for uNa, uCa was negatively associated with SI. Our findings suggest that urinary mineral concentrations are associated with calcaneal QUS parameters and may therefore implicate bone properties. These findings should be confirmed in longitudinal studies that include the food intake and repeated measurement of urinary mineral concentrations to better estimate usual intake and minimize bias. PMID:27164120

  18. Close reduction and percutaneous internal fixation with hollow screw in treatment of posterior malleolus fractures%闭合复位经皮空心螺钉内固定治疗后踝骨折

    Institute of Scientific and Technical Information of China (English)

    冯青; 许效坤; 苏海涛

    2011-01-01

    目的探讨闭合复位经皮空心螺钉内固定选择性治疗后踝骨折的手术方法、适应证及临床效果.方法回顾性分析2004年7月至2010年4月期间采用闭合复位经皮空心拉力螺钉内固定治疗42例成人后踝骨折的临床资料,其中旋后-外旋型28例,旋前-外旋型6例,旋前-外展型8例.采用X线片评估骨折愈合率,采用美国足踝骨科协会(AOFAS)推荐的足踝评分系统评估踝关节功能.结果平均随访22个月(6~75个月),骨折愈合时间为6~12周.按AOFAS足踝评分系统评分,平均为96分(78~100分),优41例,可1例,优良率为97.6%.结论闭合复位经皮空心螺钉内固定是一种可用于治疗后踝骨折的微创术式,具有骨折愈合快,骨折愈合率高,踝关节功能好的优点.%Objective To investigate the indication and efficacy of close reduction and percutaneous internal fixation with hollow screws in the treatment of posterior malleolus fractures. Methods The clinical data of 42 cases of posterior malleolus fracture treated by this method from July,2004 to April ,2010 were retrospectively analyzed,including 28 cases of supination-eversion fractures,6 cases of pronation-eversion fractures and 8 cases of pronation-abduction fractures. The fracture healing rate was assessed by X-ray film and the function of the ankle joint was evaluated by foot and ankle scoring system recommended by American Orthopedic Foot & Ankle Society ( AOFAS). Results The followup averaged for 22 months (6 ~75 months). The fracture healing time ranged form 6 to 12 weeks. According to the results of foot and ankle function scores, the average score was 96 points (78 ~ 100 points), including 41 cases of excellence and 1 case of fairness, the rate of excellent and good amounting to 97.6%. Conclusion With the advantage of quick recovery, high healing rate and better healing effect, close reduction and percutaneous internal fixation with hollow screws is feasible in the treatment of

  19. 闭合手法复位 U 形螺旋石膏功能位固定治疗Colles骨折%Treatment of Colles fracture with manipulative closed reduction and U shaped gypsum functional fixation

    Institute of Scientific and Technical Information of China (English)

    苏建才

    2016-01-01

    Objective:To investigate the effect of U shaped gypsum functional fixation after closed manipulative reduction for treatment of Colles' fractures. Methods:From January 2011 to April 2014,47 cases of Colles fracture were treated by closed reduction and U shaped gypsum functional fixation including 12 males and 35 females with an average age of 54.8 years old ranging from 8 to 72 years old. The time from injury to treatment was 40 min to 3 d. The patients were closed fractures with-out neurovascular injury. After manual reduction and U shaped gypsum functional fixation,the thumb of injury hand were trac-tion by contralateral hand,and other fingers of injury hand were taken flexion to exercise grip function. According to the situa-tion of fracture healing,plaster was removed at 4 to 8 weeks'fixation,the wrist joint functional exercise was strengthened after plaster removed. Results:All patients were followed up from 6 to 12 months with an average of 6.4 months ,the fracture healing time was 4 to 8 weeks. According to the Cooney wrist function scoring:the result was excellent in 44 cases,good in 2 cases,1 case. Conclusion:U shape gypsum functional fixation for treatment of Colles fracture limits the activity of thumb and extensor tendon,can reduce shortening of radial by traction of the injury thumb with the contralateral hand;it is good for blood circula-tion of hand and wrist,and swelling.%目的:探讨Colles骨折手法复位后U形螺旋石膏功能位固定的疗效。方法:2011年1月至2014年4月采用闭合手法复位 U 型螺旋石膏功能位固定47例 Colles 骨折患者,其中男12例,女35例;年龄8~72岁,平均54.8岁。伤后来院就诊时间40 min~3 d。患者均为闭合性骨折,无神经血管损伤。手法复位后采用U形螺旋石膏功能位固定,术后即可在健手牵引患侧拇指同时余四指伸曲功能握力练习。根据骨折愈合情况,4~8周拆除石膏,拆石膏后加强腕关节功能锻炼

  20. Femur ultrasound (FemUS)-first clinical results on hip fracture discrimination and estimation of femoral BMD

    DEFF Research Database (Denmark)

    Barkmann, R; Dencks, S; Laugier, P;

    2010-01-01

    A quantitative ultrasound (QUS) device for measurements at the proximal femur was developed and tested in vivo (Femur Ultrasound Scanner, FemUS). Hip fracture discrimination was as good as for DXA, and a high correlation with hip BMD was achieved. Our results show promise for enhanced QUS......-based assessment of osteoporosis. INTRODUCTION: Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement...... has been introduced yet. We developed a QUS scanner for measurements at the femur (Femur Ultrasound Scanner, FemUS) and tested its in vivo performance. METHODS: Using the FemUS device, we obtained femoral QUS and DXA on 32 women with recent hip fractures and 30 controls. Fracture discrimination...

  1. 闭合复位空心钉内固定治疗Ideberg Ⅲ型肩胛盂骨折的近期疗效%Closed reduction and cannulated screws fixation of Ideberg Ⅲ type glenoid fractures

    Institute of Scientific and Technical Information of China (English)

    杨国跃; 贾健; 张银光; 张海彬; 江汉

    2013-01-01

    Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed

  2. SACRAL FRACTURES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To delineate the clinical spectrum and treatment choice of sacral fractures.Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis′ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurological deficits were present in seven patients. Thirty seven patients were treated conservatively and two underwent surgical management.Results.Thirty eight patients were followed up for three months to 19 years. Thirty three have recovered, four improved, and one remained disabled.Conclusion.The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture reduction and stability reconstruction. When the patients with pelvic fracture are complicated with neurological deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.

  3. The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years.

    Science.gov (United States)

    Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Gray, Bridget; Briggs, Andrew; Lall, Ranjit; Chesser, Tim Js; Pallister, Ian; Lamb, Sarah E; Willett, Keith

    2016-01-01

    BACKGROUND Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. OBJECTIVES We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. DESIGN A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. SETTING Trauma and orthopaedic departments of 24 NHS hospitals. PARTICIPANTS Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. INTERVENTIONS CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. MAIN OUTCOME MEASURES Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. RESULTS We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later

  4. Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures%股骨颈骨折闭合复位的实际效果分析

    Institute of Scientific and Technical Information of China (English)

    李欣; 陈仲; 杨洪昌

    2011-01-01

    Objective To evaluate the actual displacement of a femoral neck fracture following close reduction under the C-arm X-ray perspective.Methods From June, 2006 to June, 2009, we managed 12 patients with femoral neck fracture by open reduction and internal fixation.They were 8 males and 4 females, aged from 23 to 65 (average, 42.3) years old.We tried close reduction of their fractures under the C-arm X-ray perspective before a temporary fixation.Next we performed open reduction, readjusted the fracture ends, and placed internal fixation.The actual displacement of the fracture measured after open reduction was carefully compared with the close reduction under the X-ray perspective.Results A substantial displacement was found after open reduction in 7 patients who had achieved anatomic reduction under the X-ray perspective.In the other 5 patients who presented with a slight displacement after close reduction under X-ray perspective, the actual displacements were larger than the X-ray observations but completely reduced after open reduction.The actual measurements after open reduction were significantly larger (3.21 ± 0.96 mm on average) in the anteroposterior displacement ( t = 11.540, P = 0.000), but insignificantly larger (0.58 ±0.93 mm on average) in the superior-inferior displacement ( t = 2.184, P = 0.346) than those after close reduction.Conclusions In general, anatomic reduction can not be achieved for a femoral neck fracture under the C-arm X-ray perspective.Consequently, open reduction may be better than close reduction in the treatment of femoral neck fracture in that improper reduction can block blood supply to the femoral neck and dissection of the capsula articularis coxae can improve blood supply as well as help decompression.%目的 探讨股骨颈骨折闭合复位在C型臂X线机下达解剖复位时骨折端的实际移位情况.方法 自2006年6月至2009年6月对12例股骨颈骨折患者行切开复位内固定,其中男8例,女4例;年龄23

  5. A comparative study of effect on reducing pain, inflammation and side effect of combination of enzymes (bacterial proteases, papain, bromelain, vitamin C and rutin) versus conventional non-steroidal anti-inflammatory drugs (diclofenac) in patients of closed fracture lower end radius coming at orthopaedic department of a tertiary care hospital

    OpenAIRE

    Tejas A. Acharya; Madhav D. Trivedi; Mehta, Dimple S.; Sunita B. Chhaiya; Shreyas P. Gandhi

    2016-01-01

    Background: Diclofenac and oral systemic enzymes both are commonly used for control of pain and inflammation in fracture lower end radius as well as other such conditions. Some studies have shown that combination of enzymes like bacterial proteases, papain, bromelain, vitamin C and rutin can reduce pain and Inflammation which is comparable to diclofenac but it still not definite. Methods: Total 50 patients with closed fracture lower end radius were enrolled and randomly divided in to two g...

  6. DETERMINING OSTEOPOROSIS RISK IN OLDER COLONO ADULTS FROM RURAL AMAZONIAN ECUADOR USING CALCANEAL ULTRASONOMETRY

    Science.gov (United States)

    MADIMENOS, FELICIA C.; LIEBERT, MELISSA A.; CEPON-ROBINS, TARA J.; SNODGRASS, J. JOSH; SUGIYAMA, LAWRENCE S.

    2014-01-01

    Objective Low bone density and osteoporosis prevalence, while well-documented in wealthy nations, are poorly studied in rural, non-clinical contexts in economically-developing regions such as Latin America. This study contributes preliminary osteoporosis risk data for a rural Colono (mestizo) population from Amazonian Ecuador. Methods Anthropometrics were collected for 119 adult participants (74 females, 45 males [50–90 years old]). Heel bone density and T-scores were recorded using calcaneal ultrasonometry Results Approximately 33.6% of the participants had low bone density and were at high-risk for osteoporosis. Four times as many females as males were considered high-risk. Consistent with epidemiological literature, advancing age was significantly associated with lower bone density values (p=0.001). Conclusions Low bone density and osteoporosis prevalence are expected to increase in this and other economically-transitioning populations, yet infrastructure to monitor this changing epidemiological landscape is almost non-existent. Human biologists are uniquely positioned to contribute data from remote populations, a critical step towards initiating increased resource allocation for diagnosis and prevention. PMID:25242164

  7. Definition, classification and treatment of destructive fractures

    Institute of Scientific and Technical Information of China (English)

    FANG Guo-jun; QU Zhi-guo; LIU Zhuo; CHEN Yuan

    2011-01-01

    Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as "destructive injury" indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term "destructive fractures" after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types: al type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type,open joint-involved destructive fracture; cl type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructivefracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures.

  8. Erratum to: The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures.

    Science.gov (United States)

    Backes, Manouk; Schep, Niels W L; Luitse, Jan S K; Goslings, J C; Schepers, Tim

    2015-08-01

    Erratum to: Arch Orthop Trauma Surg DOI 10.1007/s00402-015-2219-5. The original version of this article unfortunately contained a mistake and has been corrected. The fourth author J. Carel Goslings' family name has been published incorrectly. The correct family name should be Goslings. PMID:26099514

  9. Fuzzy logic structure analysis of trabecular bone of the calcaneus to estimate proximal femur fracture load and discriminate subjects with and without vertebral fractures using high-resolution magnetic resonance imaging at 1.5 T and 3 T.

    Science.gov (United States)

    Patel, Priyesh V; Eckstein, Felix; Carballido-Gamio, Julio; Phan, Catherine; Matsuura, Maiko; Lochmüller, Eva-Maria; Majumdar, Sharmila; Link, Thomas M

    2007-10-01

    Newly developed fuzzy logic-derived structural parameters were used to characterize trabecular bone architecture in high-resolution magnetic resonance imaging (HR-MRI) of human cadaver calcaneus specimens. These parameters were compared to standard histomorphological structural measures and analyzed concerning performance in discriminating vertebral fracture status and estimating proximal femur fracture load. Sets of 60 sagittal 1.5 T and 3.0 T HR-MRI images of the calcaneus were obtained in 39 cadavers using a fast gradient recalled echo sequence. Structural parameters equivalent to bone histomorphometry and fuzzy logic-derived parameters were calculated using two chosen regions of interest. Calcaneal, spine, and hip bone mineral density (BMD) measurements were also obtained. Fracture status of the thoracic and lumbar spine was assessed on lateral radiographs. Finally, mechanical strength testing of the proximal femur was performed. Diagnostic performance in discriminating vertebral fracture status and estimating femoral fracture load was calculated using regression analyses, two-tailed t-tests of significance, and receiver operating characteristic (ROC) analyses. Significant correlations were obtained at both field strengths between all structural and fuzzy logic parameters (r up to 0.92). Correlations between histomorphological or fuzzy logic parameters and calcaneal BMD were mostly significant (r up to 0.78). ROC analyses demonstrated that standard structural parameters were able to differentiate persons with and without vertebral fractures (area under the curve [A(Z)] up to 0.73). However, none of the parameters obtained in the 1.5-T images and none of the fuzzy logic parameters discriminated persons with and without vertebral fractures. Significant correlations were found between fuzzy or structural parameters and femoral fracture load. Using multiple regression analysis, none of the structural or fuzzy parameters were found to add discriminative value to BMD

  10. Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, M.R.; Chung, C.B.; Mendes, L.; Mohana-Borges, A.; Trudell, D.; Resnick, D. [Department of Radiology, Musculoskeletal Section, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161 (United States)

    2003-01-01

    To determine the relationship between sites of calcaneal plantar enthesophytes and surrounding fascial and soft tissue structures using routine radiography, MR imaging, and data derived from cadaveric and paleopathologic specimens.Design and patients. Two observers analyzed the MR imaging studies of 40 ankles in 38 patients (35 males, 3 females; mean age 48.3 years) with plantar calcaneal enthesophytes that were selected from all the ankle MR examinations performed during the past year. Data derived from these MR examinations were the following: the size of the enthesophyte; its location in relation to the plantar fascia (PF) and flexor muscles; and the thickness and signal of the PF. The corresponding radiographs of the ankles were evaluated at a different time by the same observers for the presence or absence of plantar enthesophytes and, when present, their measurements. A third observer reviewed all the discordant observations of MR imaging and radiographic examinations. Two observers analyzed 22 calcaneal specimens with plantar enthesophytes at an anthropology museum to determine the orientation of each plantar enthesophyte. MR imaging of a cadaveric foot with a plantar enthesophyte with subsequent sagittal sectioning was performed to provide further anatomic understanding.Results. With regard to MR imaging, the mean size of the plantar enthesophytes was 4.41 mm (SD 2.4). Twenty (50%) enthesophytes were located above the PF, 16 (40%) between the fascia and abductor digiti minimi, flexor digitorum brevis and abductor hallucis muscles, and only one (3%) was located within the PF. In three (8%) cases the location was not determined. The size of enthesophytes seen with MR imaging and radiographs was highly correlated (P<0.01). The interobserver agreement for all measurements was good (Pearson >0.8, kappa >0.9). Eleven of the 22 bone specimens had plantar enthesophytes oriented in the direction of the abductor digiti minimi and 11 oriented in the direction of the

  11. 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....

  12. Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's Disease: a randomised control trial

    Directory of Open Access Journals (Sweden)

    Williams Cylie M

    2010-03-01

    Full Text Available Abstract Background Posterior Heel pain can present in children of 8 to 14 years, associated with or clinically diagnosed as Sever's disease, or calcaneal apophysitis. Presently, there are no comparative randomised studies evaluating treatment options for posterior heel pain in children with the clinical diagnosis of calcaneal apophysitis or Sever's disease. This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children. Method Design: Factorial 2 × 2 randomised controlled trial with monthly follow-up for 3 months. Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Sever's disease (n = 124. Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear foot control. The alternate condition in this factor is no footwear prescription/replacement, with the participant wearing their current footwear. Outcomes: Oxford Foot and Ankle Questionnaire and the Faces pain scale. Discussion This will be a randomised trial to compare the efficacy of various treatment options for posterior heel pain in children that may be associated with calcaneal apophysitis also known as Sever's disease. Trial Registration Trial Number: ACTRN12609000696291 Ethics Approval Southern Health: HREC Ref: 09271B

  13. Medial displacement calcaneal osteotomy with posterior tibial tendon reconstruction for the flexible flatfoot with symptomatic accessory navicular.

    Science.gov (United States)

    Cao, Hong-Hui; Tang, Kang-Lai; Lu, Wei-Zhong; Xu, Jian-Zhong

    2014-01-01

    We investigated the clinical outcomes after medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular, in patients with flexible flatfoot with accessory navicular symptoms. From December 2008 to July 2011, 16 patients (21 feet) with a flexible flatfoot, symptomatic accessory navicular, and obvious heel valgus underwent medial displacement calcaneal osteotomy and reconstruction with posterior tibial tendon insertion on the navicular bone. The patients were evaluated preoperatively, 6 weeks and 3, 6, and 12 months postoperatively, and every 6 months thereafter. The clinical examination was undertaken using the American Orthopaedic Foot and Ankle Society ankle and midfoot scores. The radiologic assessments included the arch height, calcaneus inclination angle, talocalcaneal angle, and talar first metatarsal angle on the lateral weightbearing radiograph. The talocalcaneal angle and talar first metatarsal angle was assessed on the anteroposterior view of the weightbearing foot. Heel valgus alignment was assessed on the axial hindfoot radiographs. The mean follow-up duration was 28.5 months (range 18 to 48). All patients were satisfied with the clinical results and were pain free 6 months postoperatively. No cases of wound infection or nerve injury developed. The mean American Orthopaedic Foot and Ankle Society score improved from 53.3 ± 6.5 to 90.8 ± 1.4 at the last follow-up visit (p flatfoot with symptomatic accessory navicular, associated with excellent clinical outcomes and correction of the deformity.

  14. A comparative study of effect on reducing pain, inflammation and side effect of combination of enzymes (bacterial proteases, papain, bromelain, vitamin C and rutin versus conventional non-steroidal anti-inflammatory drugs (diclofenac in patients of closed fracture lower end radius coming at orthopaedic department of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Tejas A. Acharya

    2016-06-01

    Conclusions: Diclofenac was better in reducing pain, while combination of enzymes used in the study was better in reducing oedema. Combination of the enzymes used in this study is safer than diclofenac in cases of the closed fracture lower end radius. [Int J Basic Clin Pharmacol 2016; 5(3.000: 1017-1021

  15. [Gait analysis after intra-articular calcaneus fractures].

    Science.gov (United States)

    Siegmeth, A; Petje, G; Mittlmeier, T; Vécsei, V

    1996-01-01

    We retrospectively compared 20 patients with displaced intra-articular calcaneal fractures by clinical assessment and dynamic pedography. Eleven were treated operatively, 9 conservatively. The purpose was to identify differences in post-traumatic gait performance and to correlate the pedographic data to a clinical score to show its reliability. Twenty individuals without a history of foot injuries were used as a control group. Both groups had restricted motion in the subtalar joint, increased hindfoot and midfoot loading and decreased forefoot loading. Furthermore, they showed prolonged contact phases and an impaired ability to speed up gait during the toe-off phase. Load transfer from the hindfoot to the forefoot showed typical distribution patterns. The operatively treated group showed better functional results with fewer subjective complaints.

  16. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M. [Division of Musculoskeletal Radiology, Massachusetts General Hospital, Boston, MA (United States)

    2006-11-15

    To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief.

  17. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

    International Nuclear Information System (INIS)

    To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief

  18. Foundation and static analysis of calcaneal three-dimensional finite element model%跟骨三维有限元模型的建立与静态分析

    Institute of Scientific and Technical Information of China (English)

    黄海晶; 王捷; 马建雄; 张清功; 王志彬; 金鸿宾

    2010-01-01

    目的 建立一个基于健康人体的跟骨三维有限元模型,静态分析双足站立相时跟骨内部的生物力学特性,探讨跟骨骨折疼痛的内外侧应力不均衡因素.方法 选取1名健康男性志愿者,年龄28岁,体重64kg.采用16排螺旋CT对足部沿横断面连续扫描,将符合DICOM 3.0标准的CT断层图像导入MIMICS10.1中,设定阈值为226~3071 Houfield unit,确定方位后经手动编辑、区域增长、形态学操作及空洞处理等,生成足部的三维模型,从整个足部模型中提取跟骨模型.对跟骨进行面网格的优化处理后,导入ANSYS10.0中得到体网格模型.根据CT断层图像的灰度值完成模型材质的添加,生成最终的三维有限元模型.模拟研究对象双足静止站立的状态,距下关节面在整个分析过程中被全约束,自足跟及跟腱附着点处对模型分别施加垂直向上的320 N和160 N载荷,观察跟骨的Vonmises应力分布.结果 MIMICS软件能够迅速建立更为精确的有限元模型,当垂直载荷作用于跟骨后,跟骨内、外侧存在一定的应力不均衡因素.跟骨的外侧结构是明显的薄弱区域,随着跟骨外侧壁的应力增加,导致继发外侧畸形,压迫腓骨长短肌及跟骰关节产生疼痛.结论 创建的跟骨三维有限元模型,经验证是一个较为精确的正常跟骨三维模型,可用于理解跟骨内部的应力分布变化.%Objective To establish a more rapid and precise calcaneal three-dimensional (3D) finite element model based on the healthy human foot, to analyze the internal biomechanical properties of calcaneus, and to explore the relationship between caleaneal fracture pain with the stress imbalance factors in medial and lateral side of calcaneus. Methods One healthy male volunteer (28 years old, 64 kg) was selected. Input DICOM 3.0 standard CT sectional images into MIMICS10.1 software, set the threshold of 226-3071 Houfield unit, generate foot 3D model, extract caleaneus

  19. Using closed reduction and minimally invastive locking plate fixation to treat distal radius fractures%闭合复位微创锁定钢板内固定治疗桡骨远端骨折

    Institute of Scientific and Technical Information of China (English)

    明立功; 明朝戈; 王自方; 王新德; 孟维娜; 王慧

    2016-01-01

    目的:探讨采用闭合复位微创接骨板固定术(minimally invasive plate osteosynthesis, MIPO )置入锁定加压接骨板(locking compression plate, LCP)内固定治疗桡骨远端骨折的手术技巧及疗效。方法自2010年以来,在桡骨远端解剖学基础上,采用远端腕关节横弧形切口、近端纵行小切口MIPO技术置入LCP内固定治疗桡骨远端骨折12例。结果12例患者术后获12~25个月(平均15个月)随访。骨折愈合时间6~12周,平均8周。采用AO组织建议的Garland and Werley评分方法,对本组的疗效进行评估。优10例,良1例,可1例,优良率91.7%。12例平均手术时间为(55±15) min,术中平均失血量为(35±10) mL,术后平均住院时间为(7±2) d。无一例发生医源性正中神经损伤,所有患者伤口均Ⅰ期愈合。结论采用小切口MIPO技术置入LCP内固定治疗桡骨远端骨折,具有骨折愈合快、并发症少、功能恢复快的优点,临床效果良好。%Objective To describe the surgical skill and the effect of using closed reduction MIPO technology into LCP internal fixation for the treatment of distal radius fractures. Methods Since from 2010, based on the anatomy of distal radius, 12 cases with distal radius fractures were treated by using MIPO technology into LCP internal fixation, by which applying horizontal arc incision of distal wrist joint and longitudinal small incision of proximal of wrist joint. Results 12 cases were followed-up from 12 to 24 months (average 15 months), bone union time from 6 to 12 weeks (average 8 weeks). The scoring methods used Garland and Werley, the results showed excellent in 10 cases, good in 1 case, fair in 1 case, with an excellent and good rate of 91.7%. The mean operative time was (55 ±15) min in 12 cases, mean intraoperative blood lose was (35 ±10) mL, the average hospitallization time was (7 ±2) d. None of the iatrogenic injury of the median nerve, all

  20. Interpreting Dual Laterolog Fracture Data in Fractured Carbonate Formation

    Institute of Scientific and Technical Information of China (English)

    Deng Shaogui; Wang Xiaochang; Zou Dejiang; Fan Yiren; Yang Zhen

    2006-01-01

    The estimation of fractures is key to evaluating fractured carbonate reservoirs. It is difficult to evaluate this kind of reservoir because of its heterogeneously distributed fractures and anisotropy.A three-dimensional numerical model was used to simulate the responses of the dual laterolog (DLL) in a fractured formation based on a macro-isotropic anisotropic model. Accordingly, a fast fracturecomputing method was developed. First, the apparent conductivity of the DLL is linearly related to the porosity of the fracture and the conductivity of pore fluid. Second, the amplitude difference of the deep and shallow apparent resistivity logs is mainly dependenton the dip angle of the fracture. Then the response of the DLL to a formation with dip angle fracturesis approximately depicted as a function of the bulk resistivity of the rock, the porosity of the fractures and the conductivity of fracture fluid. This function can be used to compute the porosity of fracture quickly. The actual data show that the fracture parameters determined by the DLL closely coincide with the formation micro imager log.

  1. Hip fracture - discharge

    Science.gov (United States)

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge

  2. Emergency department external fixation for provisional treatment of pilon and unstable ankle fractures

    Directory of Open Access Journals (Sweden)

    Craig R Lareau

    2015-01-01

    Full Text Available Unstable ankle fractures and impacted tibial pilon fractures often benefit from provisional external fixation as a temporizing measure prior to definitive fixation. Benefits of external fixation include improved articular alignment, decreased articular impaction, and soft tissue rest. Uniplanar external fixator placement in the Emergency Department (ED ex-fix is a reliable and safe technique for achieving ankle reduction and stability while awaiting definitive fixation. This procedure involves placing transverse proximal tibial and calcaneal traction pins and connecting the pins with two external fixator rods. This technique is particularly useful in austere environments or when the operating room is not immediately available. Additionally, this bedside intervention prevents the patient from requiring general anesthesia and may be a cost-effective strategy for decreasing valuable operating time. The ED ex-fix is an especially valuable procedure in busy trauma centers and during mass casualty events, in which resources may be limited.

  3. Unstable Pelvic Fractures Associated with Femoral Shaft Fractures: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Chun-Liang Wu

    2013-04-01

    Full Text Available Background: Both pelvic fractures and femoral shaft fractures are caused by high-energy injuries. When unstable pelvic fractures and femoral shaft fractures occur concomitantly, the optimal treatment method is controversial. The aim of this study was to establish a reasonable principle for treating such complicated injuries. Methods: Forty patients sustaining unstable pelvic fractures and concomitant femoral shaft fractures were treated in a 7-year period. The initial management of the fractures was started at the emergency service according to the Advanced Trauma Life Support protocol. Unstable pelvic fractures were wrapped by cloth sheets and femoral shaft fractures were immobilized with a splint. Angiography was performed on patients with unstable hemodynamic status. The definitive treatment for combined fractures was performed after stabilizing the hemodynamics. Closed nailing was used for femoral shaft fractures, and pelvic fractures were treated with various techniques. Results: The mortality rate was 12.5% (5/40 during admission. Thirty-three patients were followed up for an average of 32 months (range, 12-76 months. There were 33 cases of unstable pelvic fractures and 36 instances of femoral shaft fractures. The union rate for pelvic fractures was 100% (33/33, while femoral shaft fractures had a 94.4% (34/36 union rate. The average healing time was 3.3 months (range, 1.6-8.1 months and 4.1 months (range, 2.5-18.2 months for pelvic and femoral shaft fractures, respectively. After fracture, 34 hips (94% achieved a satisfactory result in the Harris hip score and 30 knees (83% achieved a satisfactory result in the Mize knee score. Conclusions: Stabilization of the hemodynamics in patients with combined fractures should be the first aim. Angiography to stop arterial bleeding in the pelvis is often life-saving. The definitive treatment for combined fractures, such as pelvic fractures and femoral shaft fractures, should wait until hemodynamics

  4. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2014-01-01

    Full Text Available Plantar fasciitis (PF is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF. Following a diagnostic medial calcaneal nerve (MCN block at its origin, we observed reduction in verbal numerical rating scale (VNRS in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF. All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  5. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality.

    Science.gov (United States)

    Thapa, Deepak; Ahuja, Vanita

    2014-03-01

    Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  6. Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sendeht Ayuba J

    2008-05-01

    Full Text Available Abstract Background Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading. Methods We recruited 102 male athletes: these included football (n = 68, running (n = 15, handball (n = 7, taekwando (n = 6, cycling (n = 2, judo (1, badminton (1 and high jump (1. Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer. Results The mean age of athletes was 25 ± 6 years. The means of BMI and energy expenditure were 21.9 ± 2.0 kg/m2 and 35.0 ± 13.7 kcal/kg/day, respectively. Footballers were younger (p Conclusion Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.

  7. Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography.

    Science.gov (United States)

    Ballard, David H; Campbell, Kevin J; Blanton, Lee E; Williams, Jason T; Sangster, Guillermo; Hollister, Anne M; Simoncini, Alberto A

    2016-08-01

    The purpose of this study was to assess the incidence of tendon entrapments and tendon dislocations associated with ankle and hindfoot fractures in patients studied by multidetector computed tomography (MDCT). Additionally, we describe particular tendon injuries associated with specific fractures. This was a retrospective review of all individuals with a trauma-protocol CT for suspected ankle and/or hindfoot fractures during a consecutive 41-month time period at a single Level I Trauma Center. Each patient's images were evaluated by two radiologists and an orthopedic surgeon for tendon entrapment, tendon dislocation, and bone(s) fractured or dislocated. There were 398 patients with ankle and/or hindfoot fractures that showed tendon entrapment or dislocation in 64 (16.1 %) patients. There were 30 (46.9 %) patients with 40 tendon entrapments, 31 (48.4 %) patients with 59 tendon dislocations, and three (4.7 %) patients with both tendon entrapment and dislocation. All patients with tendon entrapments were seen with either pilon fractures and/or a combination of posterior, medial, or lateral malleolar fractures. The most frequently entrapped tendon was the posterior tibialis tendon (PTT) in 27 patients (27/30, 90.0 %). The peroneal tendons were the most frequently dislocated, representing 27 (87.1 %) of patients with tendon dislocation; all resulted from a talar or calcaneal fracture or subluxation. This study demonstrates that tendon entrapments and tendon dislocations are commonly seen in complex fractures of the ankle and hindfoot. Pilon fractures were associated with the majority of tendon entrapments, whereas calcaneus fractures were associated with the majority of tendon dislocations. PMID:27234977

  8. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level of...... radiological outcomes and a level of health related quality of life (Eq5d) below but not significantly different from the Danish reference population at a mean of 5.2 years follow-up. Furthermore, a knee injury-specific questionnaire (KOOS) reported a level of disability close to a reference population with...... only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...

  9. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  10. Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.

    Science.gov (United States)

    Chadwick, C; Whitehouse, S L; Saxby, T S

    2015-03-01

    Flexor digitorum longus transfer and medial displacement calcaneal osteotomy is a well-recognised form of treatment for stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flat-foot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction. PMID:25737518

  11. Injection through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Johns, R.A.

    1987-05-01

    Tracer tests are conducted in geothermal reservoirs as an aid in forecasting thermal breakthrough of reinjection water. To interpret tracer tests, mathematical models have been developed based on the various transport mechanisms in these highly fractured reservoirs. These tracer flow models have been applied to interpret field tests. The resulting matches between the model and field data were excellent and the model parameters were used to estimate reservoir properties. However, model fitting is an indirect process and the model's ability to estimate reservoir properties cannot be judged solely on the quality of the match between field data and model predictions. The model's accuracy in determining reservoir characteristics must be independently verified in a closely controlled environment. In this study, the closely controlled laboratory environment was chosen to test the validity and accuracy of tracer flow models developed specifically for flow in fractured rocks. The laboratory tracer tests were performed by flowing potassium iodide (KI) through artificially fractured core samples. The tracer test results were then analyzed with several models to determine which best fit the measured data. A Matrix Diffusion model was found to provide the best match of the tracer experiments. The core properties, as estimated by the Matrix Diffusion model parameters generated from the indirect matching process, were then determined. These calculated core parameters were compared to the measured core properties and were found to be in agreement. This verifies the use of the Matrix Diffusion flow model in estimating fracture widths from tracer tests.

  12. Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon

    OpenAIRE

    Kobsar, Bradley; Alcantara, Joel

    2009-01-01

    The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achill...

  13. External fixation of complex femoral shaft fractures

    OpenAIRE

    Zlowodzki, M; Prakash, J. S.; Aggarwal, N. K.

    2006-01-01

    Conversion of temporary external fixation to an intramedullary nail within the first 2 weeks after a femoral shaft fracture is standard practice. However, due to financial constraints, in large parts of the world external fixation of femoral shaft fractures is often the definitive treatment. Out of 60 fractures, 47 were followed-up for a minimum period of 39 weeks. The average follow-up time was 75 weeks. Fourteen fractures were closed, and 33 open. Forty-four fractures united at an average o...

  14. Usefulness of calcaneal quantitative ultrasound stiffness for the evaluation of bone health in HIV-1-infected subjects: comparison with dual X-ray absorptiometry

    Science.gov (United States)

    Fantauzzi, Alessandra; Floridia, Marco; Ceci, Fabrizio; Cacciatore, Francesco; Vullo, Vincenzo; Mezzaroma, Ivano

    2016-01-01

    Objectives With the development of effective treatments and the resulting increase in life expectancy, bone mineral density (BMD) alteration has emerged as an important comorbidity in human immunodeficiency virus type-1 (HIV-1)-infected individuals. The potential contributors to the pathogenesis of osteopenia/osteoporosis include a higher prevalence of risk factors, combined antiretroviral therapy (cART)-exposure, HIV-1 itself and chronic immune activation/inflammation. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” technique for assessing bone status in HIV-1 population. Methods We conducted a cross-sectional study to investigate bone mineral status in a group of 158 HIV-1-infected subjects. The primary endpoint was the feasibility of calcaneal quantitative ultrasound (QUS) as a screening tool for BMD. All subjects were receiving stable cART and were virologically suppressed (HIV-RNA vitamin D levels ng/mL (P-values: 0.004, 0.016, and 0.015, respectively). Conclusion As an alternative and/or integrative examination to DXA, calcaneal QUS could be proposed as a useful screening in HIV-1-infected patients for assessing bone health impairment. In fact, the results obtained confirm that calcaneal QUS may be useful for monitoring bone status, being a noninvasive and inexpensive technique, especially in those subjects with the classical traditional risk factors for bone damage that were observed earlier in HIV-1 population. PMID:27330330

  15. Calcaneal reconstructive plate plus bone graft in treatment of intra-articular calcaneal fractures%跟骨重建钢板加植骨治疗跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    袁瑞斌

    2010-01-01

    @@ 跟骨骨折是足部的常见损伤,伤者以青壮年居多.跟骨骨折占所有骨折的1%~2%, 严重损伤易遗留伤残.2005年至2008年我科采用跟骨重建钢板加植骨治疗跟骨关节内骨折16例,疗效满意.现报告如下.

  16. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  17. Operative strategy of acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    WANG Yan; TANG Pei-fu; HUANG Peng

    2006-01-01

    Anatomic structure of acetabular fractures are complex and operative exposure and fixation are extremely difficult.For those obviously displaced acetabular fractures, close reduction is doomed to cause deformative healing. Open reduction with internal fixation (ORIF) not only results in anatomic reduction, but also brings complications. No matter which method will be adopted, traumatic arthritis or avascular necrosis of femoral head might occur. In order to treat acetabular fractures more effectively, orthopedic surgeons should be required to fully master the acetabular anatomy, biomechanics, classification and the necessary knowledge for complication prevention.

  18. Epidemiology of tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Grecco Marco Aurélio Sertório

    2002-01-01

    Full Text Available In this work an epidemiological analysis on tibial shaft fractures was performed. During four years, our service treated 179 fractures, 132 in male, 47 in female, aged 14 to 83 years. The 21 to 30-year-old patiens were the more injured. Of these, 120 were open and 59 close fractures of which prevailing cause was road traffic accident. The study based on patients promptuaries analyses and radiographs. The fractures occurred 97 times in the middle third (54.18%; 102 times (56.98% presented simple fragments, and 57 (31.38% oblique lines. We treated close and open fractures, respectively, 48 and 38 cases with plaster cast immobilization; 3 and 67 with external fixation after plaster cast immobilization; 5 and 12 with osteosynthesis by means of plate and screws, and 2 and 3 with external fixation only. In both close and open fractures, respectively, 7 and 20 cases of pseudarthrosis and 1 and 11 of infections have occurred. With the data obtained we verified an actual validity of the epidemiological studies as a contribution for better identifying lesions features and their treatment and complications. This allows proceedings and apprenticeship refinement.

  19. US Geological Survey Committee for the Advancement of Science in the Yucca Mountain Project symposium on {open_quotes}Fractures, Hydrology, and Yucca Mountain{close_quotes}: Abstracts and summary

    Energy Technology Data Exchange (ETDEWEB)

    Gomberg, J. [ed.

    1991-12-31

    The principal objective of this symposium is to review the available information on fractured/faulted terrains in terms of a coherent hydrogeologic model of ground-water fluid flow and transport, particularly as it pertains to the Yucca Mountain region. This review addresses the influence and significance of fractures on ground-water flow and the transport of conservative-species solutes within the context of the hydrogeologic setting of the Yucca Mountain area. The relations between fluid flow and fractured or faulted host rock are examined integrally from information on geologic, seismologic, hydrologic, and geomechanical properties of the system. The development of new hydrogeologic approaches that incorporate information from this integrated database are contrasted with more standard approaches toward understanding flow in fractured reservoirs. Ground-water flow in both the unsaturated zone and the saturated zone are considered. The application of various models of flow is addressed, examples include porous-media equivalent and discontinuum fracture-network models. Data and interpretations from the Yucca Mountain area are presented to establish a context for information exchange. The symposium includes discussions relevant to technical considerations for characterizing the Yucca Mountain area hydrogeology. On the basis of these discussions, CASY has compiled this document in order to formally summarize the proceedings and communicate recommendations for future directions of research and investigation.

  20. Anisotropic characteristics of electrical responses of fractured reservoir with multiple sets of fractures

    Institute of Scientific and Technical Information of China (English)

    Shen Jinsong; Su Benyu; Guo Naichuan

    2009-01-01

    In fractured reservoirs, the fractures not only provide the storage space for hydrocarbons, but also form the main flow channels which connect the pores of the matrix, so fractures dominate the productivity of reservoirs.However, because of the heterogeneity and randomness of the distribution of fractures, exploration and evaluation of fractured reservoirs is still one of the most difficult problems in the oil industry.In recent years, seismic anisotropy has been applied to the assessment of fractured formations, whereas electrical anisotropy which is more intense in fractured formations than seismic anisotropy has not been studied or used so extensively.In this study, fractured reservoir models which considered multiple sets of fractures with smooth and partly closed, rough surfaces were established based on the fractures and pore network, and the vertical and horizontal electrical resistivities were derived as a function of the matrix and fracture porosities according to Ohm's law.By using the anisotropic resistivity equations, variations of the electrical anisotropy of three types of fractured models under the conditions of free pressure and confining pressure were analyzed through the variations of the exerted pressure, matrix porosity, fracture aperture and formation water resistivity.The differences of the vertical and horizontal resistivities and the anisotropy between the connected and non-connected fractures were also analyzed.It is known from the simulated results that an increase of the confining pressure causes a decrease of electrical anisotropy because of the elasticity of the closed fractures and the decrease of the fracture aperture.For a fixed fracture porosity, the higher the matrix porosity, the weaker the electrical anisotropy in the rock formation.

  1. Distribution and natural history of stress fractures in U.S. Marine recruits

    International Nuclear Information System (INIS)

    In a prospective study of stress injuries of the lower extremities of U.S. Marine recruits, researchers derived a frequency distribution of stress fractures. The most frequently fractured bone was the tibia (73%), while the single most common site was the posterior calcaneal tuberosity (21%). The natural history of stress fractures by scintigraphy and radiography has been outlined, showing the evolutionary changes on either study as a universal progression independent of injury site or type of stress. An identical spectrum of changes should be present within any group undergoing intense new exercise. The frequency distribution of stress fractures should be a function of differing forms and intensities of exercise, therefore, our figures should not be applied to other groups. Researchers used the presence of a scintigraphic abnormality at a symptomatic site as the criterion for diagnosis of stress fracture. Since the distribution of skeletal radiotracer uptake is directly dependent on local metabolic activity, it is expected that a focal alteration in bone metabolism will result in a scintigram approaching 100% sensitivity for the abnormality (9). In the proper clinical setting, the specificity should approximate this figure; however, a focal, nonstress-related bone abnormality which has not manifested any radiographic change, such as early osteomyelitis, could result in a false-positive examination. Specificity cannot, therefore, be accurately determined without an actual determination of the pathologic changes within the bone, necessarily involving biopsy

  2. Ulnar nerve paralysis after forearm bone fracture

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2016-08-01

    Full Text Available ABSTRACT Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  3. Ulnar nerve paralysis after forearm bone fracture.

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Ruschel, Paulo Henrique; Huyer, Rodrigo Guimarães

    2016-01-01

    Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  4. Ulnar nerve paralysis after forearm bone fracture.

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Ruschel, Paulo Henrique; Huyer, Rodrigo Guimarães

    2016-01-01

    Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen. PMID:27517030

  5. Arthroscopy assisted management of tibia plateau fractures

    OpenAIRE

    Cetik, Ozgur; Asik, Mehmet; Sozen, Yunus V.; Taser, Omer F.; Cetinkaya, Sarper M.

    2004-01-01

    We report our experience with the arthroscopy management of tibial plateau fractures. Twenty eight closed tibial plateau fractures in twenty seven patients were treated with arthroscopy assisted reduction between January 1993 and December 1997. The mean follow-up period was 25 months (range 6 months to 55 months). Schatzker classification system was used for evaluation and classification of the fractures patterns. The plateau depression has been reconstructed with elevation through a window...

  6. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  7. Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011

    Directory of Open Access Journals (Sweden)

    Mohammad Javdan

    2013-01-01

    Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

  8. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M

    2011-02-01

    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  9. Early history of scapular fractures.

    Science.gov (United States)

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

    2016-01-01

    The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939. PMID:26133287

  10. Early history of scapular fractures.

    Science.gov (United States)

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

    2016-01-01

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

  11. The treatment of subtrochanteric fractures

    Directory of Open Access Journals (Sweden)

    Vučetić Čedomir S.

    2011-01-01

    Full Text Available Subtrochanteric fractures of the femur have a special place because of a significant number of complications following treatment. Powerful loading forces asymmetrically acting to this bone segment, as well as poor vascularization interfere with bone union. There are basically two current approaches in the fixation of subtrochanteric fractures; the first involves a plate with a compression screw and another one is intramedullary (IM nail, with two options: centromedullary (standard interlocking femoral nail and cephalomedullary femoral nail with two modifications, reconstructive and trochanteric. All IM nails may be used by open technique or closed minimal invasive method. IM nailing is favoured in view of a shorter operative time, shorter hospitalisation and complications. Indirect fracture reduction and knowledge of biology of bone fracture may result in full success without any bone graft.

  12. Fracture source

    Directory of Open Access Journals (Sweden)

    2003-07-01

    Full Text Available The fracture properties of many different types of fibers are covered in a timely new book that will prove to be a tremendous source of information and references for researchers in the wide and diverse field of fibers and composites, says Bill Clegg.

  13. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig

    2013-01-01

    Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate...

  14. Association between vitamin D status and serum parathyroid hormone concentration and calcaneal stiffness in Japanese adolescents: sex differences in susceptibility to vitamin D deficiency.

    Science.gov (United States)

    Tsugawa, Naoko; Uenishi, Kazuhiro; Ishida, Hiromi; Ozaki, Reo; Takase, Tomoki; Minekami, Takuya; Uchino, Yuri; Kamao, Maya; Okano, Toshio

    2016-07-01

    There is currently insufficient information on serum 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) concentrations, and bone mineral status in healthy adolescents to allow reference values to be set. This study aimed to provide comparable data on vitamin D status in Japanese adolescents and to assess sex differences in susceptibility to vitamin D insufficiency. Serum 25OHD and PTH concentrations were measured in 1,380 healthy adolescents (aged 12-18 years). Subjects completed a questionnaire on exercise history, diet, and lifestyle factors. Calcaneal stiffness was evaluated by quantitative ultrasound. Serum 25OHD concentrations in boys and girls were 60.8 ± 18.3 and 52.8 ± 17.0 nmol/L, respectively. Approximately 30 % of boys and 47 % of girls had suboptimal 25OHD concentrations (<50 nmol/L). Serum PTH concentration was negatively correlated with serum 25OHD concentration in boys, but negatively correlated with calcium intake rather than serum 25OHD in girls. In contrast, the increment in calcaneal stiffness as a result of elevation of serum 25OHD was higher in girls than in boys. As vitamin D deficiency is common in Japanese adolescents, it was estimated that intakes of ≥12 and ≥14 μg/day vitamin D would be required to reach 25OHD concentrations of 50 nmol/L in boys and girls, respectively. Moreover, the results of the present study indicate that vitamin D deficiency has a greater association with calcaneal stiffness in girls than in boys. PMID:26260151

  15. Identical fracture patterns in combat vehicle blast injuries due to improvised explosive devices; a case series

    Directory of Open Access Journals (Sweden)

    Commandeur Joris

    2012-10-01

    Full Text Available Abstract Background In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar. During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. Case presentation The described cases comprise paired thoracic vertebral fractures, radial neck fractures, calcaneal fractures and talar fractures. Moreover, the different types of blast injury are mentioned and related to the injuries described in our series. Acknowledging the different blast mechanisms is important for understanding possible injury patterns. Conclusion From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS.

  16. Nonunion of forearm fracture: a rare instance in a toddler

    Institute of Scientific and Technical Information of China (English)

    Pramod Saini; Sanjay Meena; Vishal Shekhawat; Tanmay S Kishanpuria

    2012-01-01

    When compared to adults,pediatric fractures unite readily and nonunion is quite rare.Nonunion is often associated with open fractures,operative interventions,infection,pediatric osteogenesis imperfecta and neurofibromatosis.There are only a few studies and reports mentioning nonunion following conservative management of closed pediatric fractures.We report here a case of an eighteen-month-old child who developed nonunion following treatment of fracture of both forearm bones with cast and was successfully treated with plating.To the best of our knowledge,this is the youngest reported case of nonunion following conservative management of closed diaphyseal pediatric fracture.

  17. Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon

    Science.gov (United States)

    Kobsar, Bradley; Alcantara, Joel

    2009-01-01

    The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon. The care provided involves an array of modalities from exercise and rehabilitation to spinal manipulative therapy. PMID:19421349

  18. Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report☆

    Science.gov (United States)

    Gomes Júnior, Nelson Pelozo; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Raduan, Fernando Cipolini; Ejnisman, Benno; Cohen, Moisés

    2015-01-01

    The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome. PMID:26962495

  19. The effect of friction on simulated dynamic fracturing of rocks

    International Nuclear Information System (INIS)

    During underground nuclear tests, rocks may fail by plastic yielding, which limits shear strength, or by tensile fracture, wherever maximum principal stress exceeds tensile strength. A third mode of failure exists due to friction along closed fractured surfaces. There, friction affects slipping and can thus limit stress. In this paper, we study the effect of friction on the simulated dynamic response of rocks to underground nuclear explosions. The coefficient of friction is the ratio of total shear stress applied to a closed fracture surface to normal applied compressive total stress. At low coefficients of friction, the evolving stress field tends to be weakened by frictional slip, which also eases closing of fractures. At high coefficients of friction, the stress field tends to be strengthened, where fractures have closed, but remains weak, where fractures are left open. 4 refs., 4 figs

  20. Effect of Aloe vera application on the content and molecular arrangement of glycosaminoglycans during calcaneal tendon healing.

    Science.gov (United States)

    Aro, Andrea Aparecida de; Esquisatto, Marcelo Augusto Marretto; Nishan, Umar; Perez, Mylena Oliveira; Rodrigues, Rodney Alexandre Ferreira; Foglio, Mary Ann; Carvalho, João Ernesto de; Gomes, Laurecir; Vidal, Benedicto De Campos; Pimentel, Edson Rosa

    2014-12-01

    Although several treatments for tendon lesions have been proposed, successful tendon repair remains a great challenge for orthopedics, especially considering the high incidence of re-rupture of injured tendons. Our aim was to evaluate the pharmacological potential of Aloe vera on the content and arrangement of glycosaminoglycans (GAGs) during tendon healing, which was based on the effectiveness of A. vera on collagen organization previously observed by our group. In rats, a partial calcaneal tendon transection was performed with subsequent topical A. vera application at the injury site. The tendons were treated with A. vera ointment for 7 days and excised on the 7(th) , 14(th) , or 21(st) day post-surgery. Control rats received ointment without A. vera. A higher content of GAGs and a lower amount of dermatan sulfate were detected in the A. vera-treated group on the 14(th) day compared with the control. Also at 14 days post-surgery, a lower dichroic ratio in toluidine blue stained sections was observed in A. vera-treated tendons compared with the control. No differences were observed in the chondroitin-6-sulfate and TGF-β1 levels between the groups, and higher amount of non-collagenous proteins was detected in the A. vera-treated group on the 21(st) day, compared with the control group. No differences were observed in the number of fibroblasts, inflammatory cells and blood vessels between the groups. The application of A. vera during tendon healing modified the arrangement of GAGs and increased the content of GAGs and non-collagenous proteins.

  1. Elastic intramedullary nail for treatment of extremity fractures in children

    Institute of Scientific and Technical Information of China (English)

    MA Hong-ru; MA Shu-lin; ZHANG Wen-lu; YANG Jin-chang; CUI Hou-xuan

    2008-01-01

    Objective: To assess the clinical therapeutic effects of elastic intramedullary nail on extremity fractures in children. Methods: From June 2005 to March 2008, 40 children with extremity fractures were treated by elastic intramedullary nail, in whom femoral shaft fractures occurred in 26 cases, tibiofibular fractures in 8 cases, radial capitular fractures in 4 cases, ulnoradial fractures in 2 cases. All patients were treated by closed reduction and elastic intramedullary nail fixation. Results: All the fractures gained satisfactory reduc-tion and healing. The average duration needed for fracture healing was 1-2 months. Postoperative follow-up confirmed a sound functional recovery. Conclusions: The elastic intramedullary nail is a minimally invasive and effective surgical approach for treatment of extremity fractures in children. It allows early functional exercises after operation and secures a satisfactory bone union and functional recovery.

  2. Optimizing Shear Stresses at the Tip of a Hydraulic Fracture - What Is the Ideal Orientation of Natural Fractures with respect to Hydraulic Fracture?

    Science.gov (United States)

    Sheibani, F.; Hager, B. H.

    2015-12-01

    While many shale and unconventional plays are naturally fractured (or contain planes of weakness), these are often cemented and effectively impermeable to flow. Stress shadow behind the tip of a hydraulic fracture stablizes natural fractures. It essentially means that if impermeable natural fractures and weakness planes are not opened when the hydraulic fracture tip passes, they will remain closed and impermeable to flow. In this work a detailed and comprehensive evaluation of tip shear stresses and associated natural fracture or weakness plane shear is presented. From analytical work, the theoretical shear stresses from a fracture tip are first presented. The effect of fracture length, in-situ pore pressure, maximum horizontal remote stress, net pressure, natural fracture friction coefficient and the direction of natural fracture with respect to the hydraulic fracture on shear stimulation at the tip are calculated using the plane strain analytical solution of a 2-D fracture, and assuming simple linear coulomb friction law. Since slippage along natural fractures will locally violate the assumptions used in the analytical solutions and to incorporate the effect of weakness planes on stress-strain and displacement field, 2-D and 3-D finite element model (FEM) simulations are presented that build upon both the analytical and continuum solutions. FEM models are capable of numerically simulating the slippage through weakness planes by using contact elements. This advantage makes FEM tools very appropriate for synthetically generating microseismicity, which can then be evaluated for mode, focal mechanism, and magnitude. The results of the simulations highlight the critical parameters involved in shearing and opening cemented natural fractures in unconventionals - which is a critical component of stimulation and production optimization for these plays. According to the results, the ideal orientation of natural fractures with respect to hydraulic fracture from shear

  3. Bilateral Monteggia fracture in adults

    Directory of Open Access Journals (Sweden)

    Ristić Dejan

    2011-01-01

    Full Text Available Introduction. In 1814 Giovanni Monteggia first described two cases of fractures of the proximal third of ulna with dislocation of the radial head. These fractures are more common in children than in adults, and mutual Monteggia fracture is a rare complication. This study presents a treatment course of a patient with bilateral Monteggia fracture. Case report. A 55- year-old patient was injured by falling in the yard. Radiography showed bilateral Monteggia fracture type II (by the Badon classification. Operative treatment of fracture was done by a compression plate on the right side and by the zuggurtung technique on the left one. Closed repositioning of the radial head was done on both sides. The patient was wearing a plaster splint for the upper arm for 21 days. After removing the fixation, the function of the elbow was determined by the Broberg Morrey score (BM which was on the right side 45.5 and on the left side 47.5. After the proper physical therapy, four months after the surgery, BM score was 100 on the right side, and 93 on the left one. Conclusion. Surgical treatment and early rehabilitation is the key for the return of good function of both elbows.

  4. Como são tratadas as fraturas diafisárias fechadas do fêmur no Brasil? Estudo transversal How are closed femoral diaphyseal fractures treated in Brazil? A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Robinson Esteves Santos Pires

    2006-01-01

    Full Text Available Realizou-se um estudo transversal no 36º Congresso Brasileiro de Ortopedia e Traumatologia, onde foi pesquisada a opinião de ortopedistas brasileiros sobre aspectos do tratamento de fraturas diafisárias do fêmur no adulto. Quinhentos e sete questionários foram respondidos integralmente e encontrou-se concordância entre os ortopedistas em relação aos seguintes aspectos: configuração do traço de fratura e lesão de partes moles ou de estruturas neurovasculares como parâmetros principais para decisão sobre o tratamento; classificação das fraturas, em que a AO foi a mais adotada; haste intramedular anterógrada bloqueada fresada para tratamento das fraturas transversas e oblíquas curtas no istmo; placa ponte para o tratamento das fraturas com traço complexo; tração esquelética pré-operatória; infecção como complicação mais freqüente e uso de heparina de baixo peso molecular no pós-operatório. Houve conflito de opiniões nas seguintes questões: uso de mesa de tração para realização de osteossíntese intramedular; intervalo de tempo entre o trauma e a cirurgia; tempo de utilização de antibióticos e tempo médio de hospitalização. Em relação à literatura, houve concordância em relação aos parâmetros principais para decisão sobre o tratamento; método de fixação das fraturas com traço simples no istmo; classificação adotada; profilaxia antitrombótica. Diferiram da literatura questões como o método de fixação das fraturas com traço complexo; tempo de utilização dos antibióticos, intervalo médio entre o trauma e a osteossíntese e tempo de internação.A cross-sectional study was performed during the 36th Brazilian Congress of Orthopaedics and Traumatology, where the opinions of Brazilian orthopaedic surgeons addressing the treatment of femoral diaphyseal fractures in adults were surveyed. Five hundred and seven questionnaires were fully completed and the results show agreement in the following

  5. [Closing diastemas].

    Science.gov (United States)

    Vieira, L C; Pereira, J C; Coradazzi, J L; Francischone, C E

    1990-01-01

    The authors describe a clinical case of closing upper central incisives diastema, reconstructiva of a conoid upper lateral and the rechaping of an upper canine to a lateral incisive. The material used was composite resin.

  6. Open Calcaneus Fractures and Associated Injuries.

    Science.gov (United States)

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  7. Open Calcaneus Fractures and Associated Injuries.

    Science.gov (United States)

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  8. Flow upscaling in propped fracture

    Science.gov (United States)

    Jasinski, Lukasz; Dabrowski, Marcin

    2016-04-01

    Proppants in combination with hydraulic fracturing are widely used to maintain the production of oil or gas from low permeability formations (i.e. shale rocks). There are also examples of proppants use in geothermal reservoirs. Flow patterns in propped fracture control transport processes and give information about fracture/matrix exchange surface. Our main motivation is to understand flow behavior in such structures using direct numerical simulations and to find a good upscaling technique to be able to investigate models on reservoir scale. We study fracture made of two parallel plane walls, where void space between them is filled with partial monolayer of proppant. As the fracture is affected by closing pressure, the proppant grains are squeezed between two opposite fracture walls which can change the grain shapes or embed the grains into impermeable rock matrix. To take this effect into account and simplify the geometry, the grains are approximated as cylinders. Imposed macroscopic pressure gradient invokes flow in such medium. As the flow is considered in the low Reynolds number regime, a stationary velocity flow field is obtained by solving the Stokes equations in 3D by means of finite element method. Void space between the grains is accurately discretized by using tetrahedral mesh. To reduce computational effort, the Stokes equation is reduced over the fracture aperture to 2D Stokes-Brinkman equation, which is further numerically solved and compared against numerical solution in 3D. Systematic flow calculations using 2D Stokes-Brinkman equation are performed for periodic domain and no slip boundary condition on the grain surface. Results are discussed in terms of effective properties as a function of geometrical parameters of the medium, such as proppant packing fraction and proppant grain diameter to fracture aperture ratio.

  9. Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy.

    Science.gov (United States)

    Marks, Richard M; Long, Jason T; Ness, Mary Ellen; Khazzam, Michael; Harris, Gerald F

    2009-01-01

    Posterior tibial tendon dysfunction (PTTD) may require surgical intervention when nonoperative measures fail. Different methods of bony reconstruction may supplement tendon substitution. This study compares two types of bony procedures used to reinforce reconstruction of the posterior tibial tendon-the lateral column lengthening (LCL), and the medial displacement calcaneal osteotomy (MDCO). Twenty patients with PTTD were evaluated before and after scheduled reconstruction comprised of either flexor digitorum longus (FDL) substitution combined with MDCO (MDCO group, 14 patients) or FDL substitution with LCL fusion or osteotomy (LCL group, 6 patients). Foot/ankle kinematics and temporal-spatial parameters were analyzed using the Milwaukee Foot Model, and results were compared to a previously evaluated normal population of 25 patients. Post-operatively, both patient groups demonstrated significantly improved stride length, cadence and walking speed, as well as improved hindfoot and forefoot position in the sagittal plane. The LCL group also demonstrated greater heel inversion. All post-operative subjects revealed significant improvement in the talo-MT1 angle in the A/P and lateral planes, calcaneal pitch and medial cuneiform-MT5 height. Surgical reconstruction of PTTD with either the LCL or MDCO shows comparable improvements in gait parameters, with better heel inversion seen with the LCL, but improved 1st ray plantarflexion and varus with the MDCO. Both procedures demonstrated comparable improvements in radiographic measurements. PMID:18603429

  10. 跟骨内移截骨治疗获得性扁平足临床分析%Acquired flat foot medial displacement calcaneal osteotomy

    Institute of Scientific and Technical Information of China (English)

    张奉琪; 王慧娟; 张奇; 赵海涛; 李智勇; 高巍; 张英泽

    2011-01-01

    [ Objective] To study the c haracteristic and clinic curative effect of the acquired flatfoot treated by a medial displacement calcaneal osteotomy. [ Methods] From Jan. 2006 ~ Dec. 2008, 31 patients with an average age of 26. 7 years (range, 19 ~50 years), were treated by a medial displacement calcaneal osteotomy together with other technique. Seventeen of them were male and 14 were female. The lateral position, calcaneal axial and CT of calcaneal were taken preoperatively. The mean first talocalcaneal angle was 22.3° ( range, 5° ~ 32°) . All patients had contracture of achilles tendon, posterior tibial tendon dysfunction, calcaneovalgus, forefoot pronation and abduction ( weight bearing ) and pains. The American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale was 45.8. Posterior tibial tendon irsufficiency (PTTI) were stageⅡ. Thirteen feet were treated by a medial displacement calcaneal osteotomy, 4 feet by a medial displacement calcaneal osteotomy and tendocalcaneus lengthening, 14 feet by a medial displacement calcaneal osteotomy , tendo calcaneus lengthening and flexor digitorum longus tendon transfer. [ Results] After a mean follow up of 18. 8 months (range, 6 ~ 26 months), the medial longitudinal arch improved postoperatively, 10 feets pain disappeared, 15 foot reliefed and 6 foot remained. The mean first talocalcaneal angle was 3.2° (range, 0° ~7°) (t = 22. 57, P≤0. 001 ), strephexopodia and the abduction of foot obviously improved . The rating of clinic curative effect was 80. 6% (25/31) . The American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale was 84. 5. [ Conclusion ] Medial displacement calcaneal osteotomy treating the flexible flatfoot can reliablely correct calcaneovalgus , partly resume the medial longitudinal arch, improve weight bearing and biomechanical characteristic of foot and ankle. We can combine with other technique to improve curativeeffect of the acquired flat foot. The operative indication

  11. Accuracy of closed reduction for displaced subcapital femoral neck fractures assisted by C-arm X-ray machine%移位股骨颈头下骨折模拟C臂X射线机观察闭合复位的真实精确性

    Institute of Scientific and Technical Information of China (English)

    戚珊红

    2012-01-01

    BACKGROUND: Traction bed C-arm X-ray machine is used for closed reduction and internal fixation to treat femoral neckfracture has some errors.OBJECTIVE: To perspectively analyze the accuracy of closed reduction for femoral neck fractures by assisted C-arm X-raymachine.METHODS: Complete reduction of artificial femoral neck fractures was realized under direct vision and then fixed by kirschnerpins which were knocked in at both fractured ends respectively on lateral femoral neck to be used as metal marker. Femoral neckspecimens and C-arm X-ray machine were not removed and then the femoral neck specimens revolved 15° clockwise and 30°anticlockwise respectively. Anterior-posterior of the standard femoral neck was examined by C-arm X-ray machine, thencorresponding imaging was collected.RESULTS AND CONCLUSION: There was no significant difference of the displacement in the both ends of the subcapitalfemoral neck fractures (around 1 mm both) when the necks were located at the position of 15°, 30° clockwise and anticlockwiserespectively. There was significant difference of the displacement in the both ends of the subcapital femoral neck fractures(around 2 mm both) when the necks were located at the position of 30°, 30° clockwise and anticlockwise respectively. It is shownthat C-arm X-ray machine is used to observe the subcapital femoral neck fractures and can meet the reduction requirement ofGarden scores, but the femur head rotation cannot be identified. As a result, displaced femoral neck fractures necessitate openreduction.%背景:采用牵引床C臂X射线机下闭合复位、内固定治疗股骨颈头下骨折,可能有一定的误差.目的:模拟C臂X射线机下闭合复位透视分析骨折闭合复位的真实精确性.方法:直视下完全复位人工骨股骨颈头下骨折标本,使用克氏针固定.在股骨颈外侧,两个断端处分别使用克氏针打入,作为金属标志物.保持股骨颈标本、C臂X射线机位置不动,随后将股骨头

  12. Identifying Fracture Types and Relative Ages Using Fluid Inclusion Stratigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Dilley, Lorie M.; Norman, David; Owens, Lara

    2008-06-30

    Enhanced Geothermal Systems (EGS) are designed to recover heat from the subsurface by mechanically creating fractures in subsurface rocks. Understanding the life cycle of a fracture in a geothermal system is fundamental to the development of techniques for creating fractures. Recognizing the stage of a fracture, whether it is currently open and transmitting fluids; if it recently has closed; or if it is an ancient fracture would assist in targeting areas for further fracture stimulation. Identifying dense fracture areas as well as large open fractures from small fracture systems will also assist in fracture stimulation selection. Geothermal systems are constantly generating fractures, and fluids and gases passing through rocks in these systems leave small fluid and gas samples trapped in healed microfractures. Fluid inclusions trapped in minerals as the fractures heal are characteristic of the fluids that formed them, and this signature can be seen in fluid inclusion gas analysis. Our hypothesis is that fractures over their life cycle have different chemical signatures that we can see in fluid inclusion gas analysis and by using the new method of fluid inclusion stratigraphy (FIS) the different stages of fractures, along with an estimate of fracture size can be identified during the well drilling process. We have shown with this study that it is possible to identify fracture locations using FIS and that different fractures have different chemical signatures however that signature is somewhat dependent upon rock type. Open, active fractures correlate with increase concentrations of CO2, N2, Ar, and to a lesser extent H2O. These fractures would be targets for further enhancement. The usefulness of this method is that it is low cost alternative to current well logging techniques and can be done as a well is being drilled.

  13. Ultrasound attenuation as a quantitative measure of fracture healing

    Science.gov (United States)

    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.

  14. PRODUCTIVITY OF FRACTURED HORIZONTAL WELLS

    Directory of Open Access Journals (Sweden)

    Stjepan Antolović

    2009-12-01

    Full Text Available The interest and performance of horizontal drilling and completions has increased during the last two decades. Horizontal wells are advantageous compared to vertical wells in thin reservoirs, reservoirs with favorable vertical permeability and reservoirs with water and gas coning problems. In many reservoirs, the ratio of horizontal permeability to the vertical permeability is substantially larger than one and often is close to 10. Thus, these reservoirs are very good candidates for hydraulic fracturing. By hydraulic fracturing one or more fractures are created, which can be longitudinal or orthogonal. By that, flow is altered and it mostly conducts horizontally through reservoir toward horizontal wellbore. With this altered flow, fluid is produced faster, with less pressure loss by fluid unit of produced fluid. Some of the existing mathematical models to determine the productivity of multifractured horizontal wells are presented in this work (the paper is published in Croatian.

  15. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture.

    Directory of Open Access Journals (Sweden)

    Duo Wai-Chi Wong

    Full Text Available Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis.A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval.At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites.The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.

  16. Imaging of fractures of the lateral process of the talus, a frequently missed diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Bonvin, Florent; Montet, Xavier; Copercini, Michele; Martinoli, Carlo; Bianchi, Stefano E-mail: stefano.bianchi@hcuge.ch

    2003-07-01

    Although if fractures of the lateral process of the talus (LPT) have been considered rare the widespread diffusion in snowboard practice has resulted in a dramatic increase in their frequency. If unrecognized they can result in secondary osteoarthritis of the ankle and/or talo-calcaneal joints and chronic pain and stiffness. Due to the complex anatomy of the region, these fractures are difficult to detect by standard radiographs. A high degree of suspicion is then necessary to diagnose them. Once suspected on the basis of physical examination and/or non concluding radiographs, computed tomography (CT) is the best modality to confirm the diagnosis and accurately appreciate the number of the fragments and their position which have therapeutic consequences (medical vs. surgical treatment). A better knowledge of these lesions seems necessary to the general radiologist to allow an early diagnosis in order to avoid chronic sequel. The purpose of this article is to report three additional cases of LPT fractures and discuss their pathogenesis, diagnosis and treatment.

  17. Wave Propagation in Fractured Anisotropic Media

    Science.gov (United States)

    Shao, S.; Pyrak-Nolte, L. J.

    2012-12-01

    Discontinuities such as fractures, joints and faults occur in the Earth's crusts in a variety of rock types. While much theoretical, experimental and computational research have examined seismic wave propagation in fractured isotropic rock, few experimental studies have investigated seismic wave propagation in fractured anisotropic media. The co-existence of fractures and layers can complicate the interpretation of seismic properties because of the discrete guided modes that propagate along or are confined by the fractures. In this study, we use seismic arrays and acoustic wavefront imaging techniques to examine the competing sources of seismic anisotropy from fractures and from layers. Samples with textural anisotropy (100 mm x 100 mm x 100 mm) were fabricated from garolite, an epoxy - cloth laminate, with layer thickness 0f ~ 0.5 mm. Two sets of fractured samples were fabricated: (1) two single fractured samples with one fracture either parallel or (and) perpendicular to layers, and (2) four multi-fractured samples with 5 parallel fractures oriented either parallel, 30 degrees, 60 degrees or perpendicular to the layers. An intact sample containing no fractures was used as a standard orthorhombic medium for reference. Seismic arrays were used on the first set of samples to measure bulk waves and fracture interface waves as a function of stress. The seismic array contained two compressional and five shear-wave source-receiver pairs with a central frequency of 1 MHz. Shear wave transducers were polarized both perpendicular and parallel to the layering as well as to the fracture. Measurements were made for a range of stresses (0.4 - 4MPa). From these measurements it was observed that a fractured layered medium appears more isotropic or anisotropic than the orthorhombic background, depending on the orientation of the fracture relative to layers. The matrix anisotropy was recovered by increasing the normal stress on a fracture (i.e., by closing the fracture). For the

  18. 新型闭合交汇穿钉外固定支架修复肱骨近端骨折:6个月随访%Novel closed intersection nailing external fixation repairs proximal humerus fractures:6-month follow-up

    Institute of Scientific and Technical Information of China (English)

    黄海晶; 何锦泉; 王捷; 金鸿宾

    2015-01-01

    BACKGROUND:Proximal humeral fracture fixation can provide a more stable fixation, has a stronger biomechanical stability, but open reduction and fixation wil cause extensive soft tissue dissection and heavy damage to the rotator cuff. Closed wear nail has a high failure rate of fixation, fracture re-displacement and other defects. OBJECTIVE:To investigate the technical methods of applying closed reduction, percutaneous pinning anatomical external fixation in repair of proximal humeral fracture, and to analyze the application characteristics and safety in different types of proximal humerus fractures. METHODS:Based on the special anatomical structure of proximal humerus, a shoulder external fixator has been independently researched and developed by author. The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation (homemade) because of proximal humerus fracture at the Department of Traumatology, Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed. In accordance with Neer classification type, there were 19 cases of 2-part fractures of the humerus, 4 cases of 3-parts fractures of the humerus, with greater tuberosity avulsion fractures, which were al fresh fractures and were treated with closed reduction pinning and external fixation. Regular fol ow-up was conducted after treatment. Radiographic assessment, pain and function evaluation were conducted during fol ow-up, so as to work out the functional recovery, determine the final repair result. RESULTS AND CONCLUSION:Al patients were fol owed up for 6-24 months. Total y 23 patients initial y healed in fracture within 8 weeks. After treatment, visual analogue pain score of patients was 0.8 points. In the final fol ow-up, the American Shoulder and Elbow Surgery Association of shoulder function scoring system (ASES) score was an average of (91.7±2.6) points, Constant shoulder function score was an average of (88.3±4.7) points, the

  19. Detection of radiographically occult-ankle fractures. Positive predictive value of post-traumatic soft-tissue swelling

    International Nuclear Information System (INIS)

    The objective of this study was to assess the value of soft-tissue swelling on plain radiographs as a predictor of radiographically occult fracture, after acute ankle injury (trauma). Patients with acute ankle trauma and plain radiographic evidence of soft-tissue swelling were included in this study. Patients were excluded if ankle trauma was sustained more than 48 hours previously or if fracture was visible on plain radiographs. All subjects (n=25) underwent computed tomography (CT) of the ankle in sagittal and coronal planes. Size of soft-tissue swelling was measured from initial Antero-posterior (AP) radiographs. The subjects in the study were placed into two groups according to whether a fracture was identified on CT or not. The results identified that those subjects without a fracture demonstrated by CT, had a soft-tissue swelling of less than 12.6 mm, while those with over 17.1mm swelling, showed a fracture on CT. Twelve patients (48 per cent) had radiographically occult fractures identified with CT. Fracture sites included: Talus/Talar Dome (n=9), posterior or lateral malleolos (n=2), distal tibia/fibula (n=1). CT detected significant soft-tissue injuries in six patients (24 per cent), composed of damaged anterior talo-fibular ligament (n=4), torn flexor tendons (n=1), and damaged fibular calcaneal ligament (n=1). One patient also showed gas in the talar dome. This study concludes that presence of a large soft-tissue swelling on plain radiographs after acute ankle trauma suggests an underlying fracture. A soft-tissue swelling of >15 mm is a reasonable threshold to prompt further imaging. Helical computed tomography provides good visualisation of subtle bone injuries and may detect clinically important soft-tissue injuries. While the study has a small sample, there is clear evidence that there is a trend worth investigating. Future research will seek to investigate a larger sample. Copyright (1999) Australian Institute of Radiography

  20. Spontaneous stress fractures of the femoral neck

    International Nuclear Information System (INIS)

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head

  1. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  2. Combined radial and median nerve injury in diaphyseal fracture of humerus: a case report

    OpenAIRE

    Rohilla Rajesh; Singla Rohit; Magu Narender Kumar; Singh Roop; Devgun Ashish; Mukhopadhyay Reetadyuti; Gogna Paritosh

    2013-01-01

    【Abstract】Radial nerve palsy is the most common neurological involvement in humeral shaft fractures. But combined radial and median nerve injury in a closed dia- physeal fracture of the humerus is rare. Combined injury to both radial and median nerve can cause significant disability. A detailed clinical examination is therefore necessary fol- lowing humeral shaft fractures. We report a patient with closed diaphyseal humeral fracture (AO 12A-2.3) together with radial an...

  3. Observation of the efficacy of closed reduction and lateral cross joint Kirschner wire fixation in the treatment of children with supracondylar fractures%闭合复位配合外侧克氏针交叉固定治疗儿童肱骨髁上骨折疗效观察

    Institute of Scientific and Technical Information of China (English)

    周晓康; 郝建宗; 甄磊; 何明哲

    2012-01-01

    OBJECTIVE To study the clinical efficacy of closed reduction and lateral cross joint Kirschner wire fixation in the treatment of children with supracondylar fractures. METHODS 67 children with the closed reduction and percutaneous Kirschner cross-fixation treatment in the humeral condyle fracture and their follow-up from July 2008 to January 2012 were chosen as the research objects. The fractures for the patients were closed fractures. Took C-arm X-ray machine when anesthesia to guide fracture reduction, of which 30 cases were treated with percutaneous Kirschner wire lateral cross fixed, nine cases were with simple closed reduction and plaster external fixation, and 28 cases were with percutaneous Kirschner wire fixation for the treatment. The data in follow-up were taken for statistics. RESULTS 58 patients were followed up, they had reached a degree of clinical healing 4 to 5 weeks after surgery. In the performance score for flunn elbow, the Kirschner lateral cross-fixed group were excellent in 14 cases (46.67%), the good was in 10 cases (33.33%), the general was in five cases (16.67%), and the poor was in 1 case (3.33%). In the plaster external fixation group, the excellent was in 3 cases (33.33%), the good was in 4 cases (44.44%), the usual was in two cases (22.22%), the poor was in one case (11.11%). In the Kirschner wire fixation group, the excellent was in 12 cases (42.85%), the good was in 9 cases (32.14%), the usual was in 5 cases (17.86%), and the poor was in 1 case (3.57%). The treatment efficiency for Kirschner lateral cross-fixation group and Kirschner wire fixation group had a significant difference (χ2 = 22.858, P< 0.05). CONCLUSION The application of joint closed reduction and Kirschner wire lateral cross-fixation in the treatment of children with supracondylar fracture trauma, it is a reliable fixation and can be achieved more significant than the Kirschner wire fixation treatment in the clinical efficacy. It gets a good elbow function, and reduce

  4. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. Fracture and Medium Modeling, by Analizing Hidraulic Fracturing Induced Microseismicity

    Science.gov (United States)

    Gomez Alba, S.; Vargas Jiménez, C. A.

    2014-12-01

    Hydraulic fracturing is an essential technology for most unconventional hydrocarbon resources and many conventional ones as well. The primary limitation on the improvement and optimization of the fracturing process is the minimal access to observe the behavior of the fracture in the subsurface. Without direct observational evidence, hypothetical mechanisms must be assumed and then tested for their validity with indirect information such as wellbore measurements, indirect production and pressure behavior. One of the most important sources of information today is the relation made between micro seismic source mechanisms and fracture behavior. Hydraulic fractures induce some level of micro seismicity when the stress conditions in the Earth are altered by changes in stress during the operations. The result is the sudden movement between rock elements and the radiation of both compressional and shear energy in a seismic range that can be detected and recorded with sensitive receivers. The objective of this work is to provide reasonable information when applying inversion methods in order to estimate the vertical and horizontal spatial heterogeneities in medium and energy radiation distribution of microseisms while fracking operations. The method consist in record microseisms at a previous lineal array of stations (triaxial accelerometers) which are located close to the source coordinates and cover the area of study. The analysis clarify some ideas about what information can be gained from the micro seismic source data and according to the obtained results, what kind of comparisons and associations might be done to evaluate the fracking performance operation. Non uniformities in medium such as faults would be revealed by interpreted scattering coefficients. Fracture properties like distance, velocity and orientation would be also determined by analyzing energy radiation.

  6. 跟骨内移截骨术在平足症治疗中的应用%Medial displacement calcaneal osteotomy for flatfoot

    Institute of Scientific and Technical Information of China (English)

    燕晓宇; 俞光荣

    2005-01-01

    扁平足是足部常见畸形,出现症状者为平足症,表现为足踝部疼痛、行走无力,久之可影响整个下肢和脊柱.目前平足症的治疗仍是一个棘手的问题,国内主要采用保守治疗.国外已经倾向于手术治疗,并报道多种手术方法,其中跟骨内移截骨术(medial displacement calcaneal osteotomy,MDCO)及其联合手术在临床上应用广泛,效果肯定,现综述如下.

  7. 闭合复位内固定和切开复位内固定治疗Bennett 骨折的对比研究%A retrospective trial of closed reduction internal fixation versus open reduction internal fixation for treatment of Bennett fractures

    Institute of Scientific and Technical Information of China (English)

    王晨霖; 李丹; 隋海明; 梁晓丽; 吴红军

    2016-01-01

    目的:比较闭合复位内固定和切开复位内固定治疗 Bennett 骨折的临床疗效。方法:回顾性分析42例 Bennett 骨折患者的病例资料,其中24例采用闭合复位内固定、18例采用切开复位内固定。男26例,女16例。年龄18~61岁,中位数32岁。Bennett 骨折参照 Büchler 等制定的标准,Ⅰ型9例、Ⅱ型21例、Ⅲ型12例。受伤至手术时间1~7 d,中位数3 d。比较2组患者的骨折复位情况及拇指腕掌关节功能。结果:所有患者均获随访,随访时间3~12个月,中位数6个月。采用 Kjaer -petersen 标准评价骨折复位情况,闭合复位内固定组优10例、良11例、差3例,切开复位内固定组优12例、良6例;2组患者的骨折复位情况比较,差异无统计学意义(Z =-1.801,P =0.072)。采用拇指腕掌关节功能评定标准评定拇指腕掌关节功能,闭合复位内固定组优10例、良9例、差5例,切开复位内固定组优11例、良5例、差2例;2组患者的拇指腕掌关节功能比较,差异无统计学意义(Z =-1.266,P =0.205)。结论:闭合复位内固定治疗 Bennett 骨折,临床疗效与切开复位内固定相当,但其具有操作简单及组织创伤小等优点,值得临床推广应用。%Objective:To compare the clinical curative effects of closed reduction internal fixation versus open reduction internal fixa-tion in the treatment of Bennett fractures.Methods:The medical records of 42 patients with Bennett fractures were analyzed retrospectively. Twenty-four patients were treated with closed reduction internal fixation(group A),while the others were treated with open reduction inter-nal fixation(group B).The patients consisted of 26 males and 1 6 females,and ranged in age from 1 8 to 61 years(Median =32 yrs).The fractures belonged to typesⅠ(9),Ⅱ(21 )andⅢ(1 2)according to the classification standards of Bennett fracture established by B

  8. Surgical management of complex humerus head fractures

    Directory of Open Access Journals (Sweden)

    Mohamed M.H. El-Sayed

    2010-06-01

    Full Text Available The locked plate systems provided adequate fixation of osteoporotic fractures of the proximal humerus in the elderly. But is the PHILOS plate adequate for stabilization of high-energy fractures, and fracture-dislocations of the proximal humerus in relatively younger age populations? In this retrospective study, performed at a referral, academic supervised, level III-trauma center, all high-energy trauma patients under the age of 55 years, with closed, 3 part, 4 part fractures, and/or fracture dislocations, were included in this study. Patients with open fractures, osteoporotic low-energy fractures, as well as patients older than 55 years were excluded. Fifty-nine patients entered and completed the study. They were all managed by open reduction and internal fixation using the PHILOS plate system. Patients’ age ranged between 31-52 years, with a mean of 42 years. A minimal follow-up period of two years was a mandatory inclusion criterion in this study. All the patients who did not complete the follow-up period were excluded from the study. The results were evaluated using the Constant, Neer and DASH scoring systems, which revealed favorable results in 41 patients (69.5%. The results were comparable to the recent articles published in the literature in relatively older age groups. It was concluded that, despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of polytrauma patients.

  9. Comparison of the Calcaneal Pitch Angle and Modified Projection Area Per Length Squared Method for Medial Longitudinal Arch Evaluation of the Foot

    Directory of Open Access Journals (Sweden)

    Esat Kıter2

    2012-12-01

    Full Text Available Objective: To compare the calcaneal pitch angle (CPA values measured on direct lateral radiographs of feet, and the modified projection area per length squared (PAL, which was calculated as a new method for the evaluation of the medial longitudinal arch (MLA of the foot.Material and Methods: Direct lateral radiographs of patients who had weightbearing feet radiographies for any reason except trauma were retrospectively obtained from the archives. Direct lateral radiographs of the feet were printed and a transparent sheet was placed on it. A straight line was drawn between the most plantar process of the calcaneus and the head of the first metatarsal bone for the calculation of the PAL of the MLA. Two semilunar arcs were drawn upon this straight line. PAL1 and PAL2 were estimated using a point-counting technique. The CPA, lateral talo-calcaneal angles (LTCA, and talo-first metatarsal angles (TFMA were measured. The correlations between PAL1, PAL2 of right and left feet and CPA, LTCA, and TFMA were explored.Results: Fifty patients (27 females, 23 males with a mean age of 40.12 (4-78 years were evaluated. Significant correlations were detected between PAL1, PAL2 and CPA, and TFMA for both right and left feet (p<0.05. Conclusion: A significant correlation was detected between the modified PAL method as a new technique and the standard CPA method for MLA evaluation. The PAL method is suggested as a simple and practical method for MLA evaluation.

  10. 经皮闭合复位锁定钢板和交锁髓内钉及切开复位钢板置入修复胫骨中下段骨折:生物稳定性比较%Percutaneous closed reduction locking compression plate, percutaneous closed reduction interlocking intramedullary nail and open reduction plate in the treatment of tibial fracture:comparison of biostability

    Institute of Scientific and Technical Information of China (English)

    陈刚; 钱明权; 朱国兴; 施克勤

    2014-01-01

    BACKGROUND:The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. OBJECTIVE:To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. METHODS:A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. RESULTS AND CONCLUSION:After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction (P  目的:比较经皮闭合复位锁定钢板、经皮闭合复位交锁髓内钉与切开复位钢板置入内固定修复胫骨中下段骨折的临床效果。  方法:入选180例胫骨中下段骨折患者,随机分为经皮闭合复位锁定钢板组、经皮闭

  11. Surgical Treatment of Calcaneal Spur. Tratamiento quirúrgico del espolón calcáneo.

    Directory of Open Access Journals (Sweden)

    Juan Carlos Cabrera Suárez

    2007-02-01

    Full Text Available

    Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level, antibiotic prophylaxis, final outcomes, and patient's satisfaction with the treatment were the set of variables selected. Results: High morbidity of the heel pain syndrome was evidenced in this studied. The most frequent cause was the calcaneal spur. There is predominance in female Indian race. The high influenced of the socio-cultural factor in the genesis of this disease is proved as well as the impossibility of carrying out the conservative treatment due to high cost of medications. Conclusions: The efficacy achieved with combined treatment technique allowed the results obtained. All this contributed to achieve high satisfaction levels.

    Fundamento: El dolor en la región plantar del talón, conocido técnicamente como talalgia, es motivo frecuente de consulta en el servicio de ortopedia de la República de Guyana. Objetivo: Caracterizar la aplicación del tratamiento quirúrgico a un grupo de pacientes de la República Cooperativa de Guyana, con diagnóstico de espolón calcáneo. Método: Se realizó un estudio descriptivo longitudinal de 70 pacientes tratados quirúrgicamente, por presentar talalgia rebelde al tratamiento conservador; las variables analizadas fueron: edad, sexo, raza, nivel cultural, profilaxis antibiótica y satisfacción con el resultado del tratamiento. Resultados: Se

  12. Imaging of vertebral fractures

    Directory of Open Access Journals (Sweden)

    Ananya Panda

    2014-01-01

    Full Text Available Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.

  13. Fracture Criterion for Fracture Mechanics of Magnets

    Institute of Scientific and Technical Information of China (English)

    潘灏; 杨文涛

    2003-01-01

    The applicability and limitation of some fracture criteria in the fracture mechanics of magnets are studied.It is shown that the magnetic field intensity factor can be used as a fracture criterion when the crack in a magnet is only affected by a magnetic field. For some magnetostrictive materials in which the components of magnetostriction strain do not satisfy the compatibility equation of deformation, the stress intensity factor can no longer be effectively applicable as a fracture criterion when the crack in a magnet is affected by a magnetic field and mechanical loads simultaneously.

  14. Differentiation of crack branching types in fractured glass

    Science.gov (United States)

    Rabinovitch, A.; Bahat, D.

    2011-07-01

    The influence of different physical factors on the fracture branching phenomenon was investigated on a fractured brittle (glass) bottle. A fully branched fracture tree consisting of 144 initiation sites was induced. Branching sites were concentrated in two zones: close to the fracture origin and further away from it along the bottle axis, which was shown to be related to reflection of transverse acoustic waves from the bottle's shoulder. Two types of branching formed, complete full branches (FB), and attempted branching (AB) when one branch was shorter than 5 mm. Branching in the first zone was shown to be regulated by both the distribution of flaw lengths and the distances from each FB to its nearest fracture neighbor. Fracture spacing was found to be proportional to the stress at the propagating fracture tips.

  15. Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

    OpenAIRE

    Anendd Jadhav; Bhushan Mundada; Rahul Deshmukh; Umesh Bhutekar; Atul Kala; Kapil Waghwani; Apoorva Mishra

    2015-01-01

    Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures tre...

  16. COMPARATIVE STUDY ON CLOSED REDUCTION WITH ELASTIC INTRAMEDULLARY NAILING AND OPEN REDUCTION WITH Kirschner WIRE FIXATIONS IN TREATMENT OF RADIAL NECK FRACTURES IN CHILDREN%闭合复位弹性髓内钉固定术与切开复位克氏针固定术治疗儿童桡骨颈骨折疗效比较

    Institute of Scientific and Technical Information of China (English)

    孙建华; 张新虎; 周连军; 范秋生; 刘斌

    2012-01-01

    目的 通过与切开复位克氏针固定术比较,分析闭合复位弹性髓内钉固定术治疗O'Brien Ⅲ型儿童桡骨颈骨折的疗效. 方法 2007年11月- 2010年11月,收治31例O'Brien Ⅲ型桡骨颈骨折患儿,其中18例采用闭合复位弹性髓内钉固定术治疗(闭合复位组),13例采用切开复位克氏针固定术治疗(切开复位组).两组患儿性别、年龄、病程、骨折分型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性. 结果 术后两组患儿切口均Ⅰ期愈合.31例均获随访,随访时间1~2年,平均1.5年.闭合复位组2例发生伸直受限;切开复位组6例发生屈、伸或旋前功能受限.末次随访时,闭合复位组肘关节屈、伸、旋前、旋后活动度与健侧比较,差异均无统计学意义(P>0.05);切开复位组除旋后活动度与健侧相似(P>0.05)外,屈、伸、旋前活动度均小于健侧,差异均有统计学意义(P<0.05).肘关节功能根据Metaizeau等的标准评定,闭合复位组获优16例,良2例;切开复位组获优4例,良4例,一般3例,差2例;组间比较差异有统计学意义(Z=3.435,P=0.001).X线片复查示,术后内固定物取出前两组骨折均解剖复位;取出后切开复位组4例发生骨折再移位,闭合复位组无骨折再移位.随访期间均无桡骨头骺缺血性坏死改变. 结论 与切开复位克氏针固定术比较,闭合复位弹性髓内钉固定术治疗O'Brien Ⅲ型儿童桡骨颈骨折具有微创、手术操作简便、固定牢固、允许术后早期活动、并发症少等优点,是一种较好的治疗方法.%Objective To analyze and compare the effectiveness of the closed reduction with elastic intramedullary nailing and open reduction with Kirschner wire fixations in the treatment of O'Brien type III radial neck fractures in children. Methods Between November 2007 and November 2010, 31 children with O'Brien type III radial neck fractures were treated by the closed

  17. Fracture-correlated lineaments at Great Bay, southeastern New Hampshire

    Science.gov (United States)

    Degnan, James R.; Clark, Stewart F.

    2002-01-01

    Analysis by remote-sensing techniques and observations of exposed bedrock structure were preliminary steps taken in a study to locate potential bedrock-fracture zones that may store and transmit ground water near Great Bay, N.H. To help correlate lineaments on the surface with fractures, structural measurements were made at exposed bedrock, largely along the shoreline of the bay, and analyzed to identify fracture trends and fracture characteristics. With these fracture data, lineament-filtering techniques, such as (1) buffer analysis around individual lineaments, (2) discrete-measurement analysis by domain, and (3) spacing-normalized analysis by domain, identified 'fracture-correlated lineaments.' Of the 927 lineaments identified in the study area (180 square kilometers), 406 (44 percent) were evaluated because they either were located within 305 meters of an outcrop with fracture data or intersected one of five 3,300-meter-square grid domain cells that encompassed the fracture data. Of the 406 lineaments, 190 (47 percent) are fracture correlated, although only 15 percent were correlated by more than one filtering technique. The large number of lineaments found in areas of thin glacial overburden and high densities of fractured outcrops suggests that filtering techniques are useful in these areas to selectively identify fracture-correlated lineaments. Fractures parallel to bedding in the Kittery Formation are open locally and often associated with vugs, with up to 1-centimeter aperture, and may provide appreciable secondary porosity in this rock unit. Discrete-measurement analysis by domain identified fracture-correlated lineaments with orientations parallel to these open and vug-filled fractures. Fracture-correlated lineaments related to closely spaced fractures were identified by the spacing-normalized analysis by domain. Analysis results may be used to indicate the potential bedrock pathways for ground-water-discharge points along the shoreline of Great Bay.

  18. Fracture Variability and Hydrologic Implications at Yucca Mountain, Nevada

    International Nuclear Information System (INIS)

    An understanding of the role of fractures at Yucca Mountain, Nevada, is needed to evaluate the suitability of the site to host a high-level nuclear waste repository. Current infiltration rates at Yucca Mountain require water to move through some fractures in the unsaturated welded units because the matrix porosity and permeability of these units are too small to accommodate the total flow. Though only about 20% of connected fractures are estimated to actively transmit water, flow and transport within fractures can greatly affect repository performance because fractures could be fast pathways for migration of radioactive particles. Under the current design, the potential repository would be located in a densely welded tuff sequence with highly variable fracture characteristics. This variability, resulting largely from the presence of lithophysal cavities, creates heterogeneous flow patterns through the unsaturated zone. Lithophysal cavities interrupt the continuity of fractures they intersect and may locally influence fracture propagation. In welded nonlithophysal zones, fractures tend to be longer and more widely spaced than in lithophysal zones, which generally display a greater number of closely spaced, short-length fractures. Seepage of water into potential waste-emplacement drifts will be affected by the fracture characteristics within the surrounding rock wall. Fractures with sufficient capillary suction, permeability, and lateral connectivity can enhance capillary barrier effects and lateral diversion around drift openings, thus reducing the potential for seepage. Lithophysal units, which have high secondary permeability owing to an abundance of well-connected small fractures capable of accommodating lateral flow, may be more favorable for repository performance (i. e., promote less seepage) than nonlithophysal units. Conceptual models for fracture flow based on mapped geometric and hydrologic fracture characteristics are presented, emphasizing the relevant

  19. 肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的护理%Nursing of the Chronic Calcaneal Osteomyelitis Combined with Soft Tissue Defect Repair with Myocutaneous Flaps

    Institute of Scientific and Technical Information of China (English)

    严若芬; 骆渊城; 于德美

    2012-01-01

    目的 探讨肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的护理方法.方法 经过合理的术前指导,精心术后皮瓣血运观察,及时有效的处理血管危象,并做好持续冲洗引流的护理,观察皮瓣成活及慢性跟骨骨髓炎的愈合情况.结果 肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的患者,皮瓣完全成活,伤口愈合,骨髓炎治愈无复发,患者术后功能恢复良好.结论 正确的术前指导,严格的术后观察,及时有效的处理,正确的术后持续冲洗,是肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损护理的关键.%Objective:Study on the nursing methods of the chronic calcaneal osteomyelitis combined with soft tissue defect repair with myocutaneous flaps Methods:By reasonable of preoperative instruction, elaborate flap blood revolve postoperative, timely and effective management of vascular crisis, and doing well the nurse of continuous irrigation, observed flap surviving and chronic calcaneal osteomyelitis healing Results:all cases transplanted myocutaneous flaps survived, the wound healed, without recurrence of calcaneal osteomyelitis. The function recovery is satisfactory. Conclusion:The key successful factors for the nursing of myocutaneous flap repairing chronic calcaneal osteomyelitis with soft tissue defect is correct preoperative instruction strict postoperative observation timely and effective management right continuous irrigation.

  20. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture.

    Science.gov (United States)

    Tzermiadianos, Michael N; Renner, Susan M; Phillips, Frank M; Hadjipavlou, Alexander G; Zindrick, Michael R; Havey, Robert M; Voronov, Michael; Patwardhan, Avinash G

    2008-11-01

    This study investigated the effect of endplate deformity after an osteoporotic vertebral fracture in increasing the risk for adjacent vertebral fractures. Eight human lower thoracic or thoracolumbar specimens, each consisting of five vertebrae were used. To selectively fracture one of the endplates of the middle VB of each specimen a void was created under the target endplate and the specimen was flexed and compressed until failure. The fractured vertebra was subjected to spinal extension under 150 N preload that restored the anterior wall height and vertebral kyphosis, while the fractured endplate remained significantly depressed. The VB was filled with cement to stabilize the fracture, after complete evacuation of its trabecular content to ensure similar cement distribution under both the endplates. Specimens were tested in flexion-extension under 400 N preload while pressure in the discs and strain at the anterior wall of the adjacent vertebrae were recorded. Disc pressure in the intact specimens increased during flexion by 26 +/- 14%. After cementation, disc pressure increased during flexion by 15 +/- 11% in the discs with un-fractured endplates, while decreased by 19 +/- 26.7% in the discs with the fractured endplates. During flexion, the compressive strain at the anterior wall of the vertebra next to the fractured endplate increased by 94 +/- 23% compared to intact status (p 0.05). Subsequent flexion with compression to failure resulted in adjacent fracture close to the fractured endplate in six specimens and in a non-adjacent fracture in one specimen, while one specimen had no adjacent fractures. Depression of the fractured endplate alters the pressure profile of the damaged disc resulting in increased compressive loading of the anterior wall of adjacent vertebra that predisposes it to wedge fracture. This data suggests that correction of endplate deformity may play a role in reducing the risk of adjacent fractures. PMID:18795344

  1. Clinical Observation of External Use of Radix Clematidis with Mature Vinegar for the Treatment of Calcaneal Spur%外用威灵仙配合陈醋治疗跟骨骨刺临床观察

    Institute of Scientific and Technical Information of China (English)

    张董喆; 史晓林

    2013-01-01

    Objective:To study the clinical effects of external use of radix clematidis with mature vinegar for the treatment of calcaneal spur. Methods:51 patients with calcaneal spur were applied with decoction of radix clematidis and mature vinegar to soak the affected foot, and then the drug dregs and vinegar were used for external application in the affected part. Once a day, and 20 days was regarded as a course of treatment. Results:In 51 patients,20 cases were cured;18 cases were effective;3 cases were ineffective. The effective rate was 94. 1%. Conclusion: External use of radix clematidis with mature vinegar has marked clinical therapeutic effect in treating calcaneal spur.%目的:探讨外用威灵仙配合陈醋治疗跟骨骨刺的临床疗效.方法:将51例跟骨骨刺患者,取威灵仙煎汤加陈醋浸泡患足,药渣加醋外敷患处跟骨,每日1次,连用20 d.结果:51例患者中治愈20例,显效10例,有效18例,无效3例.有效率为94.1%.结论:外用威灵仙配合陈醋治疗跟骨骨刺疗效显著.

  2. Arterial injury and pseudoaneurysm formation after lesser trochanter fracture

    Directory of Open Access Journals (Sweden)

    Susanne Regus

    2015-01-01

    Conclusion: Surgeons should pay attention to any displaced bone fragments close to calcified vessels, especially in the evaluation of routine x-rays following surgical treatment of fractures. This could minimize the potential life-threatening risk of delayed diagnosis, especially because it represents a routine image following surgical fracture treatments.

  3. Percutaneous AO Kirschner wire plus tension band wire fixation for patella closed transverse fracture%经皮穿刺克氏针加张力带钢丝固定治疗闭合性髌骨横断骨折

    Institute of Scientific and Technical Information of China (English)

    赵斌修; 王坤正

    2007-01-01

    手术方法具有创伤小、恢复快及术区美观等特点,并能允许膝关节早期活动,临床疗效满意.%BACKGROUND: Tension band suture fixation is always used in treating patellar fracture, and its modified method of Kirschner wire plus tension band steel-wire is also widely applied. But because the traditional surgery always causes massive incision and scar formation, it affects the appearance and function of knee joint.OBJECTIVE: To investigate the clinical curative effect of percutaneous puncture plus tension zone steel-wire fixation for the treatment of patella closed transverse fracture.DESIGN: Retrospective analysis:SETTING: Second Hospital of Medical College, Xi'an Jiaotong University.PARTICIPANTS: Twenty-nine patients with closed patellar transverse fracture admitted by Department of Orthopedics,Medical College of Xi'an Jiaotong University were selected from an average age of 36 years old. Only people that were diagnosed by X-ray as closed patellar transverse fracture were enrolled, and the informed consent was obtained from them.jostled until resetting, and then the fractured pieces were clamped by a clavical clamp to fix. Two incisions were made at the upper and lower ends of patella, and two were penetrated from the incision until its tip out of the lower hole of the same Kirschner wire under skin. The soft steel wire was drawn tightly and bended along the tip of Kirschner wire. The three-grading method, and the recovery of patients in 4 years after operation was evaluated according to the composite evaluation means about the knee joint established by Xu et al (pain, movement range of knee joint and reset of the fracture in patellar face. Meanwhile, the postoperative complications were observed.MAIN OUTCOME MEASURES: Wound healing, postoperative functional recovery and complications of patients.cases scored in grade 1, accounted for 93%, 2 cases in grade 2, accounted for 7%, who were recovered after change of means about the knee joint

  4. Metatarsal stress fractures - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  5. Fracture toughness correlations

    International Nuclear Information System (INIS)

    In this study existing fracture parameter correlations are reviewed. Their applicability and reliability are discussed in detail. A new KIC-CVN-correlation, based on a theoretical brittle fracture model, is presented

  6. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  7. Impaired Fracture Healing after Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    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.

  8. Clinical study on closed reduction and internal & external fixation combined with TCM rehabilitation in the treatment of proximal humeral fractures%闭合复位内外固定结合中医康复治疗肱骨近端骨折的临床研究

    Institute of Scientific and Technical Information of China (English)

    李卫国; 孙献武; 谭训香; 刘双双

    2016-01-01

    Objective:To observe the curative effect of closed reduction and internal &external fixation combined with TCMrehabilita-tion in the treatment of proximal humeral fractures.Methods:Eighty-seven patients with proximal humeral fractures enrolled in the study were randomly divided into 2 groups,and were treated with closed reduction and internal &external fixation.After the surgery,the patients were treated with TCMrehabilitation(TCM rehabilitation group)and conventional rehabilitation(conventional rehabilitation group)respec-tively.The patients were followed up,and the fracture healing time and the shoulder function recovery time were observed and compared be-tween the 2 groups.After 20 -week treatment,the curative effect was evaluated by using Constant -Murley shoulder joint scoring criterion. Results:The patients in the 2 groups were followed up for 8 -1 8 months with a median of 1 4 months.The fracture healing time and the shoulder function recovery time were shorter in TCMrehabilitation group compared to conventional rehabilitation group(1 1 .94 +/-1 .20 vs 1 3.02 +/-1 .64 weeks,t =2.790,P =0.007;1 5.80 +/-2.1 1 vs 1 7.47 +/-2.1 4 weeks,t =3.664,P =0.000).The Constant -Murley shoulder pain scores were lower in TCM rehabilitation group compared to conventional rehabilitation group(4.60 +/-1 .1 2 vs 5.40 +/-1 .1 4 points,t =3.239,P =0.002).The Constant -Murley shoulder daily activity scores and joint motion range scores were higher in TCM rehabilitation group compared to conventional rehabilitation group(1 5.70 +/-2.24 vs 1 4.64 +/-1 .90 points,t =2.362,P =0.020;30.76 +/-3.65 vs 28.47 +/-4.23 points,t =2.71 4,P =0.008).There was no statistical difference in muscle strength scores between the 2 groups(t =1 .628,P =0.1 07).Conclusion:Short fracture healing time and good shoulder function can be obtained by using TCM reha-bilitation in patients with proximal humeral fractures after closed reduction and internal &external fixation.%目的:观察闭合复位内外固

  9. Bennett Fractures A Review of Management.

    Science.gov (United States)

    Guss, Michael S; Kaye, David; Rettig, Michael

    2016-09-01

    A Bennett fracture is a common injury that involves an intra-articular fracture at the base of the first metacarpal. This fracture typically results in a dorsally and radially displaced metacarpal shaft relative to the well-anchored volar ulnar fragment. Most Bennett fractures are treated with operative fixation, including closed reduction and percutaneous fixation, open reduction and internal fixation, or arthroscopically assisted fixation. However, the optimal surgical approach is controversial. There is a paucity of literature comparing the outcomes of the various treatments, leaving the surgeon without a clear treatment algorithm. Moreover, there is no consensus on acceptable reduction parameters, including articular gap or step-off, with some series stating that up to 2 mm of displacement is acceptable. PMID:27620542

  10. Clinical observation of early anterior ankle pain after closed reduction and intramedullary nail fixation of tibial shaft fracture%胫骨干骨折闭合复位髓内钉固定术后早期踝前疼痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    田竞; 周大鹏; 于海龙; 赵勇; 项良碧

    2013-01-01

    Objective To observe the incidence rate of early anterior ankle pain after the therapy of tibial shaft fracture by closed reduction and intramedullary nail fixation method and to analyze the reason of occurrence of related complications.Methods All of 307 patients with tibial shaft fracture were treated by closed reduction and intramedtllary nail fixation method.The incidence rate and the average duration of early anterior ankle pain,VAS score and ankle function score was recorded after operation and during 3 and 12 months' follow up.Results Thirty nine cases had the anterior ankle pain at early stage after operation and the incidence rate was 12.7%.The average duration of early anterior ankle pain was (6.2±3.4)d.VAS score in resting state was (3.1±1.5) and in functional exercise state was (4.0±0.9).There were significant differences in the VAS score of two states(P <0.05).But there were no significant differences in ankle function score after operation and during 3 and 12 months' follow up.Conclusion Early anterior ankle pain is one of the complications in treating tibial shaft fracture by closed reduction and intramedullary nail fixation method.The incidence rate is related to the way of distal interlocking screw placement and intraoperative reaming.Early anterior ankle pain can increase the VAS score in functional exercise stage but has no significant effect on the ankle function.%目的 观察胫骨干骨折闭合复位髓内钉固定术后早期踝前疼痛的发生率,分析相关并发症的发生原因.方法 对307例胫骨干骨折采用闭合复位、交锁髓内钉固定术治疗,观察早期踝前痛的发生率、VAS疼痛评分和早期踝前疼痛的平均持续时间等,分别于术后即刻、3个月、1年进行踝关节功能评分.结果 39例术后早期发生踝前疼痛,发生率为12.7%,平均持续时间(6.2±3.4)d;静息状态VAS疼痛评分平均(3.1±1.5)分,功能锻炼时VAS疼痛评分平均(4.0±0.9)分,两组比

  11. Fractures of the distal radius in children: A retrospective evaluation

    Directory of Open Access Journals (Sweden)

    Selma Yazıcı

    2012-06-01

    Full Text Available Objectives: This study designed to evaluate the resultsof treatment, closed reduction and percutaneous wires, ofthe distal radius fractures in children.Materials and methods: A retrospective analysis wascarried out in children aged between 5-15 years who presentedwith a displaced fracture of the distal radius to ourhospital. They were initially treated with closed reductionand cast immobilization. If the fractures redisplaced treatedby percutaneous Kirschner (K- wire with scope undera general anaesthesia.Results: Totally 104 patients, who have distal radius fractureswere treated by closed reduction and immobilizationin a plaster cast. 13 patient who have distal radiusfractures were treated by closed reduction under generalanaesthesia and fixed by percutaneous Kirschner (K-wire. Patients with impaired the alignment of the fracturein late period were usually completely displaced fractures.(n=5, 4,3%, in early period, completely displaced fractures(n=5, 4,3% are superior to partial displaced fractures(n=2, 1,7%.Conclusion: In our study, when children with distal radiusfracture first come, they were treated by closed reductionand immobilization in a plaster cast. We thought that inredisplaced fractures patients were suitable for the closedreduction with percutaneous wire treatment.

  12. 闭合复位弹性钢纸板外固定治疗尺桡骨双骨折的疗效分析%Curative Effect Analysis of the Ulna and Radius Fractures Treated with Closed Reduction Elastic Steel Cardboard External Fixation

    Institute of Scientific and Technical Information of China (English)

    白毅

    2012-01-01

    Objective: To observe the clinical effects of the ulna and radius fractures treated with closed reduction and self - made elastic steel cardboard external fixation and the open reduction and plate screw internal fixation. Methods:The patients with the ulna and radius fractures were treated with closed reduction and self - made elastic steel cardboard external fixation (38 cases in group A ) and with open reduction and plate screw internal fixation (48 cases in group B ) respectively , and were followed up and compared. Results: All the 86 cases in the two groups were followed up, and the follow- up duration was 12 ~ 24months with an average of 12 months. According to the criteria of diagnosis and therapeutic effect evaluation of TCM diseases issued by State Administration of Traditional Chinese Medicine, group A: excellent in 30 cases, good in 6 cases, poor in 2 cases, the excellent and good rate was 94. 7% ; group B: excellent in 39 cases, good in 7 cases, poor in 2 cases, the excellent and good rate was 95. 8%. By statistical analysis, there was no significant difference between the two groups (P >0.05) , which indicated that the forearm function recovery and prognosis of the ulna and radius fractures treated with closed reduction and serf - made elastic steel cardboard external fixation and the open reduction and plate screw internal fixation is similar. Conclusion: The method of closed reduction and self - made e-lastic steel cardboard external fixation for the treatment of the ulna and radius fractures has obvious curative effect, with less trauma, quick effect, less complications, low cost, easy to accept by patients, and easy to use in clinic or in ward. The method is worthy of extensive clinical use, but requires the doctor has skilled manual reduction technology and incisive understanding for fracture displacement. Patients should choose treatment schemes according to the actual situations of their own.%目的:比较闭合复位自制弹性钢纸板外固

  13. Numerical Study on the Formation of Shear Fracture Network

    Directory of Open Access Journals (Sweden)

    Zhaobin Zhang

    2016-04-01

    Full Text Available Shear fracture network is important to the hydraulic fracturing treatment of a shale gas reservoir. In this paper, the formation of shear fracture network is investigated by a Displacement Discontinuity Method (DDM based model. The results show that the sliding of fracture surface is irreversible but may change significantly after fluid pressure dissipates. The final sliding distance is different for natural and hydraulic fractures. Most of the shear fractures are natural fractures while the newly formed hydraulic fractures tend to be totally closed after pressure dissipates. The effects of in situ stress are investigated. The affected area reaches its maximum value when the maximum principle stress direction is perpendicular to the principal fracture direction. The effects of the injection rate are also investigated. The increasing of the injection rate is helpful in increasing the fracture aperture, but has no effect on the final sliding distance. Moreover, the effects of the injection rate on the affected area depend on the connectivity of natural fractures. The affected area increases with the injection rate when the connectivity is poor but decreases slightly with injection rate when the connectivity is good.

  14. Surfactant-Driven Fracture Formation in Soft Gels

    Science.gov (United States)

    Schillaci, Mark; Bostwick, Joshua; Daniels, Karen

    2011-11-01

    The formation of fractures in gels well above the solid-liquid transition has been previously shown to initiate through a Poisson process, indicating that thermal fluctuations play a significant role. Here, we present experiments quantifying fracture formation in gels close to the solid-liquid transition. We utilize a spreading surfactant droplet to apply small forces to the surface of the gel. Fractures form along the contact-line and propagate outward in a star-burst pattern. By varying the droplet surface tension and gel modulus, we are able to tune the fracture formation and control the mean number of fractures formed. We interpret the number of fractures formed in the context of a linear elastic model for the uncompensated, Young-Dupré (out-of-plane) force acting at the contact-line. However, we also observe that there is an inherent variability in both the number of fractures formed and the delay for fractures to form. In the regime where single fractures form, we observe a range of delay times consistent with a Poisson distribution. In the regime where multiple fractures form, we observe that all fractures appear simultaneously and the long delays are suppressed. This work was supported by NSF grant number DMS-0968258.

  15. EXTERNAL FIXATION OF INTERTROCHANTERIC FRACTURES AS AN OPTION IN HIGH RISK GERIATRIC PATIENTS

    OpenAIRE

    Badoo; Naveed,; Syed Baasit Shafi; Mohammad,, K

    2015-01-01

    OBJECTIVE: The purpose of this study is to evaluate the usefulness of external fixation of intertrochanteric fractures in high risk geriatric patients. DESIGN: Prospective clinical study. SETTINGS: Level - 1 trauma C entre. PATIENTS: Fifty high risk geriatric patients with intertrochanteric fractures. INTERVENTION: Close reduction and external fixation using AO external fixator. OUTCOME MEASURED: fracture union, time to union, pin tract in...

  16. ELASTIC INTRAMEDULLARY NAILING IN PAEDIATRIC DIAPHYSEAL FOREARM FRACTURES

    Directory of Open Access Journals (Sweden)

    Amit Kumar

    2016-03-01

    Full Text Available BACKGROUND The majority of paediatric diaphyseal fractures of the radius and ulna can be treated well with closed reduction and cast immobilization. The most common indications for surgery are failure of closed reduction, open fractures and fracture instability. Over recent years the forearm fractures are increasingly being treated with intramedullary elastic nails to prevent displacement during the healing phase. OBJECTIVE Recently, there has been an increased interest in determining which method provides superior results, but the optimal treatment remains controversial. This article analyses the results of 22 diaphyseal forearm fractures in children who underwent flexible intramedullary nail fixation. MATERIAL AND METHODS A prospective study was conducted from January 2012 to December 2015, on the patients with both-bone forearm fractures. Inclusion criteria of study were age between 5 and 15 years, closed displaced fractures, unacceptable closed reduction and open displaced fractures (Type 1 and 2. A single nail was used for each forearm bone. RESULTS The results of the 22 patients (16 males and 6 females who were treated in our institution with closed elastic nails were studied systematically with a follow-up period from 4 months to 15 months. At follow-up clinics, all patients went on to osseous union and regained a full range of movement after rehabilitation. There were no cases of delayed union, non-union or mal-union. All implants were routinely removed within average time of 8 months (Range: 6-10 after nailing. There were no complications after implant removal in our patients. CONCLUSION Conservative management is still the first line of treatment for paediatric forearm fractures, especially in children less than 10 years old. Treatment with an elastic intramedullary nail is indicated for unstable, irreducible or open fractures when non-operative management fails.

  17. Seventeen Cases of Calcaneal Tumors and Tumor-like Lesions%跟骨肿瘤与瘤样病变17例

    Institute of Scientific and Technical Information of China (English)

    张智长; 杨庆诚; 董扬; 曾炳芳

    2011-01-01

    目的 足踝部肿瘤尤其是跟骨肿瘤非常少见,多数临床医师对跟骨肿瘤认识较少,延误诊断和治疗不当很常见.总结并回顾我院治疗的跟骨肿瘤病例及相关文献,评价其诊断及治疗方法.方法 自2003年1月至2007年12月共收治17 例跟骨原发肿瘤,其中男性13 例,女性4 例;年龄13~67 岁,平均年龄31.5 岁.均行病灶刮除植骨术.结果 术后病理证实,跟骨脂肪瘤7 例(8足),软骨母细胞瘤6 例(6足,其中5 例继发动脉瘤样骨囊肿),单纯性骨囊肿2 例(2足),骨内腱鞘囊肿2 例(2足).17 例均获随访,随访时间29~76个月,平均52个月.术后均无复发病例.结论 跟骨肿瘤少见,多为良性,原发或转移性恶性肿瘤罕见.诊断依赖于临床表现、影像学检查和病理检查,多数肿瘤通过临床表现、影像学检查可以明确性质.对良性肿瘤可以随访观察,常规手术方案为经外侧入路行病灶刮除植骨.恶性肿瘤多采取膝下截肢.%Objective Tumors occurred in foot and ankle especially in heel are rare, most clinicians know little of the calcaneal tumors,delayed diagnosis and improper treatment are common. So,review to our hospital for treatment of calcaneal tumor cases,review and summarize the literature and evaluate its diagnostic and treatment methods. Methods Sinccan 2003 to Dec2007,17 cases of primary calcaneal tumors,including 13 males and 4 females,average age 31.5 years,underwent curettage and bone graft. Results Pathologically confirmed,calcaneus lipoma in 7 patients (8 feet), 6 cases of chondroblastoma (6 feet), 5 patients with secondary aneurysmal bone cyst,simple bone cyst in 2cases(2 feet),bone Ganglion cyst in 2 patients (2 feet). 17 cases were followed up for 29-76 months (mean 52 months). There was no recurrence. Conclusion Tumors occurred in calcaneus are rare,most are benign,primary or metastatic malignancy are rare. Diagnosis depends on clinical manifestations,imaging and pathological

  18. Proximal humerus fractures.

    Science.gov (United States)

    Price, Matthew C; Horn, Pamela L; Latshaw, James C

    2013-01-01

    Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.

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

    Energy Technology Data Exchange (ETDEWEB)

    Nachtrab, O. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Cassar-Pullicino, V.N., E-mail: Victor.Pullicino@rjah.nhs.uk [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom)

    2012-12-15

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

  20. [Fractures of carpal bones].

    Science.gov (United States)

    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  1. 股骨干骨折闭合复位髓内钉固定术中大转子倾斜指数的应用%Application of the greater trochanter tilting index in close reduction and intramedullary nail fixation of a femoral shaft fracture

    Institute of Scientific and Technical Information of China (English)

    付世杰; 高海军; 张建志; 董天华; 吴希瑞; 郑占乐; 张国川

    2013-01-01

    Objective To assess the usage of the greater trochanter tilting index in the close reduction and intramedullary nail fixation of femoral shaft fracture for correction of rotational deformity.Methods From January 2011 to January 2012 we treated 24 patients with one-sided and closed femoral shaft fracture.They were 20 men and 4 women,aged from 17 to 61 years (average,36.5 years).By AO classification,11 cases were of 32A2,8 of 32B2 and 5 of 32C2.After the anteroposterior radiograph of the proximal femur was taken,its rotational angle was calculated according to the greater trochanter tilting index.When the external rotation angle of the proximal femur was ≥ 15°,the Schanz pin skill was used to rectify the extorsion before inserting the main intramedullary nail; when the angle was < 15°,the main intramedullary nail was inserted and the proximal locking screws were locked before the rotational deformity was corrected.The anteversion angles of both healthy and affected sides were measured and compared to judge the rotation reduction quality using CT scans.Results In the 24 patients,the anteversion angle was 15.36°± 7.91° at the affected side and 14.54° ± 7.44° at the healthy side,showing no statistically significant difference (t =0.958,P =0.348).The mean value of D-values between the affected and healthy sides (deformity degrees) was 3.58°± 2.26°.The deformity degrees of all patients averaged less than 9°.Fifteen cases had internally rotational deformity at the distal fracture end,8 externally rotational deformity and one no deformity.The 24 patients were followed up for 8 to 20 months (average,13 months).All fractures obtained union after an average of 5.1 months (from 3 to 7 months).No complications like bone nonunion or knee stiffness were found.Conclusion The greater trochanter tilt index can be used as an aid in close reduction and intramedullary nail fixation of femoral shaft fracture because it can help judge the rotational state of the proximal

  2. Long term surgical treatment outcome of talar body fracture

    Institute of Scientific and Technical Information of China (English)

    Ramesh Kumar Sen; Sujit Kumar Tripathy; Shakthivel RR Manoharan; Vibhu Krishnan; Tajir Tamuk; Vanyambadi Jagadeesh

    2011-01-01

    Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures.Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level Ⅰ trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views) and ankle (antero-posterior, lateral and mortise views) were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI) after 3 weeks, 6 weeks, 3 months, 6 months and then annually.Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear),with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis oftalar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome.Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation.

  3. [Fracture endoprosthesis of distal humerus fractures].

    Science.gov (United States)

    Müller, L P; Wegmann, K; Burkhart, K J

    2013-08-01

    The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

  4. Coupled exofixator for comminuted fracture of humeral shaft

    Institute of Scientific and Technical Information of China (English)

    马红如; 马树林; 尹同珍

    2005-01-01

    Objective: To report and assess the efficacy of a coupled exofixator in the treatment of comminuted fracture of the humeral shaft.Methods: From June 1999 to September 2003, 24 patients with comminuted fracture of the humeral shaft were treated in our department, in whom 11 were involved in left humerus fractures and 13 in right humerus fractures. Closed reduction or open reduction with a small incision as well as a coupled exofixator was used to treat these patients. Results: All cases got anatomical reduction after 6-12 months follow-up. The time for fracture union averaged 5.8 months with a good functional recovery of the shoulder-elbow joints. Conclusions: The coupled exofixator is favorable to the treatment of comminuted humeral shaft fractures. It can shorten union time and avoid nonunion occurrence.

  5. PHILOS humerus plate for a distal tibial fracture.

    Science.gov (United States)

    Twaij, Haider; Damany, Dev

    2013-01-04

    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required plate was unavailable. A PHILOS humeral plate seemed to fit the contours of the distal tibia. The broad end of the PHILOS, when placed distally, gave options to place locking screws in the medial malleolar fragment. The fracture was stable after fixation. The patient made a full post-operative recovery and follow-up at 4 months was satisfactory. Despite adequate planning, there will be instances where one has to improvise. An understanding of the principles of fracture management can aid in finding solutions. PHILOS humeral plate may be used to stabilize a distal tibial fracture if an appropriate distal tibial locking plate is not available.

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

    OpenAIRE

    Mohd Azri Abd Jalil; Ahmad Nazrun Shuid; Norliza Muhammad

    2012-01-01

    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 th...

  7. Novel methods for 3-D semi-automatic mapping of fracture geometry at exposed rock faces

    OpenAIRE

    Feng, Quanhong

    2001-01-01

    To analyse the influence of fractures on hydraulic andmechanical behaviour of fractured rock masses, it is essentialto characterise fracture geometry at exposed rock faces. Thisthesis describes three semi-automatic methods for measuring andquantifying geometrical parameters of fractures, and aims tooffer a novel approach to the traditional mapping methods. Three techniques, i.e. geodetic total station, close-rangephotogrammetry and 3-D laser scanner, are used in this studyfor measurement of f...

  8. Stress fractures in athletes.

    Science.gov (United States)

    Hulkko, A; Orava, S

    1987-06-01

    During the 14-year period of 1971-1985, 368 stress fractures in 324 athletes were treated. The series contained 268 fractures in males and 100 fractures in females; 32 fractures occurred in children (less than 16 years), 117 in adolescents (16-19 years), and 219 in adults. Forty-six fractures were incurred by athletes at an international level, 274 by athletes at a national or district level and 48 by recreational athletes. Of the total cases, 72% occurred to runners and a further 12% to athletes in other sports after running exercises. The distribution of the stress fractures by site was: tibia 182, metatarsal bones 73, fibula 44, big toe sesamoid bones 15, femoral shaft 14, femoral neck 9, tarsal navicular 9, pelvis 7, olecranon 5 and other bones 10. Of the total fractures, 342 were treated conservatively and 26 fractures required surgical treatment. The operative indication was dislocation in 5 cases and delayed union/nonunion in 21 cases. The sites most often affected by delayed union were: anterior midtibia, sesamoid bones of the big toe, base of the fifth metatarsal, olecranon, and tarsal navicular. The athletes at an international level experienced the greatest risk of multiple separate fractures, protracted healing, or fractures requiring surgery. PMID:3623785

  9. Fracture initiates systemic inflammatory response syndrome through recruiting polymorphonuclear leucocytes.

    Science.gov (United States)

    Li, Haipeng; Liu, Jia; Yao, Jianhua; Zhong, Jianfeng; Guo, Lei; Sun, Tiansheng

    2016-08-01

    Fracture, a common type injury in trauma patients, often results in the development of the systemic inflammatory response syndrome (SIRS). Though the mechanism of the fracture-initiated SIRS still remains not well characterized, it is well documented that the polymorphonuclear leucocytes (PMN) play an important role in the inflammatory process. We hypothesize that fractures recruit PMN to the local tissue, which is followed by an increase in the number of peripheral PMN and initiation of SIRS. In the current study, we established a closed femoral fracture rat model. We evaluated the levels of MPO, IL-1β and CINC-1 in fractured tissue homogenate, and we measured the levels of IL-6 and IL-10, the biomarkers for systemic inflammatory response, in the rat sera. In clinical part of the study, we collected blood from patients with isolated closed femoral fractures and evaluated PMN-related chemoattractants (IL-8, IL-1β and G-CSF) and the number of peripheral PMN. We further evaluated the level of mitochondrial DNA in the local haematoma of fracture and the circulating plasma of the patients with fracture. In the animal model of closed femoral fracture, we found a significant recruitment of PMN to the local tissue after fracture, which correlates with the elevated MPO level. We also showed that the concentration of IL-1β and CINC-1 in local tissue is significantly increased and might be responsible for the PMN recruitment. Recruitment of PMN to the local tissue was accompanied with a significant increase in the systemic levels of IL-6 and IL-10 in serum. In the patients with closed femoral fracture, we observed an increase in the number of peripheral PMN and PMN-related chemoattractants, including IL-8, IL-1β and G-CSF. The level of mitochondrial DNA in the local haematoma of fracture and the circulating plasma of patients were significantly higher compared to the healthy volunteers. Our data suggest that fracture released mitochondrial DNA into the local haematoma of

  10. Closed posteromedial dislocation of ankle in a 12 year-old boy: a case report

    OpenAIRE

    Yurttaş, Yüksel; Kilinçoğlu, Volkan; Toker, Serdar; Kürklü, Mustafa; Atilla, Atil; Başbozkurt, Mustafa

    2009-01-01

    Ankle fractures and fracture dislocations are common injuries in orthopaedic practice however pure ankle dislocation without an associated fracture is extremely rare. There are a few cases reporting such a lesion in the literature. Also this injuries are generally open high energy trauma injuries. Closed treatments are reported to be effective and ligament injuries are generally not reported. In this study, we report a closed pure posteromedial ankle dislocation with anterior talofibular liga...

  11. Ankle Injury Management (AIM): design of a pragmatic multi-centre equivalence randomised controlled trial comparing Close Contact Casting (CCC) to Open surgical Reduction and Internal Fixation (ORIF) in the treatment of unstable ankle fractures in patients over 60 years

    OpenAIRE

    Willett, K; Keene, DJ; Morgan, L.; Gray, B.; Handley, R; Chesser, T; Pallister, I; Tutton, E; Knox, C; Lall, R; A. Briggs; Lamb, SE

    2014-01-01

    BACKGROUND: Ankle fractures account for 9% of all fractures with a quarter of these occurring in adults over 60 years. The short term disability and long-term consequences of this injury can be considerable. Current opinion favours open reduction and internal fixation (ORIF) over non-operative treatment (fracture manipulation and the application of a standard moulded cast) for older people. Both techniques are associated with complications but the limited published research indicates higher c...

  12. 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. PMID:11430739

  13. Analytic crack solutions for tilt fields around hydraulic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Warpinski, N.R.

    2000-01-05

    The recent development of downhole tiltmeter arrays for monitoring hydraulic fractures has provided new information on fracture growth and geometry. These downhole arrays offer the significant advantages of being close to the fracture (large signal) and being unaffected by the free surface. As with surface tiltmeter data, analysis of these measurements requires the inversion of a crack or dislocation model. To supplement the dislocation models of Davis [1983], Okada [1992] and others, this work has extended several elastic crack solutions to provide tilt calculations. The solutions include constant-pressure 2D, penny-shaped, and 3D-elliptic cracks and a 2D-variable-pressure crack. Equations are developed for an arbitrary inclined fracture in an infinite elastic space. Effects of fracture height, fracture length, fracture dip, fracture azimuth, fracture width and monitoring distance on the tilt distribution are given, as well as comparisons with the dislocation model. The results show that the tilt measurements are very sensitive to the fracture dimensions, but also that it is difficult to separate the competing effects of the various parameters.

  14. Laboratory testing of cement grouting of fractures in welded tuff

    International Nuclear Information System (INIS)

    Fractures in the rock mass surrounding a repository and its shafts, access drifts, emplacement rooms and holes, and exploratory or in-situ testing holes, may provide preferential flowpaths for the flow of groundwater or air, potentially containing radionuclides. Such cracks may have to be sealed. The likelihood that extensive or at least local grouting will be required as part of repository sealing has been noted in numerous publications addressing high level waste repository closing. The objective of this work is to determine the effectiveness of fracture sealing (grouting) in welded tuff. Experimental work includes measurement of intact and fracture permeability under various normal stresses and injection pressures. Grout is injected into the fractures. The effectiveness of grouting is evaluated in terms of grout penetration and permeability reduction, compared prior to and after grouting. Analysis of the results include the effect of normal stress, injection pressure, fracture roughness, grout rheology, grout bonding, and the radial extent of grout penetration. Laboratory experiments have been performed on seventeen tuff cylinders with three types of fractures: (1) tension induced cracks, (2) natural fractures, and (3) sawcuts. Prior to grouting, the hydraulic conductivity of the intact rock and of the fractures is measured under a range of normal stresses. The surface topography of the fracture is mapped, and the results are used to determine aperture distributions across the fractures. 72 refs., 76 figs., 25 tabs

  15. Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chin-Hua Yang

    Full Text Available Flatfoot (pes planus is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA-MT5 angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA-MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot.

  16. Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan

    Science.gov (United States)

    Yang, Chin-Hua; Chou, Kuei-Ting; Chung, Mu-Bai; Chuang, K. S.; Huang, Tzung-Chi

    2015-01-01

    Flatfoot (pes planus) is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA–MT5) angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI) registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA–MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot. PMID:26126115

  17. 两种手术方法治疗儿童不可复性肱骨髁上骨折的疗效比较%Limited open reduction with internal fixation versus closed reduction with external fixation in the treatment of irreducible supracondylar humerus fractures in children: an outcome comparison

    Institute of Scientific and Technical Information of China (English)

    李凡; 李明静; 刘郁东; 徐剑; 胡涛

    2016-01-01

    目的 比较有限切开复位克氏针经皮内固定与闭合复位外固定支架外固定治疗儿童不可复性肱骨髁上骨折的疗效.方法 自2012年1月至2014年1月,我们共收治34例儿童不可复性Gartland Ⅲ型肱骨髁上骨折患儿,其中18例行有限切开复位克氏针经皮内固定(内固定组),16例行闭合复位外固定支架外固定(外固定组).比较两组患儿的手术时间、术中透视次数、骨折愈合时间、术后3d与2个月时Baumann角的变化及肘关节功能.结果 术后所有患儿均获得随访,时间为12~24个月,平均16.5个月.内固定组手术时间(49.1±6.6)min较外固定组(72.3±12.6)min短,术中透视次数(3.6±0.9)次较外固定组(10.1±2.0)次少,差异均有统计学意义(P<0.05).两组患儿均在术后4周获骨折临床愈合,术后2个月获骨性愈合.内固定组术后3d与2个月时Baumann角变化(2.4±1.3)°与外固定组(6.1±2.1)°比较,差异有统计学意义(P< 0.0001).按照Flynn肘关节评分标准评定疗效:术后3个月内固定组优良率为27.8%(5/18),外固定组为25.0%(4/16);术后1年内固定组优良率为99.4%(17/18)、外固定组为81.3%(13/16).两组患儿均无骨折延迟愈合、骨筋膜室综合征及医源性血管神经损伤等并发症.结论 有限切开复位克氏针经皮内固定与闭合复位外固定支架外固定治疗儿童不可复性Gartland Ⅲ型肱骨髁上骨折,骨折愈合时间相同,但前者可获得更满意的复位、更稳定的固定、更好的肘关节功能,而且手术时间短,术中透视次数少.%Objective To compare the clinical results of treating irreducible supracondylar humerus fractures (Gartland type Ⅲ) in children with limited open reduction and internal fixation versus closed reduction with external fixator.Methods The clinical data of 34 pediatric patients who had been treated for supracondylar humerus fractures (Gartland type Ⅲ) from January 2012 to January 2014 were

  18. Geostatistics for fracture characterization

    International Nuclear Information System (INIS)

    As the critical role of fractures has become more apparent in fluid flow and contaminant transport studies, the characterization of fracture networks has received considerable attention in a wide variety of applications such as nuclear waste repository design. The application of geostatistics to fracture characterization has traditionally involved modelling fractures as thin disks; assumptions about the frequency, orientation, length and width of these disks allow the construction of a 3D model of the fracture network. This paper examines alternatives whose statistical parameters are more relevant for contaminant transport studies and are also easier to infer and validate. A new algorithm for conditional simulation is presented, one that is able to honor multipoint statistics through annealing. By honoring statistics that capture with two-point spatial convariances, this algorithm offers an important new tool not only for the specific problem of fracture characterization but also for the more general problem of spatial simulation

  19. Jaw fractures in children.

    Science.gov (United States)

    Kotilainen, R; Kärjä, J; Kullaa-Mikkonen, A

    1990-03-01

    From a total of 350 jaw fractures treated in 1980-1984 at Kuopio University Central Hospital, 20% were in children. These injuries were evaluated retrospectively regarding age, sex, incidence and etiology. Forty-five of the patients were boys and 25 girls. The frequency of maxillary and mandibular fractures in 70 young patients was 28.6%. The most common type of bone fractures was fracture of the alveolar process, which was prevalent in persons with mixed dentition. Before the age of 7 years, falls from height were the common causes of jaw fractures. The major cause of the jaw fractures in children from 7 to 15 years old was road accidents (47.1%), especially in boys. Most of these were cycling accidents, only a few patients were victims of automobile accidents. In addition, about one third (25.7%) of the patients were treated in the hospital because of multiple injuries to other organs.

  20. 小夹板与石膏外固定治疗老年C型Colles骨折对照研究%Case-control Study on Small Splint and Plaster External Fixation after Closed Manipulative Reduction in the Treatment of Elderly Type C Colles Fractures

    Institute of Scientific and Technical Information of China (English)

    黄阿勇; 栗国强; 孙玉忠; 武庆生

    2014-01-01

    目的:比较闭合手法整复夹板与石膏外固定治疗老年 C 型 Colles 骨折的临床疗效。方法将96例老年C型Colles骨折患者随机分为治疗组和对照组,各48例。2组闭合手法整复后,治疗组予小夹板外固定,对照组予管形石膏外固定。测量整复前、整复后当天和拆除固定时(第6周)X线桡骨长度、掌倾角及尺偏角变化,观察2组的解剖位置丢失情况。拆除固定后6个月,根据Gartland-Werley腕关节功能评分法进行关节功能评价。结果2组整复后当天、拆除固定时与整复前比较,桡骨长度、掌倾角及尺偏角均有明显改善,差异有统计学意义(P<0.05)。拆除固定时与整复后当天比较,桡骨长度、掌倾角及尺偏角均有不同程度丢失(P<0.05),对照组丢失程度更为明显(P<0.05)。拆除固定后6个月治疗组腕关节功能优9例,良26例,可6例,差4例,优良率为77.8%(35/45);对照组中优4例,良22例,可10例,差9例,优良率为57.8%(26/45)。治疗组疗效优于对照组(P<0.05)。结论闭合手法整复夹板外固定治疗老年C型Colles骨折比管形石膏固定疗效显著。%Objective To compare the clinical effects of small splint fixation after closed manipulative reduction with plaster external fixation in the treatment of elderly type C Colles fractures.Methods Totally 96 elderly patients with type C Colles fractures were randomly divided into two groups, 48 patients in each group. Both groups were treated with closed manipulative reduction. The fractures were externally fixed with splint in the treatment group, and those were externally fixed with pipe plaster in the control group. The figure of radius length, palmar tilt and ulnar deviation were detected respectively in pre-reduction, the same day with reduction, and the day when external fixation was removed (6th week), in order to evaluated the drop of anatomical position. The therapeutic effects were

  1. A CLINICAL STUDY OF FIXATION O FRACTURE OF SHAFT OF HUMERUS WITH INTERLOCKING NAIL

    OpenAIRE

    Jayachandra Reddy; Athmaram; Santhi Swaroop

    2015-01-01

    the aim of the present study is to evaluate the results of closed interlocking intramedullary nail in the management of fractures of shaft humerus.20 humeral shaft fractures were treated by closed reduction and intramedullary interlocking nailing in the department of orthopaedics , government medical college , government general hospital , anantapuramu from November 2010 to A ug 2012. The cause of fracture was RTA in 17 cases and fall in 3 cas es. Age...

  2. Geometry, mechanics and transmissivity of rock fractures

    International Nuclear Information System (INIS)

    This thesis work investigates methods and tools for characterising, testing and modelling the behaviour of rock fractures. Using a 3D-laser-scanning technique, the topography of the surfaces and their position with respect to one another are measured. From the fracture topography, fracture roughness, angularity and aperture are quantified; the major features used for characterisation. The standard deviations for the asperity heights, surface slopes and aperture are determined. These statistical parameters usually increase/decrease according to power laws of the sampling size, and sometimes reach a sill beyond which they become constant. Also the number of contact spots with a certain area decreases according to a power-law function of the area. These power-law relations reveal the self affine fractal nature of roughness and aperture. Roughness is 'persistent' while aperture varies between 'persistent' and 'anti-persistent' probably depending on the degree of match of the fracture walls. The fractal models for roughness, aperture and contact area are used to develop a constitutive model, based on contact mechanics, for describing the fracture normal and shear deformability. The experimental testing results of normal deformability are simulated well by the model whereas fracture shear deformability is not as well modelled. The model predicts well fracture dilation but is too stiff compared to rock samples. A mathematical description of the aperture pattern during shearing is also formulated. The mean value and covariance of the aperture in shearing is calculated and verifies reported observations. The aperture map of samples is inserted in a numerical program for flow calculation. The 'integral transform method' is used for solving the Reynolds' equation; it transforms the fracture transmissivity pattern into a frequency-based function. This closely resembles the power laws that describe fractals. This function can be described directly from the fractal properties of

  3. Experimental Fracture Measurements of Functionally Graded Materials

    Science.gov (United States)

    Carpenter, Ray Douglas

    The primary objective of this research was to extend established fracture toughness testing methods to a new class of engineering materials known as functionally graded materials (FGMs). Secondary goals were to compare experimental results to those predicted by finite element models and to provide fracture test results as feedback toward optimizing processing parameters for the in-house synthesis of a MoSi2/SiC FGM. Preliminary experiments were performed on commercially pure (CP) Ti and uniform axial tensile tests resulted in mechanical property data including yield strength, 268 MPa, ultimate tensile strength, 470 MPa and Young's modulus, 110 GPa. Results from 3-point bending fracture experiments on CP Ti demonstrated rising R-curve behavior and experimentally determined JQ fracture toughness values ranged between 153 N/mm and 254 N/mm. Similar experimental protocols were used for fracture experiments on a 7- layered Ti/TiB FGM material obtained from Cercom in Vista, California. A novel technique for pre-cracking in reverse 4-point bending was developed for this ductile/brittle FGM material. Fracture test results exhibited rising R-curve behavior and estimated JQ fracture toughness values ranged from 0.49 N/mm to 2.63 N/mm. A 5- layered MoSi2/SiC FGM was synthesized using spark plasma sintering (SPS). Samples of this material were fracture tested and the results again exhibited a rising R-curve with KIC fracture toughness values ranging from 2.7 MPa-m1/2 to 6.0 MPa-m1/2. Finite Element Models predicted rising R-curve behavior for both of the FGM materials tested. Model results were in close agreement for the brittle MoSi2/SiC FGM. For the relatively more ductile Ti/TiB material, results were in close agreement at short crack lengths but diverged at longer crack lengths because the models accounted for fracture toughening mechanisms at the crack tip but not those acting in the crack wake.

  4. Pediatric stress fractures

    OpenAIRE

    de la Cuadra, P.; Albiñana, J.

    2000-01-01

    Stress fractures in children are uncommon. This report describes the findings of 8 cases in 6 children. One patient had 3 stress fractures: 2 consecutive midshaft stress fractures of the same tibia associated with one of the fibula. Signs and symptoms may be misdiagnosed as malignant tumors or osteomyelitis. Serial radiographs and computed tomography scans are the key to the diagnosis, although bone scan and magnetic resonance imaging can be helpful. Biopsy is unnecessary and might even be mi...

  5. Pelvic Insufficiency Fractures

    OpenAIRE

    O’Connor, Timothy J.; Cole, Peter A.

    2014-01-01

    Pelvic insufficiency fractures may occur in the absence of trauma or as a result of low-energy trauma in osteoporotic bone. With a growing geriatric population, the incidence of pelvic insufficiency fracture has increased over the last 3 decades and will continue to do so. These fractures can cause considerable pain, loss of independence, and economic burden to both the patient and the health care system. While many of these injuries are identified and treated based on plain radiographs, some...

  6. FRACTURE NASAL BONES

    OpenAIRE

    Balasubramanian Thaigarajan; Venkatesan Ulaganathan

    2013-01-01

    Nose is the most prominent part of the face, hence it is likely to be the most common structure to be injured in the face. Although fractures involving the nasal bones are very common, it is often ignored by the patient. Patients with fractures of nasal bone will have deformity, tenderness, haemorrhage, edema, ecchymosis, instability, and crepitation. These features may be present in varying combinations. This article discusses the pathophysiology of these fractures, role of radiography a...

  7. Fracture Nasal Bone

    OpenAIRE

    Balasubramanian, Thiagarajan; Venkatesan, Ulaganathan

    2013-01-01

    Nose is the most prominent part of the face, hence it is likely to be the most common structure to be injured in the face. Although fractures involving the nasal bones are very common, it is often ignored by the patient. Patients with fractures of nasal bone will have deformity, tenderness, haemorrhage, edema, ecchymosis, instability, and crepitation. These features may be present in varying combinations. This article discusses the pathophysiology of these fractures, role of radiography and u...

  8. TIBIAL SHAFT FRACTURES

    OpenAIRE

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2015-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical...

  9. OPEN REDUCTION AND K-WIRE FIXATION OF VERY LATE PRESENTING PAEDIATRIC SUPRASUPRACONDYLAR HUMERAL FRACTURES USING INVERTED V-Y TRICEPSPLASTY APPROACH AND CALLUS OSTEOCLASIS

    OpenAIRE

    Vidya Bhushan; Amit Kumar; Lakhtakia

    2015-01-01

    Fracture supracondylar humerus is a common paediatric injury. The current preferred treatment option for the displaced supracondylar fracture is early closed reduction and percutaneous pinning. Neglected displaced fractures of supracondylar humerus are not uncommon in developing countries like India. We prospectively evaluated the results of early correction of 8 malunited paediatric supracondylar humeral fractures using inverted V-Y tricepsplasty approach and callus osteoclasis (...

  10. Increasing fracture during childhood

    International Nuclear Information System (INIS)

    Although calvarial fractures usually heal well in children, it may occur that interposition of dura and arachnoidea leads to an enlargement of the fracture line, and to formation of a leptomeningeal cyst accompanied by an arrosion of the bone. This defect of the skull cap is the so-called 'growing fracture of the vault of the cranium'. Clinical manifestation of this growing fracture is a swelling that occurs after some weeks on the skull. Diagnostic evaluation can be done by CT and X-ray radiography. (orig./GDG)

  11. Atraumatic First Rib Fracture

    Directory of Open Access Journals (Sweden)

    Koray Aydogdu

    2014-12-01

    Full Text Available Rib fractures are usually seen after a trauma, while atraumatic spontaneous rib fractures are quite rare. A first rib fracture identified in our 17 years old female patient who had not a history of trauma except lifting a heavy weight was examined in details in terms of the potential complications and followed-up for a long time. We presented our experience on this case with atraumatic first rib fracture that has different views for the etiology in light of the literature.

  12. Fracture of the styloid process associated with the mandible fracture

    OpenAIRE

    K N Dubey; Ajay Bajaj; Ish Kumar

    2013-01-01

    Fracture of the styloid process (SP) of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

  13. Fracture of the styloid process associated with the mandible fracture

    Directory of Open Access Journals (Sweden)

    K N Dubey

    2013-01-01

    Full Text Available Fracture of the styloid process (SP of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

  14. Concrete fracture models and applications

    CERN Document Server

    Kumar, Shailendra

    2011-01-01

    Concrete-Fracture Models and Applications provides a basic introduction to nonlinear concrete fracture models. Readers will find a state-of-the-art review on various aspects of the material behavior and development of different concrete fracture models.

  15. Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

    Directory of Open Access Journals (Sweden)

    Anendd Jadhav

    2015-01-01

    Full Text Available Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF, and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%. In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA n = 07 (58.33% followed by fall n = 04 (33.33% and assault n = 1 (8.33%. The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.

  16. Long term surgical treatment outcome of talar body fracture

    Directory of Open Access Journals (Sweden)

    Sen Ramesh Kumar

    2012-02-01

    Full Text Available 【Abstract】Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures. Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level I trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views and ankle (antero-posterior, lateral and mortise views were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI after 3 weeks, 6 weeks, 3 months, 6 months and then annually. Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear, with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis of talar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome. Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation. Key words: Fractures, bone; Talus; Fracture fixation, internal

  17. Pneumothorax complicating isolated clavicle fracture.

    Science.gov (United States)

    Hani, Redouane; Ennaciri, Badr; Jeddi, Idriss; El Bardouni, Ahmed; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result.

  18. IPIRG programs - advances in pipe fracture technology

    Energy Technology Data Exchange (ETDEWEB)

    Wilkowski, G.; Olson, R.; Scott, P. [Batelle, Columbus, OH (United States)

    1997-04-01

    This paper presents an overview of the advances made in fracture control technology as a result of the research performed in the International Piping Integrity Research Group (IPIRG) program. The findings from numerous experiments and supporting analyses conducted to investigate the behavior of circumferentially flawed piping and pipe systems subjected to high-rate loading typical of seismic events are summarized. Topics to be discussed include; (1) Seismic loading effects on material properties, (2) Piping system behavior under seismic loads, (3) Advances in elbow fracture evaluations, and (4) {open_quotes}Real{close_quotes} piping system response. The presentation for each topic will be illustrated with data and analytical results. In each case, the state-of-the-art in fracture mechanics prior to the first IPIRG program will be contrasted with the state-of-the-art at the completion of the IPIRG-2 program.

  19. [Surgical treatment of subtrochanteric fractures in children].

    Science.gov (United States)

    Guzmán-Vargas, R; Rincón-Cardozo, D F; Camacho-Casas, J A

    2016-01-01

    Subtrochanteric fractures in children are rare events, occur in only 4% of all femur fractures, most injuries occur as a result of high energy trauma, being young males patient the most affected. The management of this type of injury is controversial, there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement and external fixators. Most suggest that children under 10 should be preferred non-operative and for older than 12 surgical management is indicated, but the discussion is between 6 and 12 years old. Through this article we present the treatment of such entity with a proximal fracture plate using a minimally invasive technique. PMID:27627774

  20. Tibia (Shinbone) Shaft Fractures

    Science.gov (United States)

    ... the recovery period. For example, if so tissue injury is present with a fracture, the knee, ankle, foot, and toes may be mobilized early in ... bone are typically the result of higher energy mechanisms (as opposed to the spiral-type fractures ... injuries). They also have increased injury to the tissues ...

  1. THORACIC SPINE FRACTURES

    Institute of Scientific and Technical Information of China (English)

    戴力扬

    2001-01-01

    Objective. To investigate the unique characteristics and treatment of thoracic spine fractures.Methods. Severty-seven patients with thoracic spine fractures were retrospectively reviewed. Of these, therewere 37 compressior fractures, 34 fracture-dislocations, 3 burst fractures and 3 burst-dislocations. Twenty-six pa-tients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 wereneurologically intact. Fifty-three patients were treated nonoperatively and 24 treated operatively.Results. All patients were followed up for 2 ~ 15 years. None of the 26 patients with a complete lesion recov-ered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them re-mained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some func-tion and 5 did not recovered.Conclusions. E ecause of the unique anatomy and biomechanics of the thoracic spine, the classification common-ly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicat-ed when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidatesfor supplemented decompression.

  2. Pediatric Thighbone (Femur) Fracture

    Science.gov (United States)

    ... carefully examine the leg, including the hip and knee. A child with a thighbone fracture should always be evaluated for other serious injuries. ... down the uninjured leg, or stop at the knee or hip. Your doctor will decide ... your child’s fracture. Your doctor will sedate your child for the ...

  3. 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.

  4. Probabilistic fracture mechanics

    International Nuclear Information System (INIS)

    It has been attempted to present the elements of probabilistic fracture mechanics in a self-contained way. First, for brittle fracture, damage theories are discussed which allow for the effects of both size and local strength of the structure on the probability of fracture. Second, combined crack and damage theories are presented. They provide insight into macro-crack formation and take into account the effects of crack orientation and multiaxial states of stress. For fatigue, both the two-phase theory of damage and crack extension as well as the cumulative theory (of damage or of crack extension) are presented. They give estimates for the lifetime of a structure under random load. The effect of random material properties may be included. Finally, an assessment of the probability of failure of reactor pressure vessels is discussed. There, brittle fracture and fatigue are taken into account and both fracture toughness and crack size are considered to be random quantities. (Auth.)

  5. Subtrochanteric femur fracture treated by intramedullary fixation

    Institute of Scientific and Technical Information of China (English)

    Zu-Bin Zhou; Song Chen; You-Shui Gao; Yu-Qiang Sun; Chang-Qing Zhang; Yao Jiang

    2015-01-01

    Purpose: To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures.Methods: From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37 -72 years (mean 53.5 years).According to Seinsheimer classification, there were 2 cases of type Ⅰ, 7 type Ⅱ,15 type Ⅲ, 23 type Ⅳ and 29 type Ⅴ.Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table.Two cases of type Ⅰ and 3 cases of type Ⅲ fractures had ideal closed reduction followed by internal fixation.The others needed additional limited open reduction.Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up.Functional recovery was evaluated by Harris Hip Scoring (HHS) system.Results: Patients were followed up for 6-12 months.All fractures were healed except one patient with delayed union.The average bone union time was 4.5 months.According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor.The proportion of the patients with excellent and good recovery was 96.05%.Conclusion: Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture.The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients' prognosis.

  6. Non-linear hydrotectonic phenomena: Part I - fluid flow in open fractures under dynamical stress loading

    Energy Technology Data Exchange (ETDEWEB)

    Archambeau, C.B. [Univ. of Colorado, Boulder, CO (United States)

    1994-01-01

    A fractured solid under stress loading (or unloading) can be viewed as behaving macroscopically as a medium with internal, hidden, degrees of freedom, wherein changes in fracture geometry (i.e. opening, closing and extension) and flow of fluid and gas within fractures will produce major changes in stresses and strains within the solid. Likewise, the flow process within fractures will be strongly coupled to deformation within the solid through boundary conditions on the fracture surfaces. The effects in the solid can, in part, be phenomenologically represented as inelastic or plastic processes in the macroscopic view. However, there are clearly phenomena associated with fracture growth and open fracture fluid flows that produce effects that can not be described using ordinary inelastic phenomenology. This is evident from the fact that a variety of energy release phenomena can occur, including seismic emissions of previously stored strain energy due to fracture growth, release of disolved gas from fluids in the fractures resulting in enhanced buoyancy and subsequent energetic flows of gas and fluids through the fracture system which can produce raid extension of old fractures and the creation of new ones. Additionally, the flows will be modulated by the opening and closing of fractures due to deformation in the solid, so that the flow process is strongly coupled to dynamical processes in the surrounding solid matrix, some of which are induced by the flow itself.

  7. 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.

  8. Medidas do tendão do calcâneo no primeiro ano de vida Measurements of the calcaneal tendon in the first year of life

    Directory of Open Access Journals (Sweden)

    Ricardo Flávio de Araújo Bezerra

    2009-06-01

    Full Text Available OBJETIVO: Determinar as espessuras e larguras dos tendões do calcâneo (tendão de Aquiles em crianças eutróficas de ambos os gêneros, aos 2, 6, 9 e 12 meses de idade. MATERIAIS E MÉTODOS: Fizeram parte deste estudo prospectivo e descritivo 38 meninos e 31 meninas. As medidas dos tendões foram obtidas por meio de ultrassonografia, utilizando transdutor linear de 14 MHz, na altura do maléolo medial. RESULTADOS: Verificou-se que as espessuras dos tendões nos meninos foram de 2,4 mm, 2,3 mm, 2,4 mm e 2,4 mm, aos 2, 6, 9 e 12 meses, respectivamente. As larguras do tendão do calcâneo foram de 6,0 mm, 6,4 mm, 6,7 mm e 7,1 mm, respectivamente. Nas meninas, as espessuras obtidas aos 2, 6 e 9 meses foram de 2,4 mm, e aos 12 meses encontrou-se o valor de 2,5 mm. As quatro medidas da largura foram de 5,7 mm, 6,2 mm, 6,5 mm e 6,5 mm, respectivamente. CONCLUSÃO: Não houve diferença na espessura do tendão do calcâneo ao longo do primeiro ano de vida para ambos os gêneros, entretanto, houve diferença nas medidas da largura.OBJECTIVE: To determine the thickness and width of the calcaneal tendon (Achilles tendon in both male and female, eutrophic children at 2, 6, 9 and 12 months of age. MATERIALS AND METHODS: The present prospective and descriptive study included 38 boys and 31 girls. Measurements of the tendons were performed by means of ultrasonography, with a linear, 14-MHz probe, at the level of the medial malleolus. RESULTS: Tendon thicknesses observed in the boys were 2.4 mm, 2.3 mm, 2.4 mm, and 2.4 mm, respectively at 2, 6, 9 and 12 months. Widths were, respectively, 6.0 mm, 6.4 mm, 6.7 mm and 7.1 mm. In the girls, the tendon thicknesses observed at 2, 6 and 9 months were 2.4 mm, and 2.5 mm at 12 months. Widths were, respectively, 5.7 mm, 6.2 mm, 6.5 mm and 6.5 mm. CONCLUSION: No difference was observed in the calcaneal tendon thickness between boys and girls along the first year of their lives; however, width measurements demonstrated

  9. [Surgical treatment of humerus condylar fracture].

    Science.gov (United States)

    Gorodnichenko, A I; Guseĭnov, T Sh; Uskov, O N

    2014-01-01

    55 patients with intra-articular condyles fractures of humerus were operated in terms 1998 to 2013 year in the Clinic of Traumatology and Orthopedics of the Presidential Administration. All patients were operated by using of perosseous osteosynthesis method with external fixing device design A.I. Gorodnichenko. Indications for osteosynthesis were open and closed fractures of C1,2,3 types accordingly to AO Classification. Closed, atraumatic and reliable fixation of bone fragments intensifies patients faster, improves their life quality, decreases time of hospitalization and minimizes complications rate. Fractures consolidation was achieved in all cases. It was observed such complications as soft tissue inflammatory around shafts in 4 (7.3%) observations. Long-term results were studied in 51 (92.7%) patients including 9 (17.6%) patients with excellent results, 24 (47.1%) patients with good results and 18 (35.3%) patients with satisfactory results. It was not detected unsatisfactory results. The method permits early reconstructive treatment of patients and improves functional results in case of condyles fractures. This preserves active moving function of damaged elbow from the first day after operation and during all period of treatment.

  10. Effects of low-intensity non-coherent light therapy on the inflammatory process in the calcaneal tendon of ovariectomized rats.

    Science.gov (United States)

    Helrigle, Carla; de Carvalho, Paulo deTarso Camilo; Casalechi, Heliodora Leão; Leal-Junior, Ernesto Cesar Pinto; Fernandes, Guilherme Henrique Cardoso; Helrigel, Panmera Almeida; Rabelo, Rogério Leão; de Oliveira Aleixo-Junior, Ivo; Aimbire, Flavio; Albertini, Regiane

    2016-01-01

    The aim of this experimental study was to investigate the effects of low-intensity light-emitting diode (LED) phototherapy on the inflammatory process in the calcaneal tendon of ovariectomized rats (OVX) through the involvement of the inflammatory mediators interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNF-α). Thirty-five female Wistar rats were divided into 4 groups: 3 groups of OVX rats totaling 30 rats (untreated OVX rats [OVX injury group], treated OVX rats [OVX LED group], and control OVX rats; subgroups existed based on the sampling times, which were 3, 7, and 14 days) and 1 group of non-OVX rats (not OVX; n = 5). Tendon injury was induced by trauma using a 208-g mass placed at 20 cm from the right tendon of each animal with energy of 0.70 J. The animals were treated 12 h after tendonitis with LED therapy and every 48 h thereafter until euthanasia (at 3, 7, or 14 days). The tendons were dissected and stored in liquid nitrogen at -196 °C, thawed only at the time of immunoenzymatic testing (ELISA). Groups treated with LED showed a decrease in the number of pro-inflammatory cells, IL-6, and TNF-α (p LED treatment using the parameters and wavelength of 945 nm in the time periods studied reduced the release of IL-6 and TNF-α and increased the release of IL-10, thereby improving the inflammatory response in OVX rats. PMID:26507001

  11. Quantitative mineral salt evaluation in the calcaneous bone using computed tomography, 125I-photon absorption and chemical analysis to compare the value of the individual methods

    International Nuclear Information System (INIS)

    It was the aim of the study described here to verify the accuracy of two different methods for the quantitative evaluation of mineral salts, which were the 125I-photon absorption technique on the one hand and wholebody CT on the other hand. For this purpose, post-mortem examinations of 31 calcaneous bones were carried out to evaluate their individual mineral salt contents in vitro using either of the above-mentioned methods. The results obtained were subsequently contrasted with calcium concentrations determined by chemical analysis. A comparison of the individual mineral salt evaluations with the results from calcium analyses pointed to a highly significant correlation (p=0.001) for both methods under investigation. The same held for the correlation of findings from CT and the 125I-hydroxylapatite technique, where the level of significance was also p=0.001. The above statements must, however, be modified in as much as the mineral salt values measured by CT were consistently lower than those obtained on the basis of 125I-photon absorption. These deviations are chiefly attributable to the fact that the values provided by CT are more susceptible to influences from the fat contained in the bones. In 125I-photon absorption a special formula may be derived to allow for the bias occurring here, provided that the composition of the bone is known. To summarise, the relative advantages and drawbacks of CT and 125I-photon absorption are carefully balanced. Mineral salt evaluations by CT permit incipient losses to be ascertained even in the trunk. The 125I-photon absorption technique would appear to be the obvious method for any kind of follow-up examination in the peripheral skeleton, as it is easily reproducible and radiation exposure can be kept to minimum. (TRV)

  12. Temporal Bone Fracture Causing Superior Semicircular Canal Dehiscence

    Directory of Open Access Journals (Sweden)

    Kevin A. Peng

    2014-01-01

    Full Text Available Importance. Superior semicircular canal dehiscence (SCD is a third window lesion of the inner ear causing symptoms of vertigo, autophony, tinnitus, and hearing loss. A “two-hit” hypothesis has traditionally been proposed, whereby thinly developed bone overlying the superior canal is disrupted by a sudden change in intracranial pressure. Although the symptoms of SCD may be precipitated by head injury, no previous reports have described a temporal bone fracture directly causing SCD. Observations. Two patients sustained temporal bone fractures after closed head trauma, and developed unilateral otologic symptoms consistent with SCD. In each instance, computed tomography imaging revealed fractures extending through the bony roof of the superior semicircular canal. Conclusions and Relevance. Temporal bone fractures, which are largely treated nonoperatively, have not previously been reported to cause SCD. As it is a potentially treatable entity, SCD resulting from temporal bone fracture must be recognized as a possibility and diagnosed promptly if present.

  13. Analytical solutions of solute transport in a fracture-matrix system with different reaction rates for fracture and matrix

    Science.gov (United States)

    Zhu, Yonghui; Zhan, Hongbin; Jin, Menggui

    2016-08-01

    This study deals with the problem of reactive solute transport in a fracture-matrix system using both analytical and numerical modeling methods. The groundwater flow velocity in the fracture is assumed to be high enough (no less than 0.1 m/day) to ensure the advection-dominant transport in the fracture. The problem includes advection along the fracture, transverse diffusion in the matrix, with linear sorption as well as first-order reactions operative in both the fracture and the matrix. A constant-concentration boundary condition and a decay source boundary condition in the fracture are considered. With a constant-concentration source, we obtain closed-form analytical solutions that account for the transport without reaction as well as steady-state solutions with different first-order reactions in the two media. With a decay source, a semi-analytical solution is obtained. The analytical and semi-analytical solutions are in excellent agreement with the numerical simulation results obtained using COMSOL Multiphysics. Sensitivity analysis is conducted to assess the relative importance of matrix diffusion coefficient, fracture aperture, and matrix porosity. We conclude that the first-order reaction as well as the matrix diffusion in the fractured rock would decrease the solute peak concentration and shorten the penetration distance into the fracture. The solutions can be applied to assess the spatial-temporal distribution of concentrations in the fracture and the matrix as well as to assess the contaminant mass stored in the rock matrix. All of these are useful for designing remediation plans for contaminated fractured rocks or for risk assessment of contaminated fracture-matrix systems.

  14. Primary fractures within a tuff cone, North Menan Butte, Idaho, U.S.A.

    Science.gov (United States)

    Russell, W. J.; Brisbin, W. C.

    1990-01-01

    North Menan Butte is a tuff cone near Idaho Falls, Idaho. It is a result of the eruption of basaltic magma through shallow water-saturated river alluvium of the Snake River. The cone is characterized by primary fractures that can be classified into four groups on the basis of their physical properties and their orientations relative to the symmetry elements of the cone. Type I fractures are short, closely spaced and usually confined to individual beds. They strike approximately at right angles to cone radii and always dip toward the rim of the tuff cone. Bed segments separated by these fractures have undergone rotation, resulting in normal displacements. Type II fractures have similar attitudes but are more continuous, less frequent, and show no shear displacement. Type III fractures also strike at right angles to cone radii, but they dip away from the cone rim. They cut across several beds and reveal inconsistent senses of shear displacement. Type IV fractures are radial, steeply dipping and tend to be the most continuous of all fracture types. Type I fractures were the earliest to develop; age relationships otherwise are uncertain. Examples of all four types of fractures are exposed on the inner and outer eroded slopes of the cone. Evidence from the cone indicates that the fractures developed in an unconsolidated aggregate of tuff with low cohesion; therefore, analysis of fracture genesis should be constrained by principles of soil mechanics. Type I fractures originated as tension fractures related to early downslope mass movement. Later movement on Type I fractures accompanied the development of Type III shear fractures and possible bedding plane displacements, all caused by overloading the crest of the cone by late-stage eruptive products. The origin of Type II fractures is unknown; shrinkage due to desiccation or large-scale creep are possible explanations. The radial Type IV fractures may be a consequence of desiccation shrinkage or possibly of subcone

  15. Inverse fracture network modelling

    International Nuclear Information System (INIS)

    The basic problem in analyzing flow and transport in fractured rock is that the flow may be largely governed by a poorly connected network of fractures. Flow in such a system cannot be modeled with traditional modelling techniques. Fracture network models also have a limitation, in that they are based on geological data on fracture geometry even though it is known that only a small portion of fractures observed is hydraulically active. This paper discusses a new technique developed for treating the problem as well as presents a modelling example carried out to apply it. The approach is developed in Lawrence Berkeley Laboratory and it treats the fracture zone as an 'equivalent discontinuum'. The discontinuous nature of the problem is represented through flow on a partially filled lattice. An equivalent discontinuum model is constructed by adding and removing conductive elements through a statistical inverse technique called 'simulated annealing'. The fracture network model is 'annealed' until the modified systems behaves like the observed. The further development of the approach continues at LBL and in a joint LBL/VTT collaboration project the possibilities to apply the technique in Finnish conditions are investigated

  16. Dry fracture method for simultaneous measurement of in-situ stress state and material properties

    Energy Technology Data Exchange (ETDEWEB)

    Serata, S. [Serata Geomechanics, Inc., Richmond, CA (United States); Oka, S.; Kikuchi, S. [JDC Corp., Tokyo (Japan)

    1996-04-01

    Based on the dry fracture principle, a computerized borehole probe has been developed to measure stress state and material properties, simultaneously. The probe is designed to obtain a series of measurements in a continuing sequence along a borehole length, without any interruptive measures, such as resetting packers, taking indentation of borehole wall, overcoming, etc. The new dry fracture probe for the single fracture method is designed to overcome the difficulties posed by its ancestor which was based on the double fracture method. The accuracy of the single fracture method is confirmed by a close agreement with the theory, FE modeling and laboratory testing.

  17. Reattachment of Fractured Tooth Fragment with Fiber Post: A Case Series with 1-Year Followup

    Directory of Open Access Journals (Sweden)

    C. M. Sapna

    2014-01-01

    Full Text Available Coronal fractures of the anterior teeth are common sequelae of dental trauma. In case of complex fractures, where the fractured segment is available and there is close approximation of the segment to the remaining tooth, root canal treatment followed by reattachment of the fractured segment with fiber post reinforcement is a feasible option. The procedure is simple and economic and needs less chair-side time as compared to many conventional methods. In addition, the procedure provides good and long-lasting esthetics, because the original morphology, color, and surface texture are maintained. This paper reports three cases of complex coronal tooth fracture successfully managed using tooth fragment reattachment.

  18. Land-Surface Subsidence and Open Bedrock Fractures in the Tully Valley, Onondaga County, New York

    Science.gov (United States)

    Hackett, William R.; Gleason, Gayle C.; Kappel, William M.

    2009-01-01

    Open bedrock fractures were mapped in and near two brine field areas in Tully Valley, New York. More than 400 open fractures and closed joints were mapped for dimension, orientation, and distribution along the east and west valley walls adjacent to two former brine fields. The bedrock fractures are as much as 2 feet wide and over 50 feet deep, while linear depressions in the soil, which are 3 to 10 feet wide and 3 to 6 feet deep, indicate the presence of open bedrock fractures below the soil. The fractures are probably the result of solution mining of halite deposits about 1,200 feet below the land surface.

  19. Dynamic plate osteosynthesis for fracture stabilization: how to do it

    Directory of Open Access Journals (Sweden)

    Juerg Sonderegger

    2010-01-01

    Full Text Available Plate osteosynthesis is one treatment option for the stabilization of long bones. It is widely accepted to achieve bone healing with a dynamic and biological fixation where the perfusion of the bone is left intact and micromotion at the fracture gap is allowed. The indications for a dynamic plate osteosynthesis include distal tibial and femoral fractures, some midshaft fractures, and adolescent tibial and femoral fractures with not fully closed growth plates. Although many lower limb shaft fractures are managed successfully with intramedullary nails, there are some important advantages of open-reduction-and-plate fixation: the risk of malalignment, anterior knee pain, or nonunion seems to be lower. The surgeon performing a plate osteosynthesis has the possibility to influence fixation strength and micromotion at the fracture gap. Long plates and oblique screws at the plate ends increase fixation strength. However, the number of screws does influence stiffness and stability. Lag screws and screws close to the fracture site reduce micromotion dramatically. Dynamic plate osteosynthesis can be achieved by applying some simple rules: long plates with only a few screws should be used. Oblique screws at the plate ends increase the pullout strength. Two or three holes at the fracture site should be omitted. Lag screws, especially through the plate, must be avoided whenever possible. Compression is not required. Locking plates are recommended only in fractures close to the joint. When respecting these basic concepts, dynamic plate osteosynthesis is a safe procedure with a high healing and a low complication rate. 

  20. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)

    2008-01-01

    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...... of the spine at at least two of the neighbouring vertebrae is calculated. The different curvature values are computed to obtain a value representative of the degree of irregularity in curvature of the spine and using the degree of irregularity, an estimate of the risk of a future fracture in vertebrae...

  1. FRACTURE NASAL BONES

    Directory of Open Access Journals (Sweden)

    Balasubramanian Thaigarajan

    2013-03-01

    Full Text Available Nose is the most prominent part of the face, hence it is likely to be the most common structure to be injured in the face. Although fractures involving the nasal bones are very common, it is often ignored by the patient. Patients with fractures of nasal bone will have deformity, tenderness, haemorrhage, edema, ecchymosis, instability, and crepitation. These features may be present in varying combinations. This article discusses the pathophysiology of these fractures, role of radiography and ultrasound in their diagnosis and their management.

  2. Application of SGD Fixator in Fractures of Tibia and Fibula

    Institute of Scientific and Technical Information of China (English)

    PING Jinzhong; SHEN Hongsheng; QIU Song

    2002-01-01

    @@ We applied SGD unilateral multifunctional external fixators(designed by Prof. Yu Zhongjia and produced by Shanghai Surgical Instruments Factory) to treat open, closed and ununited fractures of tibia and fibula caused by trauma in our hospital from Jan. 1994 to Dec. 1998. 3 months to one year after operation, the fractures were united and the satisfying results were obtained. Our reports were as follows.

  3. Hydraulic Fracture Containment in Sand

    NARCIS (Netherlands)

    Dong, Y.

    2010-01-01

    The mechanism of hydraulic fracturing in soft, high permeability material is considered fundamentally different from that in hard, low permeability rock, where a tensile fracture is created and conventional linear elastic fracture mechanics (LEFM) applies. The fracturing and associated modeling work

  4. Fracture characteristics in Japanese rock

    International Nuclear Information System (INIS)

    It is crucial for the performance assessment of geosphere to evaluate the characteristics of fractures that can be dominant radionuclide migration pathways from a repository to biosphere. This report summarizes the characteristics of fractures obtained from broad literature surveys and the fields surveys at the Kamaishi mine in northern Japan and at outcrops and galleries throughout the country. The characteristics of fractures described in this report are fracture orientation, fracture shape, fracture frequency, fracture distribution in space, transmissivity of fracture, fracture aperture, fracture fillings, alteration halo along fracture, flow-wetted surface area in fracture, and the correlation among these characteristics. Since granitic rock is considered the archetype fractured media, a large amount of fracture data is available in literature. In addition, granitic rock has been treated as a potential host rock in many overseas programs, and has JNC performed a number of field observations and experiments in granodiorite at the Kamaishi mine. Therefore, the characteristics of fractures in granitic rock are qualitatively and quantitatively clarified to some extent in this report, while the characteristics of fractures in another rock types are not clarified. (author)

  5. "Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Güven Melih

    2009-09-01

    Full Text Available Abstract Introduction Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare. Case presentation A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder. Conclusion The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.

  6. Percutaneous osteosynthesis of Galeazzi fracture-dislocation

    Directory of Open Access Journals (Sweden)

    Gadegone Wasudeo

    2010-01-01

    Full Text Available Background: A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radio-ulnar joint (DRUJ. The conventional surgical technique of nailing does not give enough stability and open reduction, internal fixation with the plate is associated with numerous complications. The stacked nailing for the management of these injuries provides adequate stability, maintains the relationship of the DRUJ and promotes uneventful union by closed technique. The purpose of this study is to evaluate the results of simple, user-friendly, low cost elastic stacked nailing for the management of Galeazzi fracture dislocation. Materials and Methods: We treated 22 young adults with fresh Galeazzi fracture-dislocation of the forearm, from January 2004 to January 2008, by percutaneous fixation of fracture by stacked elastic nailing at our institute. There were 19 males and three females and the age group ranged from 20-56 years (average 35 years. Surgery was performed within 48 to 72 hours under the guidance of image intensifier. Medullary cavity was filled with two elastic titanium nails having unequal lengths and diameter. One nail acts as a reduction nail and the other acts as a stabilizing nail. The results were evaluated using Mikic criteria based on union, alignment, relationship of the DRUJ, and movements at the inferior radio ulnar joint, elbow and wrist. Results: In six cases, following radiological union, nails in the radius were extracted between six to nine months after operation because of discomfort complained by the patient at site of insertion. After one year follow-up, 18 patients had excellent, four had fair results. Conclusion: Closed reduction and internal fixation of Galeazzi fracture by two elastic rods re-establishes the normal relationship of the fractured fragments and the DRUJ without repair of the ligaments. The stability is achieved by the flexibility and elasticity of the nails, crowding of the

  7. Hip fracture - discharge

    Science.gov (United States)

    ... 2012:chap 55. Read More Broken bone Hip fracture surgery Hip pain Leg MRI scan Osteoporosis - overview Patient Instructions Getting your home ready - knee or hip surgery Osteomyelitis - discharge Update Date 11/ ...

  8. Ankle fracture - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000548.htm Ankle fracture - aftercare To use the sharing features on this ... Sit with your foot elevated higher than your knee at least 4 times a day Apply an ...

  9. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2012-01-01

    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  10. Etiology of zygomatic fractures.

    Science.gov (United States)

    Cotter, C J; Ogunbowale, A; Beirne, C

    2005-01-01

    We report on the etiology of zygomatic fractures in an Irish population. More than half of these injuries are related to interpersonal assault. Treatment of these injuries places a considerable burden on the health service. PMID:16445148

  11. Relative permeability through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Diomampo, Gracel, P.

    2001-08-01

    The mechanism of two-phase flow through fractures is of importance in understanding many geologic processes. Currently, two-phase flow through fractures is still poorly understood. In this study, nitrogen-water experiments were done on both smooth and rough parallel plates to determine the governing flow mechanism for fractures and the appropriate methodology for data analysis. The experiments were done using a glass plate to allow visualization of flow. Digital video recording allowed instantaneous measurement of pressure, flow rate and saturation. Saturation was computed using image analysis techniques. The experiments showed that gas and liquid phases flow through fractures in nonuniform separate channels. The localized channels change with time as each phase path undergoes continues breaking and reforming due to invasion of the other phase. The stability of the phase paths is dependent on liquid and gas flow rate ratio. This mechanism holds true for over a range of saturation for both smooth and rough fractures. In imbibition for rough-walled fractures, another mechanism similar to wave-like flow in pipes was also observed. The data from the experiments were analyzed using Darcy's law and using the concept of friction factor and equivalent Reynold's number for two-phase flow. For both smooth- and rough-walled fractures a clear relationship between relative permeability and saturation was seen. The calculated relative permeability curves follow Corey-type behavior and can be modeled using Honarpour expressions. The sum of the relative permeabilities is not equal one, indicating phase interference. The equivalent homogeneous single-phase approach did not give satisfactory representation of flow through fractures. The graphs of experimentally derived friction factor with the modified Reynolds number do not reveal a distinctive linear relationship.

  12. Atomistic simulations of fracture

    Energy Technology Data Exchange (ETDEWEB)

    Farkas, D. [Virginia Polytechnic Inst. and State Univ., Blacksburg, VA (United States). Dept. of Materials Science and Engineering

    1997-12-31

    Embedded atom interaction potentials are used to simulate the atomistic aspects of the fracture process. Simulations are presented for the behavior of cracks in pure metals and intermetallics, near the Griffith condition. The materials considered include Fe, Cu, Ni as well as Fe, Ni, Co, and Ti aluminides. The work focuses on the comparative study of fracture behavior in the different materials. The role of the atomic relaxation at the crack tip and of lattice trapping phenomena is analyzed.

  13. Fractures on the calcaneus

    OpenAIRE

    Tanke, Gerhardus Marinus Henricus

    1982-01-01

    ln 823 patients with a displaced calcaneus fracturea study was carried out to assess the difference in the duration until recovery between those patients who were treated by operation and those who were treated conservatively. This was preceded by a study of the literature in which the accent was placed on the various types of calcaneus fractures regarding fracture mechanism, epidemiology, diagnostics and symptomatology as well as the different methods of treatment (chaptersl I to IV). ... Zi...

  14. The relation of sulcus nervi radialis with the fracture line of humerus fracture and radial nerve injury

    DEFF Research Database (Denmark)

    Ozden, Hilmi; Demir, Ahmet; Guven, Gul;

    2008-01-01

    PURPOSE: Radial nerve is closely in contact with the bone in sulcus nervi radialis (SNR). Location of SNR shows ethnic differences. Radial nerve is a big problem in humerus fractures and its surgery. In this study, we aimed to examine if humerus fractures of this region increases the probability...... of radial nerve injury. METHODS: Total length of humerus and the distance of SNR to proximal and distal anatomical points were measured on 57 human dry cadaver bones. The mean values of these data were calculated. The 58 cases of treated humerus fractures in our orthopedics department, whose radiological...

  15. THE TREATMENT OF THE FOREARM FRACTURES IN DOGS

    Directory of Open Access Journals (Sweden)

    E. Lika

    2011-12-01

    Full Text Available The practical implementation of this study was enabled by taking into consideration all the traumatized cases accompanied by fractures, presented at the Clinic of the Faculty of Veterinary Medicine during the period of March 2006 - March 2010. Special help for the implementation of this study was even offered by some private clinics in Tirana, from which we took a considerable number of valuable data. The cases of traumatized dogs were numerous and in different situations. Thus from this high number of the traumatizations accompanied by different fractures (altogether 115 dogs, 34 of them had fractures in the forearms bones. All these cases underwent surgical treatment through osteosynthesis with blood and external immobilization. We also treated cases of complications in healing these fractures after surgical treatment. The complications in the recovery of the fractures of the long bones in dogs are frequent. Above all they are first noticed in the bones of the forearm. Different problems might be identified such as’ mal joints, lack of joints, retarded joints and osteomyelitis. These because of the limited covering of the focus of the fracture by the soft tissues, lack of blood supply of the region as well as of the characteristic anatomo-topographic structure that this region has. Specifically the data that were taken into consideration included the period of recovery, the characteristics of the fracture, the type of surgical treatment and the final result. The fractures are often presented as closed fractures and less as transverse and oblique fractures. The most frequent treatment is the conservative one through external immobilization and in some cases of fractures of the radius the treatment was performed with endomedullar rods.

  16. Influence of piezometer construction on groundwater sampling in fractured rock.

    Science.gov (United States)

    Kozuskanich, J; Novakowski, K S; Anderson, B C

    2012-01-01

    A numerical model for groundwater flow and solute transport was employed to examine the influence of the screen and sandpack on the collection of a representative geochemical sample from a piezometer monitoring well installation in a discretely fractured bedrock aquifer. The optimization of screen and sandpack combinations was explored for the potential to reduce purging times and volumes in practice. Simulations accounted for the location of the fractures along the well screen, fracture aperture, screen length, and the pumping rate. The variability in the required purging times (t(99)-the time required to achieve 99% fractional contribution from the formation to pump discharge) can be explained by: (1) the relative hydraulic conductivities of the components of the system (fracture, sandpack, and screen), (2) the truncation of the flow field from the fracture to the screen by the upper and/or lower boundary of the sandpack of the flow field from another fracture, and (3) time-dependent drawdown. During pumping, only a portion of the sandpack may actually become hydraulically active. The optimal configuration (shortest purging time) is achieved when the ratios of the screen, sandpack, and fracture hydraulic conductivities are close to 1:1:1. More importantly, the role of the fracture hydraulic conductivity in the ratios is not as crucial to reducing t(99) as having the hydraulic conductivities of the screen and sandpack as similar as possible. This study provides a better understanding of well dynamics during pumping for the purpose of obtaining representative groundwater samples. PMID:21797851

  17. FRACTURING FLUID CHARACTERIZATION FACILITY

    Energy Technology Data Exchange (ETDEWEB)

    Subhash Shah

    2000-08-01

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

  18. Fracture toughness of graphene.

    Science.gov (United States)

    Zhang, Peng; Ma, Lulu; Fan, Feifei; Zeng, Zhi; Peng, Cheng; Loya, Phillip E; Liu, Zheng; Gong, Yongji; Zhang, Jiangnan; Zhang, Xingxiang; Ajayan, Pulickel M; Zhu, Ting; Lou, Jun

    2014-04-29

    Perfect graphene is believed to be the strongest material. However, the useful strength of large-area graphene with engineering relevance is usually determined by its fracture toughness, rather than the intrinsic strength that governs a uniform breaking of atomic bonds in perfect graphene. To date, the fracture toughness of graphene has not been measured. Here we report an in situ tensile testing of suspended graphene using a nanomechanical device in a scanning electron microscope. During tensile loading, the pre-cracked graphene sample fractures in a brittle manner with sharp edges, at a breaking stress substantially lower than the intrinsic strength of graphene. Our combined experiment and modelling verify the applicability of the classic Griffith theory of brittle fracture to graphene. The fracture toughness of graphene is measured as the critical stress intensity factor of and the equivalent critical strain energy release rate of 15.9 J m(-2). Our work quantifies the essential fracture properties of graphene and provides mechanistic insights into the mechanical failure of graphene.

  19. CT of pelvic fractures

    International Nuclear Information System (INIS)

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  20. CT of pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Falchi, Marco E-mail: marcofalchi@yahoo.it; Rollandi, Gian Andrea

    2004-04-01

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  1. Anaesthesia of the inferior alveolar and lingual nerves following subcondylar fractures of the mandible.

    Science.gov (United States)

    Politis, Constantinus; Sun, Yi; De Peuter, Bruno; Vandersteen, Marjan

    2013-10-01

    A retrospective chart review of 387 patients with condylar and subcondylar fractures revealed 2 cases of inferior alveolar nerve (IAN) and lingual nerve (LN) anaesthesia following the subcondylar fracture. Only 5 cases have been reported previously. The mechanism of action remains unknown but a review of the literature and an analysis of 120 dry human skulls supported the hypothesis that compression of the mandibular nerve at a high level, close to the foramen ovale, could cause anaesthesia. This complication is rare, because it requires compression at a particular angle. The antero-median angulation of the condyle must be close to the foramen ovale, and the fracture must be a unilaterally displaced fracture. The presence of an enlarged lateral pterygoid plate appeared to enhance the risk of compression. The IAN and LN anaesthesia could be resolved after open reduction of the fracture and IAN and LN anaesthesia constitute a strict indication for an early open fracture reduction. PMID:23453271

  2. Outcomes of long bone fractures treated by open intramedullary nailing at the St. Ann's Bay Hospital, Jamaica.

    Science.gov (United States)

    Barnes, D; McDowell, D

    2010-10-01

    Between May 2001 to August 2004, 35 patients had open nailing of long bones. There were 40 fractures fixed. Of these 40 fractures, there were 25 femoral fractures, 11 were tibial fractures and 4 were humeral fractures. There were 33 (82.5%) closed fractures and 7 (17.5%) open fractures. In the group of patients with open fractures, there were two Grade I, two Grade II and three Grade IIIB. Seven (20%) patients were lost to follow-up; all of whom had closed fractures. The final analysis as it relates to complications was done using 28 patients with 32 fractures. The majority of fractures healed without significant complication. All the patients with closed fractures went on to bony union. There was one non-union and three delayed unions. There were two infections (osteomyelitis) and this was from the open fracture cohort. This represents an infection rate of 28.6% in this cohort. Two (7.0%) patients had persistent pain and one (3.6%) patient had early removal of the nail because of failure of fixation. The mean time from injury to surgery for the fractured femur was 15.5 (range 0-49) days; fractured tibia 24.4 (range 0-40), days and fractured humerus 41.5 (20-81) days. The mean hospital stay was 18.9 (range 9-37) days for patients with fractured femur; for fractured tibia, it was 20.5 (range 3-82) days and for fractured humerus, it was 22.7 (range 3-82) days. The mean postoperative stay was 4.1 (range 1-14) days for fractured femur, 4.5 (range 1-14) days for fractured tibia and 4.0 (range 1-10) days for fractured humerus. The mean time to healing (consolidation) as defined by X-rays was 5.0 (range 3-11) months for fractured femur 5.2 (range 3-11) months for tibia and 7.0 (range 6-8) months for fractured humerus.

  3. The Effects of Multiple Interacting Fractures on Surface Deformation and Flow

    Science.gov (United States)

    Hager, B. H.

    2015-12-01

    In a number of topical contexts, the response of fluid-filled fractures is of fundamental importance. For example, hydraulic fracturing operations typically generate multiple sub-parallel fractures that may, in turn, interact with families of preexisting natural fractures. At the In Salah carbon sequestration site, space geodetic observations of surface deformation suggested opening of a fracture and leakage of fluids into the caprock. And hydrocarbon production is often facilitated by naturally occurring fractures that are typically depressurized through production or pressurized to enhance oil recovery. Both the surface deformation and the fluid flow resulting from pressure variations in a fractured medium are qualitatively different for a fractured medium compared to a medium with isotropic properties. It is straightforward to calculate the responses of a medium with a single fracture, with analytical solutions available for simple geometries. Also, in the limit of very high fracture density, continuum representations of anisotropic poroelasticity can be used. However, as in the examples above, there are many applications where a finite number of fractures are spaced closely enough that their stress fields interact. I investigate this regime numerically. Observations of both surface deformation and inferences of permeability can be effective in constraining estimates of fracture density and aperture.

  4. 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

  5. Reattachment of fractured teeth fragments in mandibular incisors: a case report

    Directory of Open Access Journals (Sweden)

    Yousef MK

    2015-04-01

    Full Text Available Mohammed K YousefDepartment of Operative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi ArabiaAbstract: The majority of dental trauma involves anterior teeth, especially the maxillary central incisors. A mandibular incisor fracture with or without pulp tissue involvement is considerably less common. Different approaches for treating these fractured teeth have been reported in the literature. The type of treatment rendered depends mainly on the extent of fracture, pulp involvement, radicular fracture, biologic width infringement or violation, and presence of the fractured piece. This case report illustrates reattachment of fractured fragments on two mandibular incisors without pulp exposure using a new proposed reattachment method using a combination of two different types of composite materials together with an orthodontic lingual retention wire. An 8-year-old female patient presented with fractured mandibular left incisors (Ellis class II fracture. Broken pieces were saved and brought in a closed container in water. Periapical radiographs revealed no evidence of pulpal involvement in either tooth and no periapical radiolucency was noticed. Fractured fragments and the broken teeth were prepared with circumferential bevels. Reattachment of the fractured fragments were done using two types of composite resin materials and a lingual orthodontic retention wire was also used. The patient was recalled after 8 months to follow up both teeth. Clinical examination revealed excellent composite restorations covering the fracture lines.Keywords: reattachment, fractured teeth, dental trauma 

  6. BOTH BONES FOREARM FRACTURES TREATED WITH LC-DCP: A SURGICAL OUTCOME

    OpenAIRE

    Ranganath; Prakash; Ravish; Sumanth

    2014-01-01

    Fractures of the forearm present a unique management problem for years. A forearm fracture involving both bones requires open anatomical reduction with stable fixation.[1] The forearm represents the critical anatomic unit of upper limb, permitting the effect of organ of the upper limb, the hand, to perform multi axial daily activities of living. Historically, the closed management of forearm fractures has been met with frustration in adults and resulted in poor functional ...

  7. Use of Gunning Splint for the Treatment of Edentulous Mandibular Fracture: A Case Report

    OpenAIRE

    Dharaskar, Shrinivas; Athavale, Smita; Kakade, Dilip

    2013-01-01

    Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. The complication rate of infection or malunion is higher compared to fractures in younger, dentulous patients. For such conditions, ‘Gunning splint’ is a better option as it provides close reduction and stabilization of mandibular fracture, thus improving the prognosis.

  8. Study on Surgical management of fracture shaft of Humerus by interlocking nail

    OpenAIRE

    N, Arun K; Paladugu, Kirthi; Reddy, Praveen Kumar P

    2014-01-01

    Back ground: Operative management of fracture shaft of humerus can be with plate osteosynthesis or with intramedullary nailing. In this study we have tried to analyze the outcome in terms of time for consolidation, union rates, functional results and complications of humeral shaft fractures managed with closed antegrade interlocking nailing. Study was conducted Navodaya Medical college Hospital and Research Centre, RaichurMethods: A series of 25 patients with acute fractures of shaft of humer...

  9. Posterolateral Elbow Dislocation with Ipsilateral Fractures of Head and Distal End Radius

    Directory of Open Access Journals (Sweden)

    Vijay C

    2011-04-01

    Full Text Available Elbow dislocation associated with ipsilateral fracture head and distal end radius is a rare pattern of Injury, although it is common for elbow dislocation and radius fractures to occur separately. We report a case of 35 year-old male who had a posterolateral elbow dislocation with ipsilateral fractures of head and distal end radius that underwent closed reduction and POP application and outcome is excellent with 9 months of follow-up.

  10. Arthroscopic study of injuries in articular fractures of distal radius extremity

    OpenAIRE

    Araf, Marcelo; Mattar, Rames

    2014-01-01

    OBJECTIVE: To analyze the incidence of wrist ligament and cartilage associated fractures of the distal radius, through arthroscopy, correlating with AO/ASIF classification. METHODS: Thirty patients aged between 20 and 50 years old, with closed fracture from groups B and C according to AO/ASIF classification were selected. All of them were submitted to wrist arthroscopy to address intra-articular injuries and reduction and osteosynthesis of the fracture. RESULTS: A high incidence of intra-arti...

  11. Atomistic Simulations of Nanotube Fracture

    CERN Document Server

    Belytschko, T; Schatz, G; Ruoff, R S

    2002-01-01

    The fracture of carbon nanotubes is studied by atomistic simulations. The fracture behavior is found to be almost independent of the separation energy and to depend primarily on the inflection point in the interatomic potential. The rangle of fracture strians compares well with experimental results, but predicted range of fracture stresses is marketly higher than observed. Various plausible small-scale defects do not suffice to bring the failure stresses into agreement with available experimental results. As in the experiments, the fracture of carbon nanotubes is predicted to be brittle. The results show moderate dependence of fracture strength on chirality.

  12. Management of penile fractures

    International Nuclear Information System (INIS)

    Objective was to present our experience with surgical and conservative management of penile fracture. This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra General and Teaching Hospital, Sana'a, Yemen from June 2003 to September 2007 and included 30 patients presenting with penile fracture. Diagnosis was made clinically in all our patients. Six patients with simple fracture were treated conservatively while 24 patients with more severe injuries were operated upon. Patient's age ranged from 24-52 years (mean 31.3 years) 46.7% of patients were under the age of 30 years and 56.7% were unmarried. Hard manipulation of the erect penis for example during masturbation was the most frequent mechanism of fracture in 53.3% of patients. Solitary tear was found in 22 patients and bilateral corporal tears associated with urethral injury were found in 2 patients. Corporal tears were saturated with synthetic absorbable sutures and urethral injury was repaired primarily. All operated patients described full erection with straight penis except 3 of the 8 patients who were managed by direct longitudinal incision, in whom mild curvature during erection was observed. The conservatively treated patients described satisfactory penile straightness and erection. The optimal functional and cosmetic results are achieved following immediate surgical repair of penis fracture. Good results can also be obtained in some selected patients with conservative management. (author)

  13. Medial calcaneal nerve and neurogenic painful heel syndrome: anatomic basis%跟内侧神经与神经源性跟痛症关系的解剖学基础

    Institute of Scientific and Technical Information of China (English)

    冯成安; 孙俊; 刘宗良; 范炜; 张东葵; 叶频

    2012-01-01

    Objective To investigate the relationship between the medial calcaneal nerve (MCN) and neurogenic painful heel syndrome (NPHS), and provide anatomical evidence for study, diagnosis and therapy. Methods 32 formalin-fixed adult lower limb specimens were used in the study. MCN was dissected for demonstrating the origin, course, branches and the distribution. Results 41.42% of MCN originated from the trunk of tibial nerve, however, 28.57% originated from the bifurcation site of tibial nerve, 18.57% from the medial plantar nerve, and 11.42% from the lateral plantar nerve. The distance from the origin of MCN to the middle point between the lowest margin of the medial malleolus and the medial process of calcaneal tuberosity was about (30.22± 15.34)mm. MCN distributed to medial heel, the skin of footplate, and soft tissue of heel, after passing through flexor retinaculum. Conclusions MCN maybe compressed in the ankle canal, or the calcaneal tunnel, or at the site of passing from the flexor retinaculum, which are probably related to the occurrence of the plantar fasciitis and heel pain.%目的 探讨跟内侧神经的局部解剖特点及其与神经源性跟痛症的关系,为临床诊断治疗提供解剖学依据.方法 32侧防腐成人尸体下肢标本,解剖观察跟内侧神经的起源、分支、走行和分布特点.结果 跟内侧神经41.42%起源于胫神经,28.57%起源于胫神经分叉处,18.57%起源于足底内侧神经,11.42%起源于足底外侧神经.起点距O点(内踝尖最下缘与跟骨结节内侧突连线中点)(30.22±15.34)mm.跟内侧神经穿出屈肌支持带后分布于足跟内侧及跟底的皮肤和跟垫组织.结论 跟内侧神经在踝管内,浅出屈肌支持带处及跟管内可能被卡压;神经卡压或病变可能与足底腱膜炎发生及疼痛有关.

  14. Epidemiology of Extraarticular Tibia Fractures, Shahid Mohammadi Hospital-Bandar Abbass-Iran 2002, 2003

    Science.gov (United States)

    Saied, A. R.; Karimi Mobarake, M.

    Tibia fractures are among the most common long bone fractures and recognition of their epidemiology helps their better management and prevention. In this cross sectional prospective study, 250 patients with extraarticular tibia fracture, of all age groups, referred to Shahid Mohammadi Hospital, Bandar Abbass were studied. Information about age and sex and the fracture side, localization, open or closed fracture, comminution, associated injuries and the mechanism of the injury were registered. Tibia fractures constituted about 65% of all diaphyseal long bone fractures (the most common) and 70% of all open diaphyseal fractures (the most common). Most of the fractures occurred in young men (90%) and in the middle third of the bone (55%). In more than 75% of the cases injury was limited to the leg, more than 55% the fractures were closed and in more than 65% there was little comminution. About half of fractures occurred on either side and no statistically significant difference was found between the left and right limb with regard to open fracture occurrence and the severity of comminution (p = 0.291 and 0.713, respectively). The most common involved factor in occurrence of the fracture was motorcycle (65%), in contrast to findings of others where it constituted about 30% of the causes. Noting the results and that 58% of tibia fractures are caused by motorcycle accident with the reason being direct trauma to the shin of the driver in the majority of them, it is suggested that the use of a guard or shield get mandatory for protection of the shin of the motorcyclists.

  15. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2014-01-01

    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  16. Fracking, fracture, and permeability

    Science.gov (United States)

    Turcotte, D. L.; Norris, J.; Rundle, J. B.

    2013-12-01

    Injections of large volumes of water into tight shale reservoirs allows the extraction of oil and gas not previously accessible. This large volume 'super' fracking induces damage that allows the oil and/or gas to flow to an extraction well. The purpose of this paper is to provide a model for understanding super fracking. We assume that water is injected from a small spherical cavity into a homogeneous elastic medium. The high pressure of the injected water generates hoop stresses that reactivate natural fractures in the tight shales. These fractures migrate outward as water is added creating a spherical shell of damaged rock. The porosity associated with these fractures is equal to the water volume injected. We obtain an analytic expression for this volume. We apply our model to a typical tight shale reservoir and show that the predicted water volumes are in good agreement with the volumes used in super fracking.

  17. DEM Particle Fracture Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Boning [Univ. of Colorado, Boulder, CO (United States); Herbold, Eric B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Homel, Michael A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Regueiro, Richard A. [Univ. of Colorado, Boulder, CO (United States)

    2015-12-01

    An adaptive particle fracture model in poly-ellipsoidal Discrete Element Method is developed. The poly-ellipsoidal particle will break into several sub-poly-ellipsoids by Hoek-Brown fracture criterion based on continuum stress and the maximum tensile stress in contacts. Also Weibull theory is introduced to consider the statistics and size effects on particle strength. Finally, high strain-rate split Hopkinson pressure bar experiment of silica sand is simulated using this newly developed model. Comparisons with experiments show that our particle fracture model can capture the mechanical behavior of this experiment very well, both in stress-strain response and particle size redistribution. The effects of density and packings o the samples are also studied in numerical examples.

  18. Tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter

    The overall purpose of the present PhD thesis was to provide up-to-date information of the epidemiology of tibial shaft fractures and to investigate the development in quality of life, pain and functional outcomes from surgery and onwards, following a tibial shaft fracture treated with...... intramedullary nailing. Study I reported an incidence of 16.9/100,000/year from a complete population. Study II reported the long-term patient-reported outcomes and showed that approximately 8 years after the fracture patients reported significantly worse outcome for 4 of the 5 KOOS subscales compared to the...... IV also showed a significant worse outcome in 3 of the 5 KOOS subscales compared to a reference population at 12-months follow-up. Moreover, this study showed that increasing difference in muscle strength for knee extension between legs was associated with a decreasing QOL. The results of this thesis...

  19. Open Galeazzi fracture with ipsilateral elbow dislocation.

    Science.gov (United States)

    Adanır, Oktay; Yüksel, Serdar; Beytemur, Ozan; Güleç, M Akif

    2016-08-01

    Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°. PMID:27499325

  20. Open Galeazzi fracture with ipsilateral elbow dislocation.

    Science.gov (United States)

    Adanır, Oktay; Yüksel, Serdar; Beytemur, Ozan; Güleç, M Akif

    2016-08-01

    Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°.

  1. Unstable femoral neck fractures in children - A new treatment option

    Directory of Open Access Journals (Sweden)

    Pruthi K

    2006-01-01

    Full Text Available Background : Femoral neck fractures in children are an uncommon but difficult situation. The aim of our study was to evaluate clinical results of closed reduction internal fixation and primary valgus osteotomy fixed with a tension band wire loop in high angled pediatric femoral neck fractures. Methods : In a prospective nonrandomized study conducted at 2 centres, sixteen children and adolescents with a Pauwel type 2/3 fracture neck femur were taken as participants. The femoral neck fractures were stabilized using closed reduction and internal fixation (6.5 mm noncannulated screw and a primary valgus osteotomy fixed with a tension band wire loop preferably within 24-36 hours of injury. Patients were evaluated to determine complications, clinical and radiological outcome. Results : At a mean post operative follow up of 5 years, union was achieved in all cases. Three patients had AVN and one developed coxavara. Results were evaluated using IOWA hip scores. Thirteen patients had an excellent result while 3 patients had a good result. Conclusion : Use of this technique holds promise in treating these difficult unstable fractures. Although results from a larger series are still awaited yet the use of this technique can safely be extended to stable fractures also, to minimize the incidence of complications as nonunion and AVN.

  2. Vertebral Geometry Parameters Can Predict Fractures

    Directory of Open Access Journals (Sweden)

    P Tofighi

    2007-01-01

    Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between verte¬bral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

  3. Sealing of fractured rock

    International Nuclear Information System (INIS)

    This paper consists of a presentation of the third phase of the Stripa Project. This phase was dedicated to fracture sealing. First of all it has been necessary to show that fine-grained grouts could effectively be injected in relatively fine cracks, and that the fluidity of bentonite could also be enhanced. The field tests comprised investigation of excavation-induced disturbance and attempts to seal disturbed rock, and, in separate tests, grouting of deposition holes and a natural fine-fracture zone. (TEC). 12 figs., 1 tab., 6 refs

  4. Fractured Petroleum Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Firoozabadi, Dr. Abbas

    2000-01-18

    In this report the results of experiments of water injection in fractured porous media comprising a number of water-wet matrix blocks are reported for the first time. The blocks experience an advancing fracture-water level (FWL). Immersion-type experiments are performed for comparison; the dominant recovery mechanism changed from co-current to counter-current imbibition when the boundary conditions changed from advancing FWL to immersion-type. Single block experiments of co-current and counter-current imbibition was performed and co-current imbibition leads to more efficient recovery was found.

  5. [Supracondylar fractures in children].

    Science.gov (United States)

    Petrov, N; Gucev, S; Kirkov, Lj; Dajljevik, S; Ruso, B

    1982-01-01

    In the Department of Pediatric surgery, during the last ten years, 190 patients with supracondylar fractures (second and third degree, according to Bauman's classification) have been treated. The operation was performed in only 5% of all hospitalized cases. There were only one patient with neurological and vascular complications in the early stage, but without any complications in the late stage. The presented cases showed a high percentage of flexion type of fractures. The conservative treatment by a reposition has given the most satisfactory results.

  6. 78 FR 31635 - Oil and Gas; Hydraulic Fracturing on Federal and Indian Lands

    Science.gov (United States)

    2013-05-24

    ...; Well Stimulation, Including Hydraulic Fracturing, on Federal and Indian Lands'' (77 FR 27691). The... 60 days (77 FR 38024). The extended comment period closed on September 10, 2012. The BLM received...; Hydraulic Fracturing on Federal and Indian Lands; Proposed Rule #0;#0;Federal Register / Vol. 78 , No....

  7. "Roller coaster maneuver via lateral orbital approach" for reduction of isolated zygomatic arch fractures.

    Science.gov (United States)

    Pilanci, Ozgur; Basaran, Karaca; Datli, Asli; Kuvat, Samet Vasfi

    2013-11-01

    Numerous techniques have been reported for the reduction of zygomatic arch fractures. In this article, we aimed to describe a technique we named as "roller coaster maneuver via lateral orbital approach" to closed reduction of the isolated-type zygomatic arch fractures. Surgical outcomes of 14 patients treated with this method were outlined. PMID:24220411

  8. Geomechanically Coupled Simulation of Flow in Fractured Reservoirs

    Science.gov (United States)

    Barton, C.; Moos, D.; Hartley, L.; Baxter, S.; Foulquier, L.; Holl, H.; Hogarth, R.

    2012-12-01

    between wells. More specifically, fractures can hydraulically open or close due to a decrease (caused by injection) or increase (caused by production) in the effective stress. Flow properties are a function of effective fracture aperture, so it is possible to predict reservoir behavior using the relationship between the mechanical behavior of natural fractures (in response to in situ stress and pore pressure changes) and their hydraulic properties. Low flow rate injection tests were used to characterize the hydraulic properties of the fractures, their width, stiffness and strength — properties that are often difficult to quantify, leading to large uncertainties in predicted response to stimulation of fractured reservoirs. Flow through the individual fractures which form the connected network was explicitly modeled. Fracture stress sensitivity was coupled to the flow simulation through the DFN with dynamic adjustment of aperture to effective normal and shear stresses (after Moos and Barton 2008) and calibrated with microseismic data (positions and times of events) and injection data (rates and pressures). Available tracer test data were used to validate the flow simulation. The results highlight the importance of combining all available data, including microseismic, wellbore image, and flow and stimulation test data, to determine reservoir flow behavior and its response to stimulation.

  9. Analysis of the pressure response of high angle multiple (HAM) fractures intersecting a welbore; Kokeisha multi fracture (HAM) kosei ni okeru atsuryoku oto kaiseki ni tsuite

    Energy Technology Data Exchange (ETDEWEB)

    Ujo, S.; Osato, K. [Geothermal Energy Research and Development Co. Ltd., Tokyo (Japan); Arihara, N. [Waseda University, Tokyo (Japan); Schroeder, R.

    1996-05-01

    This paper reports pressure response analysis on wells piercing a high angle multi (HAM) fracture model. In this model which is defined on a three-dimensional space, a plurality of slanted fractures intersect with wells at high angles (however, intersection of fractures with each other is not considered). With respect to the pressure response analysis method using this model, the paper presents a basic differential equation on pressure drawdown and boundary conditions in the wells taking flows in the fractures pseudo-linear, as well as external boundary conditions in calculation regions (a reservoir spreads to an infinite distance, and its top and bottom are closed by non-water permeating beds). The paper also indicates that results of calculating a single vertical fracture model and a slanted fracture model by using a numerical computation program (MULFRAC) based on the above equations agree well respectively with the existing calculation results (calculations performed by Erlougher and Cinco et al). 5 refs., 6 figs.

  10. ROLE OF SUPRACONDYLAR NAILING IN DISTAL FEMORAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Abhishek

    2014-08-01

    Full Text Available : BACKGROUND: Fractures of distal femur are complex injuries that can be difficult to manage. Due to poor bone stock, less cortical bone in this region, wide medullary cavity and frequently associated severe soft tissue damage. METHODS: From June 2008 to April 2012, a prospective study of 46 patients, with distal femoral fractures, including supracondylar and inter condylar fractures, treated with intramedullary supracondylar nail, was done to evaluate its results and final functional outcome and its applicability in open as well as closed distal femoral fractures. Four cases were lost to follow up; six had followed up for less than six months. These ten cases were excluded from the study hence effectively the study included total thirty six cases. Average age of patients was 41.7 yrs. with Male: Female ratio of 2.6:1. Among 36 fractures 16.6% were of type A1, 44.4% were of type A2, 27.7% were of type A3 and 11.1% were of type C1. 27.7% fractures were open and associated injuries were present in 22.2% of cases. Second generation supracondylar nail was used for definitive fixation in all eighteen cases, through percutaneous patellar tendon splitting approach in 26 patients and medial parapatellar arthrotomy approach in ten patients. RESULTS: At an average follow up of 9 months, final functional outcome was evaluated as per Neer’s criteria (1967. Average time of union was 17.5 weeks, with an average range of movement being 101.38. Functional results were excellent in 20 (55.5% cases, satisfactory in 10 (27.7% cases, unsatisfactory in 2 (5.5% and poor in 4 (11.1% cases. No significant correlation was observed in this study between the age of the patient, fracture type and the final functional outcome achieved. Similarly no significant difference was observed between the final functional outcomes achieved in open versus closed fracture. However patients treated with medial parapatellar arthrotomy approach were found to be associated with increased

  11. Progressive Fracture of Composite Structures

    Science.gov (United States)

    Chamis, Christos C.; Minnetyan, Levon

    2008-01-01

    A new approach is described for evaluating fracture in composite structures. This approach is independent of classical fracture mechanics parameters like fracture toughness. It relies on computational simulation and is programmed in a stand-alone integrated computer code. It is multiscale, multifunctional because it includes composite mechanics for the composite behavior and finite element analysis for predicting the structural response. It contains seven modules; layered composite mechanics (micro, macro, laminate), finite element, updating scheme, local fracture, global fracture, stress based failure modes, and fracture progression. The computer code is called CODSTRAN (Composite Durability Structural ANalysis). It is used in the present paper to evaluate the global fracture of four composite shell problems and one composite built-up structure. Results show that the composite shells and the built-up composite structure global fracture are enhanced when internal pressure is combined with shear loads.

  12. Stress fractures in young athletes.

    Science.gov (United States)

    Orava, S; Jormakka, E; Hulkko, A

    1981-01-01

    In a series of 16 cases of stress fractures in 15-year-old and younger athletes 8 fractures occurred in boys and 8 in girls. There were no differences between the sexes in the athletes' training habits. Ten of the fractures were located at the tibia, seven at its upper third and three at the lower part of the bone. Three fractures were found in the fibula, in the metatarsal bones two stress fractures and in the femur one stress fracture. Most stress fractures were caused by endurance type sports. The daily training distances were not particularly high at the time of the onset of the symptoms. In most cases the diagnosis was based on a radiological evaluation. A sufficiently long pause from all athletic activity was enough treatment. Stress fractures in children are very uncommon. PMID:7295000

  13. [Results following percutaneous intramedullary pin fixation in distal radius fractures].

    Science.gov (United States)

    Kirchner, R; Hüttl, T; Krüger-Franke, M; Rosemeyer, B

    1994-01-01

    42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures. PMID:7516105

  14. Experimental Simulation for Fracture of Gun Propellant Charge Bed

    Institute of Scientific and Technical Information of China (English)

    RUI Xiao-ting; YUN Lai-feng; WANG Hao; HUANG Ming; CHEN Jian-zhong; CHEN Tao; LIU Jun

    2005-01-01

    The simulation of compression and fracture of charge bed in chamber is one of the key problems in the study of launch safety of gun propellant charge. A new kind of experimental device that can be used for simulation is given. Its structure and operational principle are introduced. Using a semi-closed vessel as a source of compression force, the device can simulate any kind of dynamic environment in a gun propellant charge. Using the low temperature inert gas (N2) as the compression medium, the device can not only ensure that the simulation is real, but also protect the fragmentized propellant from combustion after experiment. Using the device, many simulation experiments have been accomplished, and dynamic environment of propellant fracture is acquired. With the experiments, fragmentized propellant for the compression and fracture of charge bed is obtained. Results of experiments show that the new device can be used to study the principle of the compression and fracture of charge bed.

  15. 手术与手法复位治疗踝关节骨折的临床有效性与安全性综合评价%Comprehensive Evaluation of efficacy and Safety of Open Reduction and Internal Fixation and Closed Manipulative Reduction on Ankle Fractures

    Institute of Scientific and Technical Information of China (English)

    成晓波

    2014-01-01

    Objective To comprehensive evaluate the efficacy and safety of Open Reduction and Internal Fixation(ORIF)and Closed Manipulative Reduction(CMR)on ankle fractures (AF). Methods 98 cases with AF in the hospital from October 2011 to October 2012 were selected, as for Lange-Hansen Typing ,30 cases were type I , 36 cases were type II, 32 cases were type IV. Of which 49 patients treated by ORIF,as the ORIF group; another 49 patients were treated by CMR,as the CMR group. Ankle X-rays Leeds score, 4,6,12 weeks finger fracture call us growth and hospitalization time and costs in two groups were recorded and compared after surgery. Results The excel ent rate of patients with I degree injury in ORIF group was 100.0% (16/16), and 92.9% (13/14) in CMR group, excel ent rate of patients with II degree injury in ORIF group 82.4% (14/17), and 57.9% (11/19) in CMR group, excel ent rate of patients with IV degree injury in ORIF group was 75.0% (12/16), and 43.8% (7/16) in CMR group, the difference of efficacy in patients with I degree injury in two groups was not statistically significant, and efficacy in patients with II-IV degree injury was higher in ORIF group than in CMR group, and the difference was statistical y significant (P<0.05); bone call us growth rates at 4,6,12 week significantly lower in ORIF group than in CMR group, the difference was statistically significant (P<0.05); hospitalization time and treatment costs in CMR group was (11.2±2.4) d and (5346.5±439.3) million, while (17.4±4.1) d and (16352.4±1252.3) million in the ORIF group, significantly less in CMR group than in ORIF group, and the difference was statistically significant (P<0.05). Conclusion Call us growth is better, and hospitalization time and costs are less when choose CMR to treat AF, but ORIF has a significantly better functional recovery of ankle, thus need to select the appropriate treatment of patients according to the degree of damage.%目的:对切开复位内固定术(ORIF)与手法复

  16. 闭合性桡骨远端骨折手法复位小夹板固定临床路径的病例对照研究%Case-control study on the manipulation reduction combined with small-splint fixation for the treatment of closed fracture of radius

    Institute of Scientific and Technical Information of China (English)

    陈启仪; 虞亚明; 任贵阳; 董霞; 袁荣霞; 傅韵

    2012-01-01

    Objective:To explore the clinical effects of the manipulation reduction combined with small splint fixation for the treatment of fresh closed fracture of radius for shorten hospital stays and reduce medical cost. Methods: From July 2007 to December 2009,200 patients ( ranged the age from 40 to 80 years) with distal radius comminute fracture were treated and divided into CP group( including 21 males and 79 females,with a mean age of (62.98±0.85)years) ,and control group( including 20 males and 80 females,with a mean age of (63.19±0.88)years). All patients were treated manipulation reduction combined with small-splint fixation,control group removed small-splint 30 days after treatment,CP group removed 25 days after treatment. Two groups were checked by X-ray and took traditional chinese medicine (taking Yuanhu tablets,Chuangshangning tablets on the early stage;Guixiangzhenggu pill was taken on the middle stage;Shuangkmgiegu pill on the late stage) .functional exercise was guided after removing of small splint. The condition of reduction and position of bone were evaluated and Gartland-Werlley scale was used to evaluate the function of wrist joint. Results:Treatment time in CP group was decreased from(30.08±3.06) to (25.06±1.07) days;treatment cost in CP group was decreased from(2 100.00±332.12) to (1 644.00± 125.20) Yuan. There was no significant difference in reduction and function recover of wrist joint between two groups. The results showed the effects of TCM clinic can be promised. Conclusion: Clinical pathway for outpatient can promote standardization of outpatient, short treatment time less medical economic burden, and worth widely used.%目的:探讨以手法复位小夹板固定治疗闭合性桡骨远端骨折在保证临床疗效的基础上,缩短治疗时间,减轻患者医疗费用,创建中医优势病种门诊诊疗的临床路径.方法:自2007年7月至2009年12月,共200例患者,年龄40~80岁,分为提前拆除小夹板组(CP

  17. Complications in Ankle Fracture Surgery

    OpenAIRE

    Ovaska, Mikko

    2014-01-01

    Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki, Finland. Helsinki 2014. Ankle fractures are among the most frequently encountered surgically treated fractures. The operative treatment of this fracture may be associated with several complications. The most frequently encountered complications are related wound healing, and deep infection may have d...

  18. Impacted Teeth and Mandibular Fracture

    OpenAIRE

    Metin, Murat; Şener, İsmail; Tek, Mustafa

    2007-01-01

    Objectives In this retrospective study, we measured the relationship between the presences of impacted or unerupted teeth in the mandible and mandibular fractures. Methods The records and radiographs of 41 patients with mandibular fracture associated with impacted or unerupted teeth were examined. The presence of impacted or unerupted teeth were assessed for each patient and related to the occurrence of fractures of mandible. Results Patients with fracture in the impacted or unerupted teeth a...

  19. Management of osteoporotic vertebral fractures

    Directory of Open Access Journals (Sweden)

    Yannis Dionyssiotis

    2010-06-01

    Full Text Available Yannis DionyssiotisRhodes General Hospital, Rhodes, GreeceAbstract: Osteoporotic vertebral fractures are associated with considerable reduction of quality of life, morbidity, and mortality. The management of patients with vertebral fractures should include treatment for osteoporosis and measures to reduce pain and improve mobility. This article provides information for management and rehabilitation of vertebral fractures based on clinical experience and literature.Keywords: vertebral fracture, quality of life, rehabilitation, osteoporosis

  20. A multiple correlation factors analysis of avascular necrosis after closed reduction and cannulated compression screws fixation of intra-capsular femoral neck fracture.A multi-center retrospective study%股骨颈骨折闭合复位加压螺纹钉内固定术后股骨头坏死多中心多因素相关分析

    Institute of Scientific and Technical Information of China (English)

    周锦春; 郭敦明; 王青; 陈哲峰; 崔维顶; 范卫民; 刘锋

    2013-01-01

    Objective To determine the incidence of avascular necrosis after closed reduction and cannulated compression screws fixation of intra-capsular femoral neck fracture and to investigate the multiple factors correlated to avascular femoral head necrosis.Methods All the patients of intra-capsular femoral neck fracture who accepted closed reduction and cannulated compression screws fixation between 2001 and 2010 in Jiangsu Province were reviewed in multi-centers retrospectively.The multiple factors were analyzed including age,gender,affected side,mechanism of injury,fracture classification,procedure delay,quality of reduction,time of full-weight-bearing,configuration of the screws and removal of the screws.Multiple correlation factors were analyzed with SPSS 13.0 statistic system.Results Complete case records were documented in 1849 cases who were followed up for an average 6.5±2.7 years (range,2-10 years).Avascular necrosis occurred in 246 cases (13.3%).The average time of diagnosis of avascular necrosis was 17±4.6months (range,8-72 months) after injury.The average Harris score of the hips which didn't develop to avascular necrosis was 93.8±8.9 (range,78~100) at the last follow up.Multiple correlation factors analysis indicated that displacement degrees of fracture and the quality of reduction were significantly correlated to the incidence of avascular necrosis (OR=2.078,3.423).Conclusion Closed reduction and cannulated compression screws fixation after the intra-capsular femoral neck fracture can get satisfactory results.Displacement degrees of fracture and the quality of reduction are significantly correlated to the incidence of avascular femoral head necrosis.%目的 调查股骨颈骨折闭合复位加压螺纹钉内固定术后股骨头坏死的发生率,探讨各影响因素与股骨头坏死的相关性.方法 对江苏地区2001至2010年期间接受闭合复位加压螺纹钉内固定治疗的股骨颈骨折患者进行回顾性调查.以股骨头坏

  1. Numerical Modeling of Fracture Propagation in Naturally Fractured Formations

    Science.gov (United States)

    Wang, W.; Prodanovic, M.; Olson, J. E.; Schultz, R.

    2015-12-01

    Hydraulic fracturing consists of injecting fluid at high pressure and high flowrate to the wellbore for the purpose of enhancing production by generating a complex fracture network. Both tensile failure and shear failure occur during the hydraulic fracturing treatment. The shear event can be caused by slip on existing weak planes such as faults or natural fractures. From core observation, partially cemented and fully cemented opening mode natural fractures, often with considerable thickness are widely present. Hydraulic fractures can propagate either within the natural fracture (tensile failure) or along the interface between the natural fracture and the rock matrix (tensile/shear failure), depending on the relative strength of cement and rock matrix materials, the bonding strength of interface, as well as the presence of any heterogeneities. In this study, we evaluate the fracture propagation both experimentally and numerically. We embed one or multiple inclusions of different mechanical properties within synthetic hydrostone samples in order to mimic cemented natural fractures and rock. A semi-circular bending test is performed for each set of properties. A finite element model built with ABAQUS is used to mimic the semi-circular bending test and study the fracture propagation path, as well as the matrix-inclusion bonding interface status. Mechanical properties required for the numerical model are measured experimentally. The results indicate that the match between experiment and modeling fracture path are extremely sensitive to the chosen interface (bonding) model and related parameters. The semi-circular bending test is dry and easily conducted, providing a good platform for validating numerical approaches. A validated numerical model will enable us to add pressurized fluid within the crack and simulate hydraulic fracture-natural fracture interaction in the reservoir conditions, ultimately providing insights into the extent of the fracture network.

  2. Microcracks and Overpressure- Induced Fractures

    Institute of Scientific and Technical Information of China (English)

    Ahmed M. Al - QAHTANI

    2001-01-01

    The microfractures and natural fractures studies have a great significance in the hydrocarbon accumulation exploration and can be a good supporter for wide geophysical study on the major structures. This paper is a brief review on microcracks and overpressure- induced fracture. It is to discuss different views on the mechanism of fractures in the subsurface of the earth.

  3. Upper tibial hyperextension fractures in infants: another occult toddler's fracture

    International Nuclear Information System (INIS)

    We describe the radiographic findings associated with occult upper tibial fractures in infants and young children and offer an explanation for the underlying mechanism from which they result. These fractures tend to be subtle, just as the classic spiral tibial fracture originally described by Dunbar et al. (1964, J Can Assoc Radiol 15: 136-144). The fracture we describe results from a hyperextension injury to the knee, and the knowledge of the mechanism of injury, the subtle radiographic findings, and the findings on physical examination allow one to diagnose this fracture with confidence. Otherwise, it easily can go undetected. (orig.)

  4. Percutaneous Screw Fixation of Crescent Fracture-Dislocation of the Sacroiliac Joint.

    Science.gov (United States)

    Shui, Xiaolong; Ying, Xiaozhou; Mao, Chuanwan; Feng, Yongzeng; Chen, Linwei; Kong, Jianzhong; Guo, Xiaoshan; Wang, Gang

    2015-11-01

    Crescent fracture-dislocation of the sacroiliac joint (CFDSIJ) is a type of lateral compression pelvic injury associated with instability. Open reduction and internal fixation is a traditional treatment of CFDSIJ. However, a minimally invasive method has never been reported. The purpose of this study was to assess the outcome of closed reduction and percutaneous fixation for different types of CFDSIJ and present their clinical outcome. The authors reviewed 117 patients diagnosed with CFDSIJ between July 2003 and July 2013. Closed reduction and percutaneous fixation was performed in 73 patients. Treatment selection was based on Day's fracture classification. For type I fractures, fixation perpendicular to the fracture line were performed. For type II fractures, crossed fixation was performed. For type III fractures, fixation was performed with iliosacral screws. Forty-four patients were treated by open reduction and plate fixation. Demographics, fracture pattern distribution, blood loss, incision lengths, revision surgeries, radiological results, and functional scores were compared. All 117 patients were followed for more than 6 months (mean, 14 months [range, 6-24 months]). Blood loss, extensive exposure, duration of posterior ring surgery, duration of hospital stay, and infection rates were lower in the closed group (P<.01). Patients in the closed group achieved better functional performance (P<.01). There were no significant differences in reduction quality (P=.32), revision surgery rates (P=.27), and iatrogenic neurologic injuries (P=.2) between the 2 groups. The authors' results indicate that closed reduction and percutaneous fixation is a safe and effective surgical method for CFDSIJ. PMID:26558677

  5. Tibia shaft fractures: costly burden of nonunions

    Directory of Open Access Journals (Sweden)

    Antonova Evgeniya

    2013-01-01

    Full Text Available Abstract Background Tibia shaft fractures (TSF are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. Methods We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives. We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32 in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date. Results Among the 853 patients with TSF, 99 (12% had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture and were more likely to have their TSF open (87% vs. 70% than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P  Conclusions Nonunions in TSF’s are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.

  6. Evaluation of K-wire fixation for nasal bone fractures using CT images

    International Nuclear Information System (INIS)

    A nasal bone fracture is the most common facial fracture. Successful treatment requires accurate diagnosis and careful surgical management. Fractures usually are diagnosed on the basis of macroscopic inspection and X-rays. In some cases, CT can be useful in diagnosis of nasal bone fractures because CT images have few shadows and consequently are of high contrast. The authors therefore utilized CT in the classification of 83 cases of nasal bone fractures. CT also was used in 36 cases for postoperative evaluation. During the five-year period from 1989 to 1994, the authors diagnosed 83 cases of nasal bone fractures. CT findings were used to evaluate the types of fractures, which were classified as lateral (unilateral and bilateral), frontal, and lateral-frontal mixed. Included were 22 cases of unilateral fracture, 26 cases of bilateral fracture, 25 cases of frontal fracture, and 8 cases of frontal-lateral fracture. The authors performed closed reduction utilizing K-wire fixation under general anesthesia. Reduction resulted in an angle of θ formed between the nasal bone and maxillary bone, and with its apex at the fracture point. Of the 36 cases postoperatively evaluated by CT, 11 showed excellent results, 12 good results, and 13 fair results. Eleven of the 13 fair reduction cases had a free bone at the fracture point. Five of the 6 cases of fair reduction lateral-frontal mixed fractures had a free bone at the fracture point. Based on CT findings, the authors concluded that reduction and fixation utilizing K-wire was insufficient in cases with free bone fragments. It therefore is important that the existence and position of any free bone fragment should be given careful consideration before undertaking surgery. (author)

  7. Neglected hangman fracture

    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Srivastava

    2015-01-01

    Full Text Available Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman′s fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

  8. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen;

    2016-01-01

    type" fracture pattern. The first patient was treated conservatively with cervical spine immobilization in a semirigid collar. However, gross displacement was noted at the 6-week follow-up visit. The second patient was therefore treated operatively by C1-C3/4 posterior fusion and the course was...

  9. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  10. Fracture Mechanics of Concrete

    DEFF Research Database (Denmark)

    Ulfkjær, Jens Peder

    Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high-strength......Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high......-strength concrete. Chapter 2 A description of the factors which influence the strength and cracking of concrete and high strength concrete is made. Then basic linear fracture mechanics is outlined followed by a description and evaluation of the models used to describe concrete fracture in tension. The chapter ends...... and the goveming equations are explicit and simple. These properties of the model make it a very powerful tool, which is applicable for the designing engineer. The method is also extended to reinforced concrete, where the results look very promising. The large experimental investigation on high-strength concrete...

  11. Fracturing rigid materials.

    Science.gov (United States)

    Bao, Zhaosheng; Hong, Jeong-Mo; Teran, Joseph; Fedkiw, Ronald

    2007-01-01

    We propose a novel approach to fracturing (and denting) brittle materials. To avoid the computational burden imposed by the stringent time step restrictions of explicit methods or with solving nonlinear systems of equations for implicit methods, we treat the material as a fully rigid body in the limit of infinite stiffness. In addition to a triangulated surface mesh and level set volume for collisions, each rigid body is outfitted with a tetrahedral mesh upon which finite element analysis can be carried out to provide a stress map for fracture criteria. We demonstrate that the commonly used stress criteria can lead to arbitrary fracture (especially for stiff materials) and instead propose the notion of a time averaged stress directly into the FEM analysis. When objects fracture, the virtual node algorithm provides new triangle and tetrahedral meshes in a straightforward and robust fashion. Although each new rigid body can be rasterized to obtain a new level set, small shards can be difficult to accurately resolve. Therefore, we propose a novel collision handling technique for treating both rigid bodies and rigid body thin shells represented by only a triangle mesh. PMID:17218752

  12. Reattachment of fractured teeth fragments in mandibular incisors: a case report.

    Science.gov (United States)

    Yousef, Mohammed K

    2015-01-01

    The majority of dental trauma involves anterior teeth, especially the maxillary central incisors. A mandibular incisor fracture with or without pulp tissue involvement is considerably less common. Different approaches for treating these fractured teeth have been reported in the literature. The type of treatment rendered depends mainly on the extent of fracture, pulp involvement, radicular fracture, biologic width infringement or violation, and presence of the fractured piece. This case report illustrates reattachment of fractured fragments on two mandibular incisors without pulp exposure using a new proposed reattachment method using a combination of two different types of composite materials together with an orthodontic lingual retention wire. An 8-year-old female patient presented with fractured mandibular left incisors (Ellis class II fracture). Broken pieces were saved and brought in a closed container in water. Periapical radiographs revealed no evidence of pulpal involvement in either tooth and no periapical radiolucency was noticed. Fractured fragments and the broken teeth were prepared with circumferential bevels. Reattachment of the fractured fragments were done using two types of composite resin materials and a lingual orthodontic retention wire was also used. The patient was recalled after 8 months to follow up both teeth. Clinical examination revealed excellent composite restorations covering the fracture lines.

  13. Physical fracture properties (fracture surfaces as information sources; crackgrowth and fracture mechanisms; exemples of cracks)

    International Nuclear Information System (INIS)

    Fracture surfaces are considered as a useful source of informations: an introduction to fractography is presented; the fracture surface may be observed through X ray microanalysis, and other physical methods such as Auger electron spectroscopy or secundary ion emission. The mechanisms of macroscopic and microscopic crackgrowth and fracture are described, in the case of unstable fracture (cleavage, ductile with shear, intergranular brittleness) and of progressive crack propagation (creep, fatigue). Exemples of cracks are presented in the last chapter

  14. ADVANCED FRACTURING TECHNOLOGY FOR TIGHT GAS: AN EAST TEXAS FIELD DEMONSTRATION

    Energy Technology Data Exchange (ETDEWEB)

    Mukul M. Sharma

    2005-03-01

    The primary objective of this research was to improve completion and fracturing practices in gas reservoirs in marginal plays in the continental United States. The Bossier Play in East Texas, a very active tight gas play, was chosen as the site to develop and test the new strategies for completion and fracturing. Figure 1 provides a general location map for the Dowdy Ranch Field, where the wells involved in this study are located. The Bossier and other tight gas formations in the continental Unites States are marginal plays in that they become uneconomical at gas prices below $2.00 MCF. It was, therefore, imperative that completion and fracturing practices be optimized so that these gas wells remain economically attractive. The economic viability of this play is strongly dependent on the cost and effectiveness of the hydraulic fracturing used in its well completions. Water-fracs consisting of proppant pumped with un-gelled fluid is the type of stimulation used in many low permeability reservoirs in East Texas and throughout the United States. The use of low viscosity Newtonian fluids allows the creation of long narrow fractures in the reservoir, without the excessive height growth that is often seen with cross-linked fluids. These low viscosity fluids have poor proppant transport properties. Pressure transient tests run on several wells that have been water-fractured indicate a long effective fracture length with very low fracture conductivity even when large amounts of proppant are placed in the formation. A modification to the water-frac stimulation design was needed to transport proppant farther out into the fracture. This requires suspending the proppant until the fracture closes without generating excessive fracture height. A review of fracture diagnostic data collected from various wells in different areas (for conventional gel and water-fracs) suggests that effective propped lengths for the fracture treatments are sometimes significantly shorter than those

  15. Sealing of rock fractures

    International Nuclear Information System (INIS)

    The major water-bearing fractures in granite usually from fairly regular sets but the extension and degree of connectivity is varying. This means that only a few fractures that are interconnected with the deposition holes and larger water-bearing structures in a HLW repository are expected and if they can be identified and cut off through sealing it would be possible to improve the isolation of waste packages very effectively. Nature's own fracture sealing mechanisms may be simulated and a survey of the involved processes actually suggests a number of possible filling methods and substances. Most of them require high temperature and pressure and correspondingly sophisticated techniques, but some are of potential interest for immediate application with rather moderate effort. Such a technique is to fill the fractures with clayey substances which stay flexible and low-permeable provided that they remain physically and chemically intact. It is demonstrated in the report that effective grouting requires a very low viscosity and shear strength of the substance and this can be achieved by mechanical agitation as demonstrated in this report. Thus, by superimposing static pressure and shear waves induced by percussion hammering at a suitable frequency, clays and fine-grained silts as well as cement can be driven into fractures with an average aperture as small as 0.1 mm. Experiments were made in the laboratory using concrete and steel plates, and a field pilot test was also conducted under realistic conditions on site in Stripa. They all demonstrated the practicality of the 'dynamic injection technique' and that the fluid condition of the grouts yielded complete filling of the injected space to a considerable distance from the injection point. The field test indicated a good sealing ability as well as a surprisingly high resistance to erosion and piping. (author)

  16. Ultrasound-Assisted Distal Radius Fracture Reduction

    Science.gov (United States)

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  17. SENILE OSTEOPOROSIS AND HIP FRACTURE

    Institute of Scientific and Technical Information of China (English)

    戴力扬

    1995-01-01

    A randomized block design was used to compare the Singh index, the cortical index of the femoral neck and the lateral cortical width of the femur of a group of patients with femoral neck fracture, a group with intertrochanterie fracture, and a normal contrrol group among a total of 102 postmenopausal women. The three irtdiees in fracture grotlp were very significantly (P<0. 01) or significantly (P<0. 05) different from those in the normal control subjects. The importance of osteopomosis in hip fracture of the aged is con-firmed. Radiographic measurement of bone mass was found to have some predictive value for the risk of hip fracture.

  18. Seismic characterization of fracture properties

    International Nuclear Information System (INIS)

    The purpose of this paper is to show that there is a relationship, both empirical and theoretical, between the measured seismic response, the mechanical stiffness (also referred to as specific stiffness) of fractures and their hydraulic conductivity. Laboratory measurements of the mechanical stiffness, hydraulic conductivity and seismic properties of natural fractures are summarized. A theoretical model for the amplitude and group time delay for compressional and shear waves transmitted across a single fracture is presented. Predictions based on this model are compared with laboratory measurements. Finally, the results for a single fracture are extended to multiple parallel fractures. 13 refs., 6 figs

  19. Management of mandibular body fractures in pediatric patients: A case report with review of literature

    Directory of Open Access Journals (Sweden)

    Baby John

    2010-01-01

    Full Text Available Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child′s protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children.

  20. Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.

    Science.gov (United States)

    Lu, Jike; Maruo Holledge, Masumi

    2016-01-01

    A 59-year-old man fell off a 60-cm-high step, with his ankle in a twisted position, and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. The TA rupture was initially missed but diagnosed by ultrasound examination, 2 weeks post-operatively. The ankle fracture was diagnosed from routine radiographs. Such a combination of injuries has been reported infrequently in the literature, but significant similarities have been described in the mechanism of injury and fracture patterns. Nevertheless, three of five reported cases with combined medial malleolus fractures were initially misdiagnosed. PMID:27141047

  1. Uncontrolled haemorrhage in pelvic fractures-Can the inevitable be avoided?

    Institute of Scientific and Technical Information of China (English)

    Rajesh Thiyam; Rajesh Lalchandani; Sambit Satyaprakash; Neeraj Godara

    2016-01-01

    Pelvic fractures carry a considerable risk for morbidity and mortality.Half or more of the early deaths in these patients have been attributed directly to haemorrhage.The transfusional requirements are four times higher for open pelvic fractures compared with a similar group of closed pelvic fractures.The loss of the tamponade effect by disruption of the pelvic soft tissues and the energy imparted play a central role in this potentially life threatening situation.We reported a case of open pelvic fracture in which persistent haemorrhage was stopped by giving recombinant activated coagulation factor Ⅶa as our last resort.

  2. Incidence of mandibular fractures in black sea region of Turkey

    Science.gov (United States)

    Şener, İsmail; Şenel, Erman; Özkan, Nilüfer; Yilmaz, Nergiz

    2015-01-01

    Background The aim of this study is to review the incidence of mandibular fractures in the Black Sea Region of Turkey and to present our treatment protocol. Material and Methods Data were collected regarding age, sex, etiology, time distribution, site of the fracture and the associated injuries and evaluated. These patients were treated at Ondokuz Mayıs University Department of Oral and Maxillofacial Surgery between 2003 and 2010. Data were collected from patient files in the archive and were analyzed using SPSS version 20.0 software. Results A total of 82 patients with 133 mandibular fractures were included in this study. After the follow up period of the patients, the results were achieved from 58 (70.7%) males and 24 (29.3%) females, whose ages ranged from 5 to 72 years and the mean age was 29. Fractures were most seen in 2008 and the busiest month was August. Falls (40.2%) were the major causes of mandibular fractures followed by traffic accidents and violence. The mandibular anatomical sites of higher fracture incidence were: condyle (34.6%), body and symphysis. The number of the fractures and injuries which were seen in other places such as zygomatic arch, alveolar process, tongue, upper and lower lips, orbita, arms was 14. 53 (64.6%) patients were treated by closed reduction, whereas 13 (15.8%) patients were treated by open reduction. Conclusions We concluded that our results were widely similar with the studies in developing countries. Socio-economic factors, cultures, geographic conditions and education could affect the etiology of the mandibular fractures and cause different results between the studies conducted in different countries. Key words:Mandibular fractures, etiology, trauma, treatment, complication. PMID:26330940

  3. A Galeazzi-variant type fracture-dislocation in adults

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya; Sundar Kumar Shrestha; Abhishek Vaish

    2013-01-01

    Objective:Fracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint (DRUJ) is not a common injury and is inherently unstable.Here we report a case series,with both-bone forearm fractures associated with dislocation of DRUJ,as a Galeazzi-variant type fracture-dislocation,and try to analyze this injury pattern.Methods:The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age (20 to 45 years).All fractures were closed type.Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft.After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.Results:All cases were followed up for 24 weeks.The maximum incidence occurred in age group between 31 and 40 years.All the fractures of both radius and ulna were united in average time of 12 weeks.Range of motion of wrist and elbow,supination and pronation at final follow-up were normal.There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.Conclusion:Galeazzi variant in adult is a new undescribed pattern of forearm with wrist injury.Stable open reduction and internal fixation of both-bone forearm fractures is mandatory,followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.

  4. A Galeazzi-variant type fracture-dislocation in adults

    Directory of Open Access Journals (Sweden)

    Vaishya Raju

    2013-12-01

    Full Text Available 【Abstract】Objective: Fracture of either radius or ulna with a dislocation either at the proximal or distal radio- ulnar joint (DRUJ is not a common injury and is inherently unstable. Here we report a case series, with both-bone fore- arm fractures associated with dislocation of DRUJ, as a Galeazzi-variant type fracture-dislocation, and try to ana- lyze this injury pattern. Methods: The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age (20 to 45 years. All fractures were closed type. Two frac- tures involved the same level and three fractures were at different levels of radius and ulna shaft. After thorough examination and investigations they were treated with limi- ted contact dynamic compression plate without additional fixation for DRUJ. Results: All cases were followed up for 24 weeks. The maximum incidence occurred in age group between 31 and 40 years. All the fractures of both radius and ulna were united in average time of 12 weeks. Range of motion of wrist and elbow, supination and pronation at final follow-up were normal. There was no subsequent re-subluxation or dislo- cation of the DRUJ in any of the cases. Conclusion: Galeazzi variant in adult is a new undescribed pattern of forearm with wrist injury. Stable open reduction and internal fixation of both-bone forearm frac- tures is mandatory, followed by 3 to 4 weeks of immobiliza- tion in a cast for the healing of disrupted DRUJ. Key words: Dislocations; Radius fractures; Ulna fractures; Wrist injuries

  5. Formative mechanism of intracanal fracture fragments in thoracolumbar burst fractures: a finite element study

    Institute of Scientific and Technical Information of China (English)

    ZENG Zhi-li; ZHU Rui; LI Shan-zhu; YU Yan; WANG Jian-jie; JIA Yong-wei; CHEN Bo

    2013-01-01

    Background Thoracolumbar burst fracture is a common clinical injury,and the fracture mechanism is still controversial.The aim of this research was to study the formation of intracanal fracture fragments in thoracolumbar burst fractures and to provide information for the prevention of thoracolumbar bursts fractures and reduction of damage to the nervous system.Methods A nonlinear three-dimensional finite element model of T11-L3 segments was established,and the injury processes of thoracolumbar bursts were simulated.The intact finite element model and the finite element model after the superior articular were impacted by 100 J of energy in different directions.The distribution and variation of stress in the superior posterior region of the L1 vertebral body were analyzed.Abaqus 6.9 explicit dynamic solver was used as finite element software in calculations.Results A three-dimensional nonlinear finite element model of the thoracolumbar spine was created.In the intact model,stress was concentrated in the superior posterior region of the L1 vertebral body.The stress peak was a maximum for the extension impact load and a minimum for the flexion impact load.The stress peak and contact force in the facet joint had close correlation with time.The stress peak disappeared after excision of the superior articular process.Conclusions The three-dimensional nonlinear finite element model was suitable for dynamic analysis.The contact force in the facet joint,which can be transferred to the superior posterior vertebral body,may explain the spinal canal fragment in thoracolumbar burst fractures.

  6. Hydraulic fracture propagation modeling and data-based fracture identification

    Science.gov (United States)

    Zhou, Jing

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

  7. OUTCOME OF LOCKING PLATES IN DISTAL TIBIA FRACTURES TREATMENT

    Directory of Open Access Journals (Sweden)

    Lokesh

    2016-05-01

    Full Text Available INTRODUCTION Most of these fractures except intra-articular fractures are treated with interlocking nail. 1,2 These nails are a boon for these fractures. But as the fracture nears to the joint stability the fracture fixation will be compromised due to malreduction and alignment, it leads to increased chances of delayed and nonunion. 3 Locking anatomical plates are evaluated for anatomical and relative stability fixation. Since then most intra and near intra-articular fractures are fixed with these plates with minimally invasive percutaneous plate osteosynthesis method, these plates have given excellent result 4 . But again these plates have some disadvantages 5 . This study is done to see the outcome of locking plates in distal tibia fracture. METHODS This study is done in the Department of Orthopaedics, Bangalore Medical College, Bangalore. This study is done from 2013 to 2015. 30 patients who came to outpatient department were treated with locking plates. All patients above 16 years having distal third tibia fracture are included. All open fractures except type 1 and elderly above 60 years and pathological fractures are excluded in our study. All patients were followed up for initial 5 months, thereafter, once in 3 months, for clinical and radiological evaluation of union status, knee range of motion, ankle range of motion and other complications. Assessment of the patient with functional recovery was done with American Orthopaedic Foot and Ankle Surgery(AOFAS 6 minimum 5 months after injury. RESULTS Majority of the patients are from age group 18-29 years (50%. Average age group was 30 years. Majority of the patients were males 80.6% (25. All fractures were closed fractures except 2 cases which are type 1. There were 12 cases of AO type A, 8 patients were AO type B and 10 patients were type C. Majority of the patients had fracture due to road traffic accidents, 74%. All fractures were united by the end of 20 weeks. There was delayed union in

  8. A STUDY ON ROLE OF INTERLOCK NAILING IN THE MANAGEMENT OF TIBIAL DIAPHYSEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Venkateswara Rao

    2015-09-01

    Full Text Available Tibial fractures are one of the commonest orthopedic injuries. Tibial fractures are one of the commonest orthopedic injuries. In the past several years there has been a trend towards by use of small diameter nails without remaining in the management of unstable tibial shaft fractures. However it is important to remember that many closed fractures with less severe soft tissue injury, Treatment with an intramedullary nail with reaming allows placement of larger implant, thereby minimizing the incidence of mechanical failure. While maintain high rates of union. METHODS: In our study, 100 cases of tibial diaphyseal fracture s were treated with Interlocking nailing in between May - 2012 to April 2015 at Siddhartha Medical College/Government General Hospital, Vijayawada. RESULTS: In our study, among 100 cases 86 were closed fractures, and 8 were open fractures and 6 non - unions. O f the 100 cases 56 (56% on right side, 38 (38% on left side, 6 cases (6% were bilateral. The commonest type of fracture is spiral or long oblique in 40 cases (40%. Transverse or short oblique in 28 cases (28%, comminuted in 24 cases (24% and segmenta l in 8 cases (8%. The average time for union is 14 weeks with a range of 12 - 40 weeks. . 2 patients developed delayed union due to distraction at the fracture site.

  9. Measuring Stress-dependent Fluid Flow Behavior in Fractured Porous Media

    Science.gov (United States)

    Huo, Da; Benson, Sally

    2014-05-01

    compression cycles, the effective stress needs to drop by more than 75% to cause a significant increase in permeability. Stress-dependent relative permeability is also likely to be stress dependent, but is very difficult to measure. Pyrak-Nolte (1990) pointed out that non-wetting phase tends to have a more significant deduction compared with wetting phase if the fracture aperture is closing. Our experiment also observes that large apertures will close first. Due to the fact that non-wetting phase tends to stay in large apertures and wetting phase tends to stay in small apertures, we also get the same phenomenon that the fracture closure/opening will mainly affect the non-wetting phase channels in fractures.

  10. Carotid Stent Fracture from Stylocarotid Syndrome

    Science.gov (United States)

    Hooker, Jeffrey D; Joyner, David A; Farley, Edward P; Khan, Majid

    2016-01-01

    Eagle syndrome is a rare condition resulting from elongation of the temporal styloid process or calcification of its associated stylohyoid ligaments. Although usually presenting with pain or odynophagia, Eagle syndrome has been reported to cause a multitude of neurologic symptoms or vascular complications, some of which can be life-threatening. We present a case in which an endovascularly placed internal carotid artery stent in close proximity to a calcified stylohyoid ligament resulted in stent fracture with subsequent stent and vessel occlusion. We review and discuss the presentation, diagnosis, etiology, complications and treatment options of the syndrome.

  11. Fibular Fracture in a Female Rugby Player.

    Science.gov (United States)

    Mendola, Jonathan A; Johnson, Michael; Goss, Don

    2016-07-01

    A 20-year-old female rugby player was injured when an opponent landed on her leg during a match. Twelve days after injury, the team's certified athletic trainer referred the patient to a physical therapist due to continued pain. Following fluoroscopic imaging, which was utilized by the physical therapist because standard radiographs were unavailable in close proximity, she was referred for radiographs, which demonstrated a midfibular diaphyseal fracture. J Orthop Sports Phys Ther 2016;46(7):608. doi:10.2519/jospt.2016.0411. PMID:27363575

  12. ANTEGRADE INTRAMEDULLARY FIXATION OF HUMERAL SHAFT FRACTURES WITH INTERLOCKING NAIL - AN ANALYSIS OF COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    Arvinder

    2013-11-01

    Full Text Available ABSTRACT : Fractures of the humeral shaft account for 3% of all the fractures . Primary cause of these fractures i s high energy traumas. Goals in managing these fractures are osseous union, minimal deformity and return of maximal extremity function. The union rate of simple fractures of humerus treated conservatively is over 90%. Surgical management of these fractures is preferred in Segmental fractures, Polytrauma patients, Pathological fractures, Open fractures , Failed conservative treatment, Associated progressive neurological deficit , Vascular injury, Morbid obesity. We analysed intraoperative and postoperative com plications in twelve patients with humeral shaft fractures managed with antegrade interlocking nails. There were seven males and five females. Their ages ranged between 20 – 60 years with an average of 32.6 years. There were 11 close and one Gustilo grade I open fractures. There were six comminuted , four transverse, and two oblique fractures. Nine fractures were in middle third one in proximal third and two in distal third. Five patients had associated injuries. We faced difficulty in localizing entry port al in 2 patients . There was difficulty in reduction in 2 patients We had one patient with iatrogenic comminution . Three patients had improper locking screw size. One had nail protrusion proximally , one patient had distraction at the fracture site . There we re two superficial entry portal skin infections and one deep proximal cross screw infection. We had two patients with shoulder and one patient with elbow stiffness. Chronic rotator cuff irritation was present in three patients. We recorded three delayed un ions, one nonunion and one rotatory malunion The results of the present study indicate that antegrade intramedullary interlocked nailing is one of the best method of treatment among the currently available methods.

  13. Restaurants closed over Christmas

    CERN Multimedia

    2011-01-01

    The restaurants will be closed during the Christmas holiday period : please note that all three CERN Restaurants will be closed from 5 p.m. on Wednesday, 21 December until Wednesday, 4 January inclusive. The Restaurants will reopen on Thursday, 5 January 2012.

  14. Surviving a School Closing

    Science.gov (United States)

    De Witt, Peter M.; Moccia, Josephine

    2011-01-01

    When a beloved school closes, community emotions run high. De Witt and Moccia, administrators in the Averill Park School District in upstate New York, describe how their district navigated through parents' anger and practical matters in closing a small neighborhood elementary school and transferring all its students to another school. With a group…

  15. Close-ups

    DEFF Research Database (Denmark)

    Fausing, Bent

    2013-01-01

    Investigations in the close-up and its meaning regarding nearness, abstraction and transparency. Face, facelike and animism are also major key-words in thsi article... . I have always been fascinated with the close-up, not as an end, but a filter of opportunities to open up for and nearness of tr...

  16. Fracture of brittle solids

    CERN Document Server

    Lawn, Brian

    1993-01-01

    This is an advanced text for higher degree materials science students and researchers concerned with the strength of highly brittle covalent-ionic solids, principally ceramics. It is a reconstructed and greatly expanded edition of a book first published in 1975. The book presents a unified continuum, microstructural and atomistic treatment of modern day fracture mechanics from a materials perspective. Particular attention is directed to the basic elements of bonding and microstructure that govern the intrinsic toughness of ceramics. These elements hold the key to the future of ceramics as high-technology materials--to make brittle solids strong, we must first understand what makes them weak. The underlying theme of the book is the fundamental Griffith energy-balance concept of crack propagation. The early chapters develop fracture mechanics from the traditional continuum perspective, with attention to linear and nonlinear crack-tip fields, equilibrium and non-equilibrium crack states. It then describes the at...

  17. Vertebral fracture classification

    Science.gov (United States)

    de Bruijne, Marleen; Pettersen, Paola C.; Tankó, László B.; Nielsen, Mads

    2007-03-01

    A novel method for classification and quantification of vertebral fractures from X-ray images is presented. Using pairwise conditional shape models trained on a set of healthy spines, the most likely unfractured shape is estimated for each of the vertebrae in the image. The difference between the true shape and the reconstructed normal shape is an indicator for the shape abnormality. A statistical classification scheme with the two shapes as features is applied to detect, classify, and grade various types of deformities. In contrast with the current (semi-)quantitative grading strategies this method takes the full shape into account, it uses a patient-specific reference by combining population-based information on biological variation in vertebra shape and vertebra interrelations, and it provides a continuous measure of deformity. Good agreement with manual classification and grading is demonstrated on 204 lateral spine radiographs with in total 89 fractures.

  18. Analysis of seismic sources for different mechanisms of fracture growth for microseismic monitoring applications

    International Nuclear Information System (INIS)

    We have developed and illustrated an approach for geomechanic modeling of elastic wave generation (microsiesmic event occurrence) during incremental fracture growth. We then derived properties of effective point seismic sources (radiation patterns) approximating obtained wavefields. These results establish connection between geomechanic models of hydraulic fracturing and microseismic monitoring. Thus, the results of the moment tensor inversion of microseismic data can be related to different geomechanic scenarios of hydraulic fracture growth. In future, the results can be used for calibrating hydrofrac models. We carried out a series of numerical simulations and made some observations about wave generation during fracture growth. In particular when the growing fracture hits pre-existing crack then it generates much stronger microseismic event compared to fracture growth in homogeneous medium (radiation pattern is very close to the theoretical dipole-type source mechanism)

  19. Irreducible ankle fracture-dislocation due to tibialis anterior subluxation: a case report.

    Science.gov (United States)

    Natoli, Roman M; Summers, Hobie D

    2015-01-01

    Irreducible ankle fracture-dislocations are rare. Several cases of irreducible ankle fracture-dislocation have been reported in published studies secondary to the tibialis posterior tendon, deltoid ligament, or extensor digitorum longus tendon blocking the reduction. We report a case of irreducible ankle fracture-dislocation resulting from posteromedial subluxation of the tibialis anterior tendon around a medial malleolar fracture fragment. Ultimately, the ankle required open reduction of the incarcerated tendon to reduce the joint and proceed with internal fixation of the associated fracture. The patient's postoperative course was uncomplicated, and the tibialis anterior tendon was functioning at 10 months postoperatively, after which he did not return for follow-up examinations. To our knowledge, this is the first reported case of the tibialis anterior tendon blocking closed reduction of an ankle fracture-dislocation. PMID:25618805

  20. Central acetabular fracture with dislocation treated by minimally invasive plate osteosynthesis.

    Science.gov (United States)

    2015-06-01

    Central acetabular fractures with dislocation are usually the result of high-energy trauma, resulting in joint incongruity, and are frequently associated with other injuries. Open reduction and internal fixation has been the standard treatment for acetabular fractures, but it is associated with extensive surgical trauma, and complications such as haematoma formation, iatrogenic nerve injury, and heterotopic ossification. We present the case of a 63-year-old female who sustained a central acetabular fracture of the hip with dislocation as a result of an automobile collision. Closed reduction of the dislocation was performed, and the fracture was managed by minimally invasive plate osteosynthesis using a specially prepared plate. At 01 year postoperatively, radiographs showed the fracture to have been well-healed with good congruity of the joint. However, heterotopic ossification of the joint was noted. The technique allowed reduction of the fracture with minimal surgical trauma.

  1. Generalized linear sampling method for elastic-wave sensing of heterogeneous fractures

    CERN Document Server

    Pourahmadian, Fatemeh; Haddar, Houssem

    2016-01-01

    A theoretical foundation is developed for active seismic reconstruction of fractures endowed with spatially-varying interfacial condition (e.g.~partially-closed fractures, hydraulic fractures). The proposed indicator functional carries a superior localization property with no significant sensitivity to the fracture's contact condition, measurement errors, and illumination frequency. This is accomplished through the paradigm of the $F_\\sharp$-factorization technique and the recently developed Generalized Linear Sampling Method (GLSM) applied to elastodynamics. The direct scattering problem is formulated in the frequency domain where the fracture surface is illuminated by a set of incident plane waves, while monitoring the induced scattered field in the form of (elastic) far-field patterns. The analysis of the well-posedness of the forward problem leads to an admissibility condition on the fracture's (linearized) contact parameters. This in turn contributes toward establishing the applicability of the $F_\\sharp...

  2. Analysis of seismic sources for different mechanisms of fracture growth for microseismic monitoring applications

    Energy Technology Data Exchange (ETDEWEB)

    Duchkov, A. A., E-mail: DuchkovAA@ipgg.sbras.ru [Trofimuk Institute of Petroleum Geology and Geophysics SB RAS, Novosibirsk, 630090 (Russian Federation); Novosibirsk State University, Novosibirsk, 630090 (Russian Federation); Stefanov, Yu. P., E-mail: stefanov@ispms.tsc.ru [Trofimuk Institute of Petroleum Geology and Geophysics SB RAS, Novosibirsk, 630090 (Russian Federation)

    2015-10-27

    We have developed and illustrated an approach for geomechanic modeling of elastic wave generation (microsiesmic event occurrence) during incremental fracture growth. We then derived properties of effective point seismic sources (radiation patterns) approximating obtained wavefields. These results establish connection between geomechanic models of hydraulic fracturing and microseismic monitoring. Thus, the results of the moment tensor inversion of microseismic data can be related to different geomechanic scenarios of hydraulic fracture growth. In future, the results can be used for calibrating hydrofrac models. We carried out a series of numerical simulations and made some observations about wave generation during fracture growth. In particular when the growing fracture hits pre-existing crack then it generates much stronger microseismic event compared to fracture growth in homogeneous medium (radiation pattern is very close to the theoretical dipole-type source mechanism)

  3. TREATMENT DISTAL RADIUS FRACTURE WITH VOLAR BUTTRES S TECHNIQUE- A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Neelanagowda V. P.

    2013-05-01

    Full Text Available Distal radius fractures account for one of every si x fractures that come through the emergency room. These displaced fractures pose sign ificant therapeutic challenges. Most authors agree that the fundamental principal of treatment i s to restore the articular congruity. A number of studies have indicated the inadequacy of closed red uction and casting of complex fractures of the distal radius 1, 2, 3. Open reduction and internal fixation is an effectiv e treatment option for simple fractures, but many intra-articular fractures are t oo comminuted for anatomic open reduction Pins and plaster treatment has been used successfully to maintain length and palmar and radial tilt of the distal radius. However, this method has been as sociated with high complication rates 4 A stable internal fixation with buttress plate permi ts early motion of the neighboring joints and optimizes functional rehabilitation of the wris t and hand

  4. Melt fracture revisited

    Energy Technology Data Exchange (ETDEWEB)

    Greenberg, J. M.

    2003-07-16

    In a previous paper the author and Demay advanced a model to explain the melt fracture instability observed when molten linear polymer melts are extruded in a capillary rheometer operating under the controlled condition that the inlet flow rate was held constant. The model postulated that the melts were a slightly compressible viscous fluid and allowed for slipping of the melt at the wall. The novel feature of that model was the use of an empirical switch law which governed the amount of wall slip. The model successfully accounted for the oscillatory behavior of the exit flow rate, typically referred to as the melt fracture instability, but did not simultaneously yield the fine scale spatial oscillations in the melt typically referred to as shark skin. In this note a new model is advanced which simultaneously explains the melt fracture instability and shark skin phenomena. The model postulates that the polymer is a slightly compressible linearly viscous fluid but assumes no slip boundary conditions at the capillary wall. In simple shear the shear stress {tau}and strain rate d are assumed to be related by d = F{tau} where F ranges between F{sub 2} and F{sub 1} > F{sub 2}. A strain rate dependent yield function is introduced and this function governs whether F evolves towards F{sub 2} or F{sub 1}. This model accounts for the empirical observation that at high shears polymers align and slide more easily than at low shears and explains both the melt fracture and shark skin phenomena.

  5. Phase Field Fracture Mechanics.

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, Brett Anthony [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-11-01

    For this assignment, a newer technique of fracture mechanics using a phase field approach, will be examined and compared with experimental data for a bend test and a tension test. The software being used is Sierra Solid Mechanics, an implicit/explicit finite element code developed at Sandia National Labs in Albuquerque, New Mexico. The bend test experimental data was also obtained at Sandia Labs while the tension test data was found in a report online from Purdue University.

  6. Zoledronic acid and clinical fractures and mortality after hip fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S;

    2007-01-01

    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS: The...... rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction with zoledronic acid (P=0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P=0.02), and the respective rates of new nonvertebral fractures...

  7. Double segmental tibial fractures - an unusual fracture pattern

    Directory of Open Access Journals (Sweden)

    Bali Kamal

    2012-02-01

    Full Text Available 【Abstract】A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech- nique with a pleasing outcome. Key words: Fracture, bone; Tibia; Fibula; Nails

  8. Opportunistic Identification of Vertebral Fractures.

    Science.gov (United States)

    Adams, Judith E

    2016-01-01

    Vertebral fractures are powerful predictors of future fracture, so, their identification is important to ensure that patients are commenced on appropriate bone protective or bone-enhancing therapy. Risk factors (e.g., low bone mineral density and increasing age) and symptoms (back pain, loss of height) may herald the presence of vertebral fractures, which are usually confirmed by performing spinal radiographs or, increasingly, using vertebral fracture assessment with dual-energy X-ray absorptiometry scanners. However, a large number (30% or more) of vertebral fractures are asymptomatic and do not come to clinical attention. There is, therefore, scope for opportunistic (fortuitous) identification of vertebral fractures from various imaging modalities (radiographs, computed tomography, magnetic resonance imaging, and radionuclide scans) performed for other clinical indications and which include the spine in the field of view, with midline sagittal reformatted images from computed tomography having the greatest potential for such opportunistic detection. Numerous studies confirm this potential for identification but consistently find underreporting of vertebral fractures. So, a valuable opportunity to improve the management of patients at increased risk of future fracture is being squandered. Educational training programs for all clinicians and constant reiteration, stressing the importance of the accurate and clear reporting of vertebral fractures ("you only see what you look for"), can improve the situation, and automated computer-aided diagnostic tools also show promise to solve the problem of this underreporting of vertebral fractures. PMID:26412139

  9. Odontoid fractures: A retrospective analysis of 53 cases

    Directory of Open Access Journals (Sweden)

    Shetty Arjun

    2009-01-01

    Full Text Available Background: The management of odontoid fracture has evolved but controversy persists as to the best method for Type II odontoid fractures with or without atlantoaxial (AA instability. The anterior odontoid screw fixation can be associated with significant morbidity while delayed odontoid screw fixation has shown to be associated with reasonable good fusion rates. We conducted a retrospective analysis to evaluate the outcome of a trial of conservative management in type II odontoid fractures without atlantoaxial instability (Group A followed by delayed odontoid screw fixation in cases in which fusion was not achieved by conservative treatment. The outcome of type II odontoid fracture with AA subluxation (Group B was also analysed where closed reduction on traction could be achieved and in those atlantoaxial subluxations that were irreducible an intraoperative reduction was done. Materials and Methods: A retrospective evaluation of 53 cases of odontoid fractures treated over a 9-year period is being reported. All odontoid fractures without AA instability (n=29 were initially managed conservatively. Three patients who did not achieve union with conservative management were treated with delayed anterior screw fixation. Twenty-four cases of odontoid fractures were associated with AA instability; 17 of them could be reduced with skeletal traction and were managed with posterior fusion and fixation. Of the seven cases that were irreducible, the initial three cases were treated by odontoid excision followed by posterior fusion and fixation; however, in the later four cases, intra operative reduction was achieved by a manipulation procedure, and posterior fusion and fixation was performed. Results: Twenty-six of 29 cases of odontoid fracture without AA instability achieved fracture union with conservative management whereas the remaining three patients achieved union following delayed anterior odontoid screw fixation. 17 out of 24 odontoid fracture with

  10. Groundwater degassing in fractured rock: Modelling and data comparison

    Energy Technology Data Exchange (ETDEWEB)

    Jarsjoe, J.; Destouni, G. [Royal Inst. of Tech., Stockholm (Sweden). Water Resources Engineering

    1998-11-01

    Dissolved gas may be released from deep groundwater in the vicinity of open boreholes and drifts, where the water pressures are relatively low. Degassing of groundwater may influence observations of hydraulic conditions made in drifts, interpretation of experiments performed close to drifts, and buffer mass and backfill performance, particularly during emplacement and repository closure. Under certain conditions, considerable fracture inflow and transmissivity reductions have been observed during degassing experiments in the field and in the laboratory; such reductions affect the outcome and interpretation of both hydraulic and tracer tests. We develop models for the estimation of the resulting degree of fracture gas saturation and the associated transmissivity reduction due to groundwater degassing in fractured rock. Derived expressions for bubble trapping probability show that fracture aperture variability and correlation length influence the conditions for capillary bubble trapping and gas accumulation. The laboratory observations of bubble trapping in an Aespoe fracture replica are consistent with the prediction of a relatively high probability of bubble trapping in this fracture. The prediction was based on the measured aperture distribution of the Aespoe fracture and the applied hydraulic gradient. Results also show that the conceptualisation of gas and water occupancy in a fracture greatly influences model predictions of gas saturation and relative transmissivity. Images from laboratory degassing experiments indicate that tight apertures are completely filled with water, whereas both gas and water exist in wider apertures under degassing conditions; implementation of this relation in our model resulted in the best agreement between predictions and laboratory observations. Model predictions for conditions similar to those prevailing in field for single fractures at great depths indicate that degassing effects in boreholes should generally be small, unless the

  11. Chemical Signatures of and Precursors to Fractures Using Fluid Inclusion Stratigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lorie M. Dilley

    2011-03-30

    Enhanced Geothermal Systems (EGS) are designed to recover heat from the subsurface by mechanically creating fractures in subsurface rocks. Open or recently closed fractures would be more susceptible to enhancing the permeability of the system. Identifying dense fracture areas as well as large open fractures from small fracture systems will assist in fracture stimulation site selection. Geothermal systems are constantly generating fractures (Moore, Morrow et al. 1987), and fluids and gases passing through rocks in these systems leave small fluid and gas samples trapped in healed microfractures. These fluid inclusions are faithful records of pore fluid chemistry. Fluid inclusions trapped in minerals as the fractures heal are characteristic of the fluids that formed them, and this signature can be seen in fluid inclusion gas analysis. This report presents the results of the project to determine fracture locations by the chemical signatures from gas analysis of fluid inclusions. With this project we hope to test our assumptions that gas chemistry can distinguish if the fractures are open and bearing production fluids or represent prior active fractures and whether there are chemical signs of open fracture systems in the wall rock above the fracture. Fluid Inclusion Stratigraphy (FIS) is a method developed for the geothermal industry which applies the mass quantification of fluid inclusion gas data from drill cuttings and applying known gas ratios and compositions to determine depth profiles of fluid barriers in a modern geothermal system (Dilley, 2009; Dilley et al., 2005; Norman et al., 2005). Identifying key gas signatures associated with fractures for isolating geothermal fluid production is the latest advancement in the application of FIS to geothermal systems (Dilley and Norman, 2005; Dilley and Norman, 2007). Our hypothesis is that peaks in FIS data are related to location of fractures. Previous work (DOE Grant DE-FG36-06GO16057) has indicated differences in the

  12. Optimisation of composite bone plates for ulnar transverse fractures.

    Science.gov (United States)

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

    2016-04-01

    Metallic bone plates are commonly used for arm bone fractures where conservative treatment (casts) cannot provide adequate support and compression at the fracture site. These plates, made of stainless steel or titanium alloys, tend to shield stress transfer at the fracture site and delay the bone healing rate. This study investigates the feasibility of adopting advanced composite materials to overcome stress shielding effects by optimising the geometry and mechanical properties of the plate to match more closely to the bone. An ulnar transverse fracture is characterised and finite element techniques are employed to investigate the feasibility of a composite-plated fractured bone construct over a stainless steel equivalent. Numerical models of intact and fractured bones are analysed and the mechanical behaviour is found to agree with experimental data. The mechanical properties are tailored to produce an optimised composite plate, offering a 25% reduction in length and a 70% reduction in mass. The optimised design may help to reduce stress shielding and increase bone healing rates. PMID:26875147

  13. Fractured reservoir discrete feature network technologies. Annual report, March 7, 1996--February 28, 1997

    Energy Technology Data Exchange (ETDEWEB)

    Dershowitz, W.S.; La Pointe, P.R.; Einstein, H.H.; Ivanova, V.

    1998-01-01

    This report describes progress on the project, {open_quotes}Fractured Reservoir Discrete Feature Network Technologies{close_quotes} during the period March 7, 1996 to February 28, 1997. The report presents summaries of technology development for the following research areas: (1) development of hierarchical fracture models, (2) fractured reservoir compartmentalization and tributary volume, (3) fractured reservoir data analysis, and (4) integration of fractured reservoir data and production technologies. In addition, the report provides information on project status, publications submitted, data collection activities, and technology transfer through the world wide web (WWW). Research on hierarchical fracture models included geological, mathematical, and computer code development. The project built a foundation of quantitative, geological and geometrical information about the regional geology of the Permian Basin, including detailed information on the lithology, stratigraphy, and fracturing of Permian rocks in the project study area (Tracts 17 and 49 in the Yates field). Based on the accumulated knowledge of regional and local geology, project team members started the interpretation of fracture genesis mechanisms and the conceptual modeling of the fracture system in the study area. Research on fractured reservoir compartmentalization included basic research, technology development, and application of compartmentalized reservoir analyses for the project study site. Procedures were developed to analyze compartmentalization, tributary drainage volume, and reservoir matrix block size. These algorithms were implemented as a Windows 95 compartmentalization code, FraCluster.

  14. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    LENUS (Irish Health Repository)

    Murphy, Colin G

    2012-01-31

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  15. Evaluation of five fracture models in Taylor impact fracture

    Science.gov (United States)

    Zhang, Wei; Xiao, Xin-Ke; Wei, Gang; Guo, Zitao

    2012-03-01

    Taylor impact test presented in a previous study on a commercial high strength and super hard aluminum alloy 7A04-T6 are numerically evaluated using the finite element code ABAQUS/Explicit. In the present study, the influence of fracture criterion in numerical simulations of the deformation and fracture behavior of Taylor rod has been studied. Included in the paper are a modified version of Johnson-Cook, the Cockcroft-Latham(C-L), the constant fracture strain, the maximum shear stress and the maximum principle stress fracture models. Model constants for each criterion are calibrated from material tests. The modified version of Johnson-Cook fracture criterion with the stress triaxiality cut off idea is found to give good prediction of the Taylor impact fracture behavior. However, this study will also show that the C-L fracture criterion where only one simple material test is required for calibration is found to give reasonable predictions. Unfortunately, the other three criteria are not able to repeat the experimentally obtained fracture behavior. The study indicates that the stress triaxiality cut off idea is necessary to predict the Taylor impact fracture.

  16. FRACTURED PETROLEUM RESERVOIRS

    Energy Technology Data Exchange (ETDEWEB)

    Abbas Firoozabadi

    1999-06-11

    The four chapters that are described in this report cover a variety of subjects that not only give insight into the understanding of mult