[Osteosynthesis by tension band wiring of displaced fractures of the olecranon].

Science.gov (United States)

Doursounian, L; Prevot, O; Touzard, R C

1994-01-01

Fifty-two displaced olecranon fractures in adults were treated over a 5-year period. Minimum follow-up was 6 months. Forty-eight fractures were operated and 38 were treated by tension band wiring technique. This technique, applied for all types of fractures, gave good functional results in 33 cases (87%) and fair functional results in 5 cases. Complications include 1 pseudarthrosis, 2 loss of reduction, 2 transient tourniquet palsy and 13 skin problems due to wire protrusion. Tension band wiring is a simple safe and effective technique for displaced olecranon fractures but often requires K-wire removal.

Current techniques for management of transverse displaced olecranon fractures

NARCIS (Netherlands)

den Hamer, A.; Heusinkveld, M.H.G.; Traa, W.; Oomen, P.; Oliva, F.; Del Buono, A.; Maffulli, N.

2015-01-01

BACKGROUND: displaced transverse fractures of the olecranon are the most common fractures occurring in the elbow in adults that requires operative intervention. METHODS: a literature search was performed on PubMed, Web of Science, Science Direct/Scopus, Google Scholar and Google using the keywords

The N-of-1 Clinical Trial: A Timely Research Opportunity in Homeopathy.

Science.gov (United States)

Ulbrich-Zürni, Susanne; Teut, Michael; Roll, Stephanie; Mathie, Robert T

2018-02-01

 The randomised controlled trial (RCT) is considered the 'gold standard' for establishing treatment efficacy or effectiveness of an intervention, but its data do not infer response in an individual patient. Individualised clinical care, a fundamental principle in complementary and alternative medicine (CAM), including homeopathy, seems well disposed in principle to being researched by single-patient (N-of-1) study design. Guidelines for reporting N-of-1 trials have recently been developed.  To overview the current status in the literature of the N-of-1 method and its application in medicine, including CAM. To consider whether the N-of-1 trial design offers an opportunity for novel research in homeopathy. N-OF-1 TRIAL DESIGN:  The N-of-1 trial applies the principles of the conventional crossover, blinded, RCT design. The treatment under study and the comparator are repeated in a randomised order, and with suitable washout time, over a defined period. N-of-1 design is constrained for use in chronic stable conditions, and for interventions that have quick onset and cessation of effect, with modest or negligible carryover. Outcome data can be aggregated and interpreted for the individual subject; they can also be pooled with data from several similar N-of-1 trials, enabling more generalisable conclusions. THE N-OF-1 TRIAL IN CAM: The typical individualisation of patient care can be accommodated in N-of-1 study design if the patient and the specific therapeutic intervention are selected within the constraints of the method. Application of the N-of-1 method in CAM has been advocated but has been mainly limited, in practice, to a small number of studies in herbal and traditional Chinese medicine. THE N-OF-1 TRIAL IN HOMEOPATHY:  Individualised homeopathy can be accommodated for investigation within the same methodological constraints; less in-depth homeopathic approaches to prescribing are also amendable to investigation using the N-of-1 method. No such studies

The number of displaced rib fractures is more predictive for complications in chest trauma patients.

Science.gov (United States)

Chien, Chih-Ying; Chen, Yu-Hsien; Han, Shih-Tsung; Blaney, Gerald N; Huang, Ting-Shuo; Chen, Kuan-Fu

2017-02-28

Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications. We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia. In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture. In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore

Rate of displacement for Jakob Type 1 lateral condyle fractures treated with a cast.

Science.gov (United States)

Zale, C; Winthrop, Z A; Hennrikus, W

2018-04-01

The aim of this retrospective study is to report the rate of displacement of Jakob Type 1 lateral condyle fractures that were initially treated in a cast. We performed a retrospective review of all patients that were treated for a non-displaced (Jakob Type 1 displaced and were converted to a closed pinning treatment plan with a conversion rate of 8.5%. There was a mean of 13.2 days (4 to 21) between treatment by initial casting and closed pinning. This study demonstrates an 8.5% displacement and conversion rate from cast treatment to closed pinning for initially non-displaced Jakob Type 1 lateral condyle fractures of the humerus. The internal oblique radiograph is most accurate to determine displacement. We recommend obtaining an internal oblique view at initial evaluation and at follow-up in the cast for lateral condyle fractures. To minimize movement at the fracture site, we recommend treating Jakob Type 1 lateral condyle fractures with a long arm cast with the elbow at 90° and the forearm in the supine position with a sling-loop design. IV - retrospective therapeutic study.

Numerical modelling of fracture displacements due to thermal load from a KBS-3 repository

Energy Technology Data Exchange (ETDEWEB)

Hakami, Eva; Olofsson, Stig-Olof [Itasca Geomekanik AB, Stockholm (Sweden)

2002-01-01

The objective of the project has been to estimate the largest shear displacements that could be expected on a pre-existing fracture located in the repository area, due to the heat release from the deposited waste. Two-dimensional numerical analyses using the 'Universal Distinct Element Code' (UDEC) have been performed. The UDEC models represent a vertical cross section of a KBS-3 type repository with a large planar fracture intersecting a deposition hole at the repository centre. The extension, dip and mechanical properties of the fracture were changed in different models to evaluate the influence of these parameters on fracture shear displacements. The fracture was modelled using a Coulomb slip criterion with no cohesion and no dilation. The rock mass surrounding the fracture was modelled as a homogeneous, isotropic and elastic material, with a Young's modulus of 40 GPa. The initial heat release per unit repository area was assumed to be 8W/m{sup 2} (total power/total repository area). The shear displacements occur due to the thermal expansion of the rock surrounding the heat generating canisters. The rock mass is almost free to expand vertically, but is constrained horizontally, which gives a temperature-induced addition of shear stresses in the plane of the fracture. The shear movement of the fracture therefore follows the temperature development in the surrounding rock and the maximum shear displacement develops about 200 years after the waste deposition. Altogether, twenty cases are analysed. The maximum shear displacement, which occurs at the fracture centre, amounts to 0.2-13.8 cm depending on the fracture parameters. Among the analysed cases, the largest shear values, about 13 cm, was calculated for the cases with about 700 m long fractures with a shear stiffness of 0.005 GPa/m. Also, for large fractures with a higher shear stiffness of 5 GPa/m, but with a low friction angle (15 deg), the shear displacement reaches similar magnitudes, about

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 f...... 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....

[Correlation analysis between residual displacement and hip function after reconstruction of acetabular fractures].

Science.gov (United States)

Ma, Kunlong; Fang, Yue; Luan, Fujun; Tu, Chongqi; Yang, Tianfu

2012-03-01

To investigate the relationships between residual displacement of weight-bearing and non weight-bearing zones (gap displacement and step displacement) and hip function by analyzing the CT images after reconstruction of acetabular fractures. The CT measures and clinical outcome were retrospectively analyzed from 48 patients with displaced acetabular fracture between June 2004 and June 2009. All patients were treated by open reduction and internal fixation, and were followed up 24 to 72 months (mean, 36 months); all fractures healed after operation. The residual displacement involved the weight-bearing zone in 30 cases (weight-bearing group), and involved the non weight-bearing zone in 18 cases (non weight-bearing group). The clinical outcomes were evaluated by Merle d'Aubigné-Postel criteria, and the reduction of articular surface by CT images, including the maximums of two indexes (gap displacement and step displacement). All the data were analyzed in accordance with the Spearman rank correlation coefficient analysis. There was strong negative correlation between the hip function and the residual displacement values in weight-bearing group (r(s) = -0.722, P = 0.001). But there was no correlation between the hip function and the residual displacement values in non weight-bearing group (r(s) = 0.481, P = 0.059). The results of clinical follow-up were similar to the correlation analysis results. In weight-bearing group, the hip function had strong negative correlation with step displacement (r(s) = 0.825, P = 0.002), but it had no correlation with gap displacement (r(s) = 0.577, P = 0.134). In patients with acetabular fracture, the hip function has correlation not only with the extent of the residual displacement but also with the location of the residual displacement, so the residual displacement of weight-bearing zone is a key factor to affect the hip function. In patients with residual displacement in weight-bearing zone, the bigger the step displacement is, the

Surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle.

Science.gov (United States)

Jing, Jie; Han, Yu; Song, Yu; Wan, Yingbiao

2011-06-01

The purpose of this study was to evaluate the effect of surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle (SFMC). Twenty-four patients with 28 displaced and dislocated SFMCs were distinguished into type M, type C, and type L fractures according the location of the fracture line. The fractured fragment was reduced and fixated with two 0.6-mm 4-hole micro-plates via a preauricular temporal incision. The fragment was extirpated when it was too small to be fixated. The postoperative position and profile of the fragment was examined by orthopantomogram radiograph or computed tomography (CT). The function of the temporal and zygomatic branches of the facial nerve was inspected. The occluding relation was surveyed, the interincisal distance at maximum mouth opening was measured, and the deviation from the midline during mouth opening was recorded. Twenty-three condyles (82%) suffered dislocated fractures with the condylar fragment out of the glenoid fossa. Five condyles (18%) were displaced, but not dislocated. There were 2 (7%) type M, 19 (68%) type C (3 comminuted), and 7 (25%) type L fractures (1 comminuted), respectively. Twenty-one (75%) fractured fragments received free-graft procedures with 2 micro-plates. Four (14%) fragments were reduced and fixated without being dissected free of their attachments. Three (11%) fragments were extirpated. There were no permanent facial never branch injuries. Micro-plate removal was necessary because of postoperative infection and necrosis of the fractured fragment in 1 condylar process. No other patients could be found with obvious postoperative bone resorption. The average postoperative maximum mouth opening and deviation at 6 months were improved significantly. The postoperative occlusion was good in 22 cases. Access with the preauricular incision, and the dislocated and displaced fragment can be reduced and fixated to its normal position easily. Free-graft procedure is a suitable

Effects of fracture surface roughness and shear displacement on geometrical and hydraulic properties of three-dimensional crossed rock fracture models

Science.gov (United States)

Huang, Na; Liu, Richeng; Jiang, Yujing; Li, Bo; Yu, Liyuan

2018-03-01

While shear-flow behavior through fractured media has been so far studied at single fracture scale, a numerical analysis of the shear effect on the hydraulic response of 3D crossed fracture model is presented. The analysis was based on a series of crossed fracture models, in which the effects of fracture surface roughness and shear displacement were considered. The rough fracture surfaces were generated using the modified successive random additions (SRA) algorithm. The shear displacement was applied on one fracture, and at the same time another fracture shifted along with the upper and lower surfaces of the sheared fracture. The simulation results reveal the development and variation of preferential flow paths through the model during the shear, accompanied by the change of the flow rate ratios between two flow planes at the outlet boundary. The average contact area accounts for approximately 5-27% of the fracture planes during shear, but the actual calculated flow area is about 38-55% of the fracture planes, which is much smaller than the noncontact area. The equivalent permeability will either increase or decrease as shear displacement increases from 0 to 4 mm, depending on the aperture distribution of intersection part between two fractures. When the shear displacement continuously increases by up to 20 mm, the equivalent permeability increases sharply first, and then keeps increasing with a lower gradient. The equivalent permeability of rough fractured model is about 26-80% of that calculated from the parallel plate model, and the equivalent permeability in the direction perpendicular to shear direction is approximately 1.31-3.67 times larger than that in the direction parallel to shear direction. These results can provide a fundamental understanding of fluid flow through crossed fracture model under shear.

Isolated Displaced Fracture of the Lesser Tuberosity

African Journals Online (AJOL)

publication of this report. The authors declare no competing interests. Discussion. A delay in diagnosis of a lesser tuberosity fracture may lead to significant future clinical disability (2). In one such case the patient presented with axillary nerve neuropraxia while another case reported displacement of the biceps tendon (4).

TREATMENT OPTIONS FOR DISPLACED FRACTURE OF THE CALCANEAL TUBEROSITY

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Siva G. Prasad

2016-12-01

Full Text Available BACKGROUND The aim of the study is to compare the outcome following conservative or surgical treatment for displaced fracture of the medial process of the calcaneal tuberosity. MATERIALS AND METHODS 14 men and 4 women aged 20 to 44 years chose to undergo conservative (9 feet or surgical (10 feet treatment by a single surgeon for closed displaced fracture of the medial process of the calcaneal tuberosity. The injury mechanism was a fall from a height of <1.5 m; the mean time from injury to treatment was 3 (range 1-7 days. Conservative treatment comprised immobilisation in a plaster cast. Surgical treatment involved fixation with a half thread cannulated screw for large fragments (in 6 feet or a mini-plate for comminuted fragments (in 4 feet. At the final follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS ankle and hind foot score was evaluated. RESULTS The conservative and surgery groups were comparable in terms of age, gender and fracture displacement. The mean follow-up duration was 20 (range, 14-24 months. All patients had bone union; none had implant loosening or breakage. One patient with surgical treatment developed skin numbness at the medial aspect of the heel that resolved following neurotrophic drug treatment for 3 months. The surgery group achieved earlier full weight bearing (5.8 vs. 7.5 weeks, p<0.001 and return to work (5.9 vs. 8.2 weeks, p=0.048, but comparable AOFAS score (89.0 vs. 88.2, p=0.4. CONCLUSION Surgery for displaced fracture of the medial process of the calcaneal tuberosity enabled earlier full weight bearing and return to work, but comparable AOFAS score.

Molecular and bioinformatic analysis of the FB-NOF transposable element.

Science.gov (United States)

Badal, Martí; Portela, Anna; Xamena, Noel; Cabré, Oriol

2006-04-12

The Drosophila melanogaster transposable element FB-NOF is known to play a role in genome plasticity through the generation of all sort of genomic rearrangements. Moreover, several insertional mutants due to FB mobilizations have been reported. Its structure and sequence, however, have been poorly studied mainly as a consequence of the long, complex and repetitive sequence of FB inverted repeats. This repetitive region is composed of several 154 bp blocks, each with five almost identical repeats. In this paper, we report the sequencing process of 2 kb long FB inverted repeats of a complete FB-NOF element, with high precision and reliability. This achievement has been possible using a new map of the FB repetitive region, which identifies unambiguously each repeat with new features that can be used as landmarks. With this new vision of the element, a list of FB-NOF in the D. melanogaster genomic clones has been done, improving previous works that used only bioinformatic algorithms. The availability of many FB and FB-NOF sequences allowed an analysis of the FB insertion sequences that showed no sequence specificity, but a preference for A/T rich sequences. The position of NOF into FB is also studied, revealing that it is always located after a second repeat in a random block. With the results of this analysis, we propose a model of transposition in which NOF jumps from FB to FB, using an unidentified transposase enzyme that should specifically recognize the second repeat end of the FB blocks.

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

Science.gov (United States)

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

2014-07-01

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

Management of displaced comminuted patellar fracture with titanium cable cerclage.

Science.gov (United States)

Yang, Li; Yueping, Ouyang; Wen, Yuan

2010-08-01

Management of a displaced comminuted patellar fracture is challenging. Tension band wiring and lag screw fixation are not suitable for such a fracture pattern. Stainless steel wiring with various configurations has been the mainstay of treatment. However, issues of loss of fixation and breakage of wire have not been resolved yet. Partial or total patellectomy is the last resort with a detrimental effect on quadriceps power. Braided titanium cable is stronger in tensile strength and better in fatigue resistance than the stainless steel monofilament wire, and the tension of fixation could be controlled by a graded instrument in its application. We used titanium cable to treat 21 consecutive patients with displaced comminuted patellar fracture. Patients were followed up for a mean period of 24 months (12 to 32 months). The mean score at the final follow-up was 27 points (25 to 30) using the Böstman method. There was no complication except breakage of one cable at the sixth week after the operation and the fracture had united despite the breakage. This technique is simple and effective for these difficult fractures and avoided prolonged immobilisation of the knee. Copyright 2010 Elsevier B.V. All rights reserved.

Displacement and stress fields around rock fractures opened by irregular overpressure variations

Directory of Open Access Journals (Sweden)

Shigekazu eKusumoto

2014-05-01

Full Text Available Many rock fractures are entirely driven open by fluids such as ground water, geothermal water, gas, oil, and magma. These are a subset of extension fractures (mode I cracks; e.g., dikes, mineral veins and joints referred to as hydrofractures. Field measurements show that many hydrofractures have great variations in aperture. However, most analytical solutions for fracture displacement and stress fields assume the loading to be either constant or with a linear variation. While these solutions have been widely used, it is clear that a fracture hosted by heterogeneous and anisotropic rock is normally subject to loading that is neither constant nor with a linear variation. Here we present new general solutions for the displacement and stress fields around hydrofractures, modelled as two-dimensional elastic cracks, opened by irregular overpressure variations given by the Fourier cosine series. Each solution has two terms. The first term gives the displacement and stress fields due to the average overpressure acting inside the crack; it is given by the initial term of the Fourier coefficients expressing the overpressure variation. The second term gives the displacement and stress fields caused by the overpressure variation; it is given by general terms of the Fourier coefficients and solved through numerical integration. Our numerical examples show that the crack aperture variation closely reflects the overpressure variation. Also, that the general displacement and stress fields close to the crack follow the overpressure variation but tend to be more uniform far from the crack. The present solutions can be used to estimate the displacement and stress fields around any fluid-driven crack, that is, any hydrofracture, as well as its aperture, provided the variation in overpressure can be described by Fourier series. The solutions add to our understanding of local stresses, displacements, and fluid transport associated with hydrofractures in the crust.

Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

Science.gov (United States)

Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

2016-02-01

Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

The use of a single titanium microplate in displaced pediatric parasymphysial mandibular fractures.

Science.gov (United States)

Abdullah, Walid A

2009-07-01

The objective of this study was to evaluate the use of one titanium microplate in the fixation of displaced pediatric parasymphysial mandibular fractures. The study was conducted on 7 children in the mixed dentition stage with displaced parasymphysial fracture. Patients' age ranged between 5 years 9 months and 8 years 4 months with an average of 7 years 1 month. Fractured bone segments were exposed, reduced and then fixed using 1.5 linear microplates at the inferior border of the mandible using monocortical screws, with 1.5 mm in diameter and 5 mm in length. Stainless steel wire was used as a tension band by ligating the teeth around the fracture line. Patients were followed up for occlusion and stability clinically and radiographically (panoramic X-ray and CT). According to clinical and radiographic post-operative follow-up, none of the patients showed displacement of the fixed bony segments. The present study concluded that using one microplate with 1.5 monocortical microscrews and dental tension band by a stainless steel wire could be adequate for fixing displaced pediatric parasymphysial mandibular fractures. This technique has the following advantages: decreases the amount of titanium used, decreases the risk of injury of the roots and teeth buds, and decreases the cost and time of surgery.

Displaced fracture through the anterior atlantal synchondrosis

International Nuclear Information System (INIS)

Thakar, Chrishan; Allibone, James; Harish, Srinivasan; Saifuddin, Asif

2005-01-01

In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report. (orig.)

Displaced fracture through the anterior atlantal synchondrosis

Energy Technology Data Exchange (ETDEWEB)

Thakar, Chrishan; Allibone, James [Royal National Orthopaedic Hospital NHS Trust, Department of Spinal Deformity, Stanmore, Middlesex (United Kingdom); Harish, Srinivasan [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); University College, The Institute of Orthopaedics and Musculoskeletal Sciences, London (United Kingdom)

2005-09-01

In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report. (orig.)

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: Current concepts' review

NARCIS (Netherlands)

T. Schepers (Tim); P. Patka (Peter)

2009-01-01

textabstractIntroduction: A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review

NARCIS (Netherlands)

Schepers, T.; Patka, P.

2009-01-01

A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different percutaneous distractional

Transosseous fixation of pediatric displaced mandibular fractures with polyglactin resorbable suture--a simplified technique.

Science.gov (United States)

Chandan, Sanjay; Halli, Rajshekhar; Joshi, Samir; Chhabaria, Gaurav; Setiya, Sneha

2013-11-01

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

The value of different imaging methods on classification in displaced proximal humeral fractures

International Nuclear Information System (INIS)

Cai Jingyu; Zhu Qingsheng

2004-01-01

Objective: To investigate the influence of common X-ray, two-dimensional computed tomography (2D-CT), spiral computed tomography (SCT), and three-dimensional (3-D) reconstruction on the classification in displaced proximal humeral fractures. Methods: Three groups were divided on the basis of various imaging methods, including group A (common X-ray), group B (common X-ray and 2D-CT), and group C (3-D reconstruction of SCT and 2D-SCT). 46 cases of displaced proximal humeral fractures were classified with Neer system. The true rate of fracture classification by use of three methods was compared with each other, and clinical significance of SCT and 3-D reconstruction was evaluated. Results: Based on operation, 46 cases of displaced proximal humeral fractures in group A included 26 cases of Neer two-part fractures, 13 cases of three-part fractures, and 7 cases of four-part fractures. The true cases of common X-ray were 22 in Neer two-part fractures and 8 in three and four-part fractures, there was significant difference between Neer two-part fractures and Neer three and four-part fractures (P<0.05); 18 cases of proximal humeral fractures in group B included 3 cases of Neer two-part fractures, 9 cases of three-part fractures, and 6 cases of four-part fractures. The true cases of common X-ray and 2D-CT were 7 in Neer three and four-part fractures. 10 cases of proximal humeral fractures in group C included 1 case of Neer two-part fracture, 5 cases of three-part fractures, and 4 cases of four-part fractures. The true cases of 3-D reconstruction, MPR of SCT, and 2D-SCT were 8 in Neer three and four-part fractures. With regard to the true cases of the classification in Neer three and four-part fractures, there was significant difference in three groups and between group A and group C (P<0.05). All SCT and 3-D reconstruction played an important role in the treatment of proximal humeral fractures. Conclusion: Series of good quality X-ray examinations were the first imaging

FUNCTIONAL OUTCOME OF INTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURE

Directory of Open Access Journals (Sweden)

Saket Jati

2016-12-01

Full Text Available BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation. The purpose of this research, the relationship exists between Bohler’s angle and the injury severity of displaced calcaneal fractures and between surgical improvement of Bohler’s angle and its practical outcome. MATERIALS AND METHODS Patients were treated surgically for unilateral closed displaced intra-articular calcaneal fractures from May 2014 to October 2016 were identified. The Bohler’s angles of bilateral calcaneus were measured and was compared to the dimension of the uninjured foot was used as its normal control. The difference in the value of Bohler’s angle measured preoperatively or after surgery between the angle of the damaged foot and that of the contralateral calcaneus was calculated, respectively. The change in Bohler’s angle by ratio was calculated by dividing the variation in the value of Bohler’s angle between bilateral calcaneus by its typical control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot and Ankle Society hindfoot scores. RESULTS 30 patients were included into the study with a mean follow-up duration of 30 months. According to Sanders classification, the fracture pattern included 12 type II, 10 type III and 8 type IV fractures. According to American Orthopaedic Foot and Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 10, 8, 4 and 2 patients, respectively. The preoperative Bohler’s angle, difference value of Bohler’s angle between bilateral calcaneus and change in Bohler’s angle by ratio each has a significant relationship with Sanders classification (P=0.003; P=0.004; P=0.005, respectively, however, is not correlated with

A versatile stereo photogrammetry based technique for measuring fracture mode displacements in structures

DEFF Research Database (Denmark)

Alvarado, Jonathan Shmueli; Eder, Martin Alexander; Tesauro, Angelo

2015-01-01

The measurement of fracture mode displacements in structures which are susceptible to cracking such as adhesive joints in composite components – is becoming increasingly important. Such measurements are essential for the understanding of the root causes for specific fracture damage types. Further......The measurement of fracture mode displacements in structures which are susceptible to cracking such as adhesive joints in composite components – is becoming increasingly important. Such measurements are essential for the understanding of the root causes for specific fracture damage types......-made automated image processing software (AIPS) allows a rapid and reliable evaluation of a multitude of subsequently taken measurements at a high-precision level. The SDMS is used to measure the LRDs at three different locations close to the trailing edge of a wind turbine rotor blade. In addition...

Displaced trochanteric fragments lead to poor functional outcome in pertrochanteric fractures treated by cephalomedullary nails.

Science.gov (United States)

Studer, Patrick; Suhm, Norbert; Wang, Qing; Rosenthal, Rachel; Saleh, Hatem Al-Fadel; Jakob, Marcel

2015-12-01

The importance of the greater trochanter and its attached abductor muscles for physiological gait is well accepted. However the influence of a displaced greater trochanter fracture after a pertrochanteric fracture is unknown. The aim of this study is to determine if there is an association between the greater trochanter position and the level of patient mobility following internal fixation of pertrochanteric fractures. One hundred and thirty-three consecutive elderly patients with a median age of 85 (interquartile range [IQR] 79-91) years, who were treated for pertrochanteric fractures at a level I trauma centre, were recruited. AO 31 A3.1 and A3.2 fracture types were excluded from the statistical analysis. Patient mobility was prospectively assessed before the fracture and one year following fracture treatment using the Parker mobility score. In a multivariable analysis, the influence of a displaced greater trochanter on patient mobility at one-year follow-up was assessed. The analysis was adjusted for age, gender, body mass index, Charlson comorbidity index, AO fracture classification, varus-/valgus malposition of the neck-shaft fragments, and Parker mobility score before fracture. Post-operative X-rays were available in 125 patients, out of which 66 (53%) patients were identified with a displaced or migrated greater trochanter. One year mortality rate was 22% (n=27). In the 82 patients who had functional assessment one year post-operatively, the median Parker mobility score before fracture and at one-year follow-up was 7 (IQR 4-9) and 7 (IQR 3-9) in patients without, and 7 (IQR 4-9) and 3 (IQR 2-5) in patients with a displaced greater trochanter. In multivariable analysis, a displaced greater trochanter was significantly associated with a lower Parker mobility score (-1.74, 95% confidence interval -2.37, -1.12, pfractures with a cephalomedullary nail is associated with a poor functional outcome. Greater attention to achieve adequate reduction and stabilisation

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture

NARCIS (Netherlands)

Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P.H.; Houwert, Roderick M.

2017-01-01

Background Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in

[Intramedullary stabilisation of displaced midshaft clavicular fractures: does the fracture pattern (simple vs. complex) influence the anatomic and functional result].

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Langenhan, R; Reimers, N; Probst, A

2014-12-01

Displaced midshaft clavicular fractures are often treated operatively. The most common way of treatment is plating. Elastic stable intramedullary nailing (ESIN) is an alternative, but seldom used. Studies showed comparable or even better results for intramedullary nailing than for plating in simple 2- or 3-fragment midshaft fractures. The indication of ESIN for multifragmentary clavicular fractures is discussed critically in the literature because of reduced primary stability and danger of secondary shortening. Until now only few studies report functional results after fracture healing depending on the fracture type. To the best of our knowledge there is no study showing significantly worse functional scores for ESIN in complex displaced midshaft fractures. The objective of this study was to examine anatomic and functional results of simple (2 or 3 fragments, OTA type 15B1 and 15B2) and complex (multifragmentary, OTA type 15B3) displaced midshaft clavicula fractures after internal fixation. Between 2009 and 2012, 40 patients (female/male 10/30; mean age 33 [16-60] years) with closed displaced midshaft clavicular fractures were treated by open reduction and ESIN (Titanium Elastic Nail [TEN], Synthes, Umkirch, Germany). Thirty-seven patients were retrospectively analysed after a mean of 27 (12-43) months. Twenty patients (group A) had simple fractures (OTA type 15B1 and 15B2), 17 patients (group B) had complex fractures (OTA type 15B3). All shoulder joints were postoperatively treated functionally for six weeks without weight limited to 90° abduction/flexion. Both groups were comparable in gender, age, body mass index, months until metal removal, number of physiotherapy sessions and time until follow-up examination. Joint function (neutral zero method) and strength (standing patient with arm in 90° abduction, holding 1-12 kg for 5 sec) in both shoulders were documented. The distance between the centre of the jugulum and the lateral acromial border was measured for

Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation

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Philippe Loriaut

2017-01-01

Conclusion: The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.

Reliability of internal oblique elbow radiographs for measuring displacement of medial epicondyle humerus fractures: a cadaveric study.

Science.gov (United States)

Gottschalk, Hilton P; Bastrom, Tracey P; Edmonds, Eric W

2013-01-01

Standard elbow radiographs (AP and lateral views) are not accurate enough to measure true displacement of medial epicondyle fractures of the humerus. The amount of perceived displacement has been used to determine treatment options. This study assesses the utility of internal oblique radiographs for measurement of true displacement in these fractures. A medial epicondyle fracture was created in a cadaveric specimen. Displacement of the fragment (mm) was set at 5, 10, and 15 in line with the vector of the flexor pronator mass. The fragment was sutured temporarily in place. Radiographs were obtained at 0 (AP), 15, 30, 45, 60, 75, and 90 degrees (lateral) of internal rotation, with the elbow in set positions of flexion. This was done with and without radio-opaque markers placed on the fragment and fracture bed. The 45 and 60 degrees internal oblique radiographs were then presented to 5 separate reviewers (of different levels of training) to evaluate intraobserver and interobserver agreement. Change in elbow position did not affect the perceived displacement (P=0.82) with excellent intraobserver reliability (intraclass correlation coefficient range, 0.979 to 0.988) and interobserver agreement of 0.953. The intraclass correlation coefficient for intraobserver reliability on 45 degrees internal oblique films for all groups ranged from 0.985 to 0.998, with interobserver agreement of 0.953. For predicting displacement, the observers were 60% accurate in predicting the true displacement on the 45 degrees internal oblique films and only 35% accurate using the 60 degrees internal oblique view. Standardizing to a 45 degrees internal oblique radiograph of the elbow (regardless of elbow flexion) can augment the treating surgeon's ability to determine true displacement. At this degree of rotation, the measured number can be multiplied by 1.4 to better estimate displacement. The addition of a 45 degrees internal oblique radiograph in medial humeral epicondyle fractures has good

Irreducible Anterior Shoulder Dislocation Associated With Displaced Fracture of the Greater Tuberosity: An Analysis of Seven Cases

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Morteza Nakhaei Amroodi

2015-11-01

Full Text Available Background: Although anterior shoulder dislocation is the most prevalent type of body dislocation, irreducible anterior shoulder dislocation is seldom reported in the literature, which is usually due to physical obstacles. Objectives: This study presents our findings regarding the causes of irreducibility of anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Patients and Methods: CT scans, open reduction of the joint, and internal fixation of the tuberosity was performed in seven patients with irreducible anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Results: As confirmed by intraoperative findings, the CT scans showed the cause of irreducible shoulder dislocation in six cases was the interposition of the long head of biceps (LHB in the anterior of the head that was displaced from the fracture line between the greater and lesser tuberosities. In another case, the greater and lesser tuberosities were attached to each other and were separated from the head. This fractured part was trapped. Conclusions: We suggest that performing CT scans in all cases of anterior shoulder dislocations with displaced fracture of the greater tuberosity can help surgeons to diagnose the accompanying fractures and possible complications, such as irreducibility. If the fracture line passes through the bicipital groove or in the case of a shield fracture, possible irreducibility should be borne in mind.

Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture

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Chaudhuri Sibaji

2008-01-01

Full Text Available Background: Management of femoral neck fracture is still considered as an unsolved problem. It is more evident in displaced fractures where this fracture is considered as some sort of vascular insult to the head of the femur. We have used closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting in fresh displaced femoral neck fractures. Materials and Methods: From April 1996 to December 2004 we operated 73 consecutive patients of displaced femoral neck fracture in the age group of 24 to 81 years, mean age being 54.6 years. The patients were operated within one week of injury, the mean delay being 3.6 days. Closed reduction internal fixation along with quadratus femoris muscle pedicle bone grafting was done in all cases. They were followed up for an average period of 5.6 years (range 2-11 years. Results: Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 53, good in 12, fair in six and poor in two patients. Bony union occurred in 68 cases, no patient developed avascular necrosis (AVN till date. Conclusion: For fresh displaced femoral neck fracture in physiologically active patients closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting is a suitable option to secure union and prevent development of AVN.

Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

Science.gov (United States)

Steinhaus, Michael E; Dare, David M; Gulotta, Lawrence V

2016-10-01

The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures. The purpose of this review is to highlight the strengths and weaknesses of the PROFHER trial and to assess the validity of its conclusion in the context of existing literature. The authors found no difference in the Oxford Shoulder Score (OSS) between the surgical and nonsurgical groups. Additionally, no difference was found between groups in any of the secondary outcomes, which included the Short-Form 12 (SF-12) health survey, surgical and fracture-related complications, additional surgery or therapy, inpatient medical complications, and mortality. They concluded that the recent increase in surgical management of proximal humerus fractures is perhaps unwarranted. While the randomization was successful and the pragmatic design may enable greater generalizability, this study possesses numerous flaws inherent in such an ambitious endeavor, including an inability to identify specific factors which explain the lack of superiority of surgical management. Despite its weaknesses, this study is a valuable datapoint which encourages surgeons to reexamine their surgical indications for this injury.

Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature

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Shimal, A.; Davies, A.M. [Department of Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP (United Kingdom); James, S.L.J., E-mail: steven.james@roh.nhs.u [Department of Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP (United Kingdom); Grimer, R.J. [Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham B31 2AP (United Kingdom)

2010-05-15

Aim: To investigate the association of a fatigue-type stress fracture and a fibrous cortical defect/non-ossifying fibroma (FCD/NOF) of the lower limb long bones in skeletally immature patients. Materials and methods: The patient database of a specialist orthopaedic oncology centre was searched to determine the number of skeletally immature patients (<=16 years of age) over an 18 year period with a lower limb long bone lesion ultimately shown to be a fatigue-type stress fracture. The diagnosis was established by a combination of typical imaging findings of a fatigue-type stress fracture, the absence of aggressive features suggestive of a sarcoma (e.g., interrupted periosteal reaction, cortical breach, and a soft-tissue mass) together with evidence of consolidation or healing on follow-up radiographs and resolution of symptoms over the subsequent weeks. The database was also used to determine the number of skeletally immature cases (<=16 years of age) referred in the same period in which the principal lesion was shown to be a fibrous cortical defect (FCD) or non-ossifying fibroma (NOF) of the lower limb long bones. The clinical and imaging features of those cases common to both groups (i.e., with both a fatigue-type stress fracture and a FCD or NOF) were reviewed. Results: Six percent of patients (five cases) referred to an orthopaedic oncology unit, who were subsequently shown to have a stress fracture of the lower limb long bones, were found to have a related FCD/NOF. All had been referred with a suggested diagnosis of a bone sarcoma and/or osteomyelitis. The possibility of a stress fracture had been raised in only one case. Four cases involved the proximal tibia and one the distal femur. Radiographs revealed that both lesions arose in the posteromedial cortex in all but one of the cases. The radiographs and magnetic resonance imaging (MRI) features were considered typical of the overlapping pathological features of the lesions. Conclusions: A sarcoma could be

Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature

International Nuclear Information System (INIS)

Shimal, A.; Davies, A.M.; James, S.L.J.; Grimer, R.J.

2010-01-01

Aim: To investigate the association of a fatigue-type stress fracture and a fibrous cortical defect/non-ossifying fibroma (FCD/NOF) of the lower limb long bones in skeletally immature patients. Materials and methods: The patient database of a specialist orthopaedic oncology centre was searched to determine the number of skeletally immature patients (≤16 years of age) over an 18 year period with a lower limb long bone lesion ultimately shown to be a fatigue-type stress fracture. The diagnosis was established by a combination of typical imaging findings of a fatigue-type stress fracture, the absence of aggressive features suggestive of a sarcoma (e.g., interrupted periosteal reaction, cortical breach, and a soft-tissue mass) together with evidence of consolidation or healing on follow-up radiographs and resolution of symptoms over the subsequent weeks. The database was also used to determine the number of skeletally immature cases (≤16 years of age) referred in the same period in which the principal lesion was shown to be a fibrous cortical defect (FCD) or non-ossifying fibroma (NOF) of the lower limb long bones. The clinical and imaging features of those cases common to both groups (i.e., with both a fatigue-type stress fracture and a FCD or NOF) were reviewed. Results: Six percent of patients (five cases) referred to an orthopaedic oncology unit, who were subsequently shown to have a stress fracture of the lower limb long bones, were found to have a related FCD/NOF. All had been referred with a suggested diagnosis of a bone sarcoma and/or osteomyelitis. The possibility of a stress fracture had been raised in only one case. Four cases involved the proximal tibia and one the distal femur. Radiographs revealed that both lesions arose in the posteromedial cortex in all but one of the cases. The radiographs and magnetic resonance imaging (MRI) features were considered typical of the overlapping pathological features of the lesions. Conclusions: A sarcoma could be

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. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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

2015-09-01

To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

Internal fixation of severely displaced mandibular condylar neck fracture with the aid of ramus osteotomy. A revised technique

DEFF Research Database (Denmark)

Hillerup, S

1997-01-01

A technique is described whereby the mandibular condyle can be located, replaced and fixed in case of a severely displaced fracture with exarticulation of the condylar head.......A technique is described whereby the mandibular condyle can be located, replaced and fixed in case of a severely displaced fracture with exarticulation of the condylar head....

Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

DEFF Research Database (Denmark)

Brorson, Stig; Frich, Lars H; Winther, Annika

2011-01-01

There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries....

Three-dimensional fracture instability of a displacement-weakening planar interface under locally peaked nonuniform loading

Science.gov (United States)

Uenishi, Koji

2018-06-01

We consider stability of fracture on a three-dimensional planar interface subjected to a loading stress that is locally peaked spatially, the level of which increases quasi-statically in time. Similar to the earlier study on the two-dimensional case (Uenishi and Rice, 2003; Rice and Uenishi, 2010), as the loading stress increases, a crack, or a region of displacement discontinuity (opening gap in tension or slip for shear fracture), develops on the interface where the stress is presumed to decrease according to a displacement-weakening constitutive relation. Upon reaching the instability point at which no further quasi-static solution for the extension of the crack on the interface exists, dynamic fracture follows. For the investigation of this instability point, we employ a dimensional analysis as well as an energy approach that gives a Rayleigh-Ritz approximation for the dependence of crack size and maximum displacement discontinuity on the level and quadratic shape of the loading stress distribution. We show that, if the linear displacement-weakening law is applied and the crack may be assumed of an elliptical form, the critical crack size at instability is independent of the curvature of the loading stress distribution and it is of the same order for all two- and three-dimensional cases.

TREATMENT OF DISPLACED MALLEOLAR FRACTURES AT CHILDREN

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Franci Vindišar

2004-04-01

Full Text Available Background. The exact knowledge of the anatomic relations of the juvenile skeleton is of great importance for the determination of the injury and proper treatment. The treatment should be uniform and carried out in one act. Considering this facts the functional results are usually very good and no late sequel are recorded.Methods. In 5-years period 25 children with age 7 to 17 were treated with displaced fracture of ankle. The Salter-Harris classification (SHC was used. Children were classified in two groups. In first group (G-I 11 children were treated with closed reduction. Whole group was classified as type II fractures of SHC. In second group (G-II 14 children were treated operatively. 10 cases were type III, 2 cases were type IV of SHC and 2 were juvenil Tillaux fracture. In follow-up we registered the duration of immobilisation, non-weight bearing period, mobility and residual pain at the end of the treatment.Results. In G-I average non-weight bearing period was 10.4 weeks, in G-II only 7.8 weeks. At the end of the treatment in both groups very good functional results were achieved. There were no complications in operative group (G-II.Conclusions. Children relatively often suffer ankle injuries. With proper diagnosis and early adequate treatment the prognosis is good and no functional sequel were recorded.

FB-NOF is a non-autonomous transposable element, expressed in Drosophila melanogaster and present only in the melanogaster group.

Science.gov (United States)

Badal, Martí; Xamena, Noel; Cabré, Oriol

2013-09-10

Most foldback elements are defective due to the lack of coding sequences but some are associated with coding sequences and may represent the entire element. This is the case of the NOF sequences found in the FB of Drosophila melanogaster, formerly considered as an autonomous TE and currently proposed as part of the so-called FB-NOF element, the transposon that would be complete and fully functional. NOF is always associated with FB and never seen apart from the FB inverted repeats (IR). This is the reason why the FB-NOF composite element can be considered the complete element. At least one of its ORFs encodes a protein that has always been considered its transposase, but no detailed studies have been carried out to verify this. In this work we test the hypothesis that FB-NOF is an active transposon nowadays. We search for its expression product, obtaining its cDNA, and propose the ORF and the sequence of its potential protein. We found that the NOF protein is not a transposase as it lacks any of the motifs of known transposases and also shows structural homology with hydrolases, therefore FB-NOF cannot belong to the superfamily MuDR/foldback, as up to now it has been classified, and can be considered as a non-autonomous transposable element. The alignment with the published genomes of 12 Drosophila species shows that NOF presence is restricted only to the 6 Drosophila species belonging to the melanogaster group. Copyright © 2013 Elsevier B.V. All rights reserved.

Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature.

Science.gov (United States)

Shimal, A; Davies, A M; James, S L J; Grimer, R J

2010-05-01

To investigate the association of a fatigue-type stress fracture and a fibrous cortical defect/non-ossifying fibroma (FCD/NOF) of the lower limb long bones in skeletally immature patients. The patient database of a specialist orthopaedic oncology centre was searched to determine the number of skeletally immature patients (lower limb long bone lesion ultimately shown to be a fatigue-type stress fracture. The diagnosis was established by a combination of typical imaging findings of a fatigue-type stress fracture, the absence of aggressive features suggestive of a sarcoma (e.g., interrupted periosteal reaction, cortical breach, and a soft-tissue mass) together with evidence of consolidation or healing on follow-up radiographs and resolution of symptoms over the subsequent weeks. The database was also used to determine the number of skeletally immature cases (lower limb long bones. The clinical and imaging features of those cases common to both groups (i.e., with both a fatigue-type stress fracture and a FCD or NOF) were reviewed. Six percent of patients (five cases) referred to an orthopaedic oncology unit, who were subsequently shown to have a stress fracture of the lower limb long bones, were found to have a related FCD/NOF. All had been referred with a suggested diagnosis of a bone sarcoma and/or osteomyelitis. The possibility of a stress fracture had been raised in only one case. Four cases involved the proximal tibia and one the distal femur. Radiographs revealed that both lesions arose in the posteromedial cortex in all but one of the cases. The radiographs and magnetic resonance imaging (MRI) features were considered typical of the overlapping pathological features of the lesions. A sarcoma could be effectively excluded in the absence of true cortical destruction and soft-tissue extension. Both fatigue-type stress fractures and FCD/NOFs occur at similar sites in the long bones. It is postulated that the existence of the latter may cause localized weakening of

Dynamic modelling of n-of-1 data: powerful and flexible data analytics applied to individualised studies.

Science.gov (United States)

Vieira, Rute; McDonald, Suzanne; Araújo-Soares, Vera; Sniehotta, Falko F; Henderson, Robin

2017-09-01

N-of-1 studies are based on repeated observations within an individual or unit over time and are acknowledged as an important research method for generating scientific evidence about the health or behaviour of an individual. Statistical analyses of n-of-1 data require accurate modelling of the outcome while accounting for its distribution, time-related trend and error structures (e.g., autocorrelation) as well as reporting readily usable contextualised effect sizes for decision-making. A number of statistical approaches have been documented but no consensus exists on which method is most appropriate for which type of n-of-1 design. We discuss the statistical considerations for analysing n-of-1 studies and briefly review some currently used methodologies. We describe dynamic regression modelling as a flexible and powerful approach, adaptable to different types of outcomes and capable of dealing with the different challenges inherent to n-of-1 statistical modelling. Dynamic modelling borrows ideas from longitudinal and event history methodologies which explicitly incorporate the role of time and the influence of past on future. We also present an illustrative example of the use of dynamic regression on monitoring physical activity during the retirement transition. Dynamic modelling has the potential to expand researchers' access to robust and user-friendly statistical methods for individualised studies.

Prevention of avascular necrosis in displaced talar neck fractures by hyperbaric oxygenation therapy: A dual case report

Directory of Open Access Journals (Sweden)

Mei-Dan O

2008-01-01

Full Text Available Talar neck fractures are a rare injury that account for less then 2% of all foot fractures. Displaced fractures are associated with an exceedingly high rate of avascular necrosis (AVN. The incidence of AVN following Hawkins Type 3 fractures of the talar neck may approach 100%, particularly if diagnosis and reduction are delayed. Severe cases may present as pain and disability of the ankle and the subtalar joints due to a talar dome collapse, resulting in degenerative changes that usually require hind foot arthrodesis. We present two cases of traumatic displaced talar neck fractures which were treated surgically more than 2 weeks following injury due to a delay in diagnosis. Both patients underwent hyperbaric oxygen therapy (HBOT after the operation and neither resulted in AVN of the talus in a three-year follow-up. We suggest that this favorable result may be due to the beneficial effects of HBOT.

Modeling the Impact of Fracture Growth on Fluid Displacements in Deformable Porous Media

Science.gov (United States)

Santillán, D.; Cueto-Felgueroso, L.; Juanes, R.

2015-12-01

Coupled flow and geomechanics is a critical research challenge in engineering and the geosciences. The flow of a fluid through a deformable porous media is present in manyenvironmental, industrial, and biological processes,such as the removal of pollutants from underground water bodies, enhanced geothermal systems, unconventional hydrocarbon resources or enhanced oil recovery techniques. However, the injection of a fluid can generate or propagate fractures, which are preferential flow paths. Using numerical simulation, we study the interplay between injection and rock mechanics, and elucidate fracture propagation as a function of injection rate, initial crack topology and mechanical rock properties. Finally, we discuss the role of fracture growth on fluid displacements in porous media. Figure: An example of fracture (in red) propagated in a porous media (in blue)

An inconvenient truth: treatment of displaced paediatric supracondylar humeral fractures.

LENUS (Irish Health Repository)

Donnelly, M

2012-06-01

The need for emergent management of displaced paediatric supracondylar humeral fractures is being questioned in the literature. Open reduction rates of up to 46% have been reported in the non-emergent management of these injuries. At our institution these fractures are managed as operative emergencies by senior personnel. To examine the ongoing need for this policy we reviewed our results. All patients managed over a five year period with Gartland type IIB or III paeditric supracondylar humeral fractures were identified and a comprehensive chart and radiographic review undertaken. The mean time from injury to fracture reduction and stabilization was 6.6 h. Consultants performed or supervised 90% of cases. Open reduction was necessary in 5% of cases. Complications included a perioperative nerve injury rate of 6% and a superficial pin site infection rate of 3%. This study suggests that, despite the challenge to trauma on-call rostering, the emergency management of these injuries is advantageous to patients in units of our size. Based on the data presented here we continue our practice of emergent management. We suggest that units of a similar size to our own would show a benefit from an analogous policy albeit an inconvenient truth.

Study protocol: non-displaced distal radial fractures in adult patients: three weeks vs. five weeks of cast immobilization: a randomized trial.

Science.gov (United States)

Bentohami, Abdelali; de Korte, Niels; Sosef, Nico; Goslings, Johan Carel; Bijlsma, Taco; Schep, Niels

2014-01-20

Up to 30% of patients suffer from long-term functional restrictions following conservative treatment of distal radius fractures. Whether duration of cast immobilisation influences functional outcome remains unclear. The aim of the study is to evaluate whether the duration of immobilization of non or minimally displaced distal radial fractures can be safely reduced. We will compare three weeks of plaster cast immobilization with five weeks of plaster cast immobilization in adult patient with non or minimally displaced distal radial fractures. a prospective randomized clinical trial. adult (>18 years) (independent in activities of daily living) patients with a non/minimal displaced distal radius fracture (dorsal angulation 15°, ulnar positive variance immobilization versus five weeks of plaster cast immobilization.Main study parameters: primary outcome parameters: Patient related wrist evaluation (PRWE) Quick Disability of Arm, Shoulder and Hand (QUICKDASH) score after a one year follow-up, and secondary parameters: range of motion, pain level (VAS) and complications. The expectation of this study is that shorter duration of plaster cast immobilisation is beneficial for the patient with a distal radius fracture. This risk of specific complications is low and generally similar in both treatment options. Moreover, the burden of the study is not much higher compared to standard treatment. Follow-up is standardized according to current trauma guidelines. Literature indicates that both treatment options from the study are accepted for displaced distal radius fractures. No clear advantage for one treatment options is found at present in the literature, although there is no level I evidence present. This trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two treatment options for non-displaced distal radial fractures. The gathered data may support the development of a clinical guideline for conservative treatment of

N-of-1 trials in the clinical care of patients in developing countries: a systematic review.

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Alemayehu, Chalachew; Nikles, Jane; Mitchell, Geoffrey

2018-04-23

N-of-1 trials have a potential role in promoting patient-centered medicine in developing countries. However, there is limited academic literature regarding the use of N-of-1 trials in the clinical care of patients in resource-poor settings. To assess the extent of use, purpose and treatment outcome of N-of-1 trials in developing countries. A systematic review of clinical N-of-1 trials was conducted between 1985 and September 2015 using PubMed, Embase, CINAHL, Web of Science and the Cochrane Central Register of Controlled Trials. Grey literature databases and clinical trial registers were also searched. This review included randomized, multi-cycle, crossover within individual patient trials involving drug intervention. Quality assessment and data extraction were conducted by two independent reviewers. Out of 131 N-of-1 trials identified, only 6 (4.5%) were conducted in developing countries. The major reason that N-of-1 trials were used was to provide evidence on feasibility, effectiveness and safety of therapies. A total of 72 participants were involved in these trials. Five of the studies were conducted in China and all evaluated Chinese traditional medicine. The remaining study was conducted in Brazil. The completion rate was 93%. More than half, 46 (69%) of subjects made medication changes consistent with trial results after trial completion. A number of threats to the validity of the included evidence limited the validity of the evidence. In particular, the estimated overall effect in four of the included studies could have been affected by the "carry over" of the previous treatment effect as no adequate pharmacokinetic evidence regarding traditional medicines was presented. The prevalence and scope of N-of-1 trials in developing countries is low. A coordinated effort among government, clinicians, researchers and sponsor organizations is needed to increase their uptake and quality in developing countries. PROSPERO CRD42015026841 .

The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows(A (R))

NARCIS (Netherlands)

Wouters, Diederick B.; de Graaf, Joost S.; Hemmer, Patrick H.; Burgerhof, Johannes G. M.; Kramer, William L. M.

This article summarises the results of a newly developed technique that utilises Meniscus Arrows(A (R)) for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents. Twelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an

A STUDY ON THE MANAGEMENT OF DISPLACED FRACTURES OF PATELLA USING MODIFIED TENSION BAND WIRING

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Hari Babu

2015-10-01

Full Text Available INTRODUCTION: Patella is an important component of the extensor mechanism of the knee. A patella fracture constitutes 1% of all skeletal fractures resulting from either direct or indirect trauma. Any improper and inadequate treatment would inevitably lead to a disability which would be most perceptibly felt in a country like India, where squatting is important activity in daily life. The goal of treatment is to regain the continuity of the extensor mechanism and congruity of patellofemoral a rticulation so that the normal function of the knee can be restored. Several techniques have been described for internal fixation of fractures of patella. The ideal fixation for the fracture patella is that it should be strong enough to allow early mobiliz ation, reduce posttraumatic stiffness and perhaps help the healing of the articular surface . AIMS: To analyze the functional outcome of displaced transverse fractures of the patella treated by Modified Tension Band Wiring principle (Muller using A. Dutta & S. K. Gupta Scoring System. To extend the application of Modified Tension Band wiring for minimally comminuted fractures of patella and assesses the results. CONCLUSION : The present study shows that modified tension band wiring (Muller is an effective p rocedure in the management of displaced transverse patellar fractures, with excellent to good results. Minimally comminuted patellar fractures also yielded excellent to good results with Modified tension band wiring as an extended application. The results in the present study are comparable to other modifications of Tension Band Wiring principle. The surgery of Modified Tension Band Wiring gives rigid fixation and helps in early mobilization. Regular and scheduled post- operative physiotherapy plays an impor tant role in the functional outcome.

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

BACKGROUND: Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures......, 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...

External fixation for displaced intra-articular fractures of the calcaneum.

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Magnan, B; Bortolazzi, R; Marangon, A; Marino, M; Dall'Oca, C; Bartolozzi, P

2006-11-01

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders' type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler's angle was 6.98 degrees (5.95 degrees to 19.86 degrees), whereas after surgery the mean value was 21.94 degrees (12.58 degrees to 31.30 degrees) (p fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing. The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique.

A Conservative Method for Treating Severely Displaced Pediatric Mandibular Fractures: An Effective Alternative Technique

OpenAIRE

Sahand Samieirad; Saeedeh khajehahmadi; Elahe Tohidi; Meysam Pakravan

2016-01-01

Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral man‌dibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and...

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

OpenAIRE

Khan, SK; Karuppaiah, K; Bajwa, AS

2012-01-01

INTRODUCTION Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. METHODS A prospective study was conducted at a tertiary unit. Fifty NOF patients (cas...

Delayed chest wall hematoma caused by progressive displacement of rib fractures after blunt trauma

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Nobuhiro Sato

2016-06-01

Full Text Available Rib fracture is a common injury resulting from blunt thoracic trauma. Although hemothorax and pneumothorax are known delayed complications of rib fracture, delayed chest wall hematoma has rarely been reported. We discuss the case of an 81-year-old woman who was not undergoing antiplatelet or anticoagulant therapy who presented to our emergency department after a traffic injury. This patient had a nondisplaced rib fracture that went undetected on the initial computed tomography scan; the development of progressive displacement led to hemorrhagic shock due to delayed chest wall hematoma. The chest wall hematoma was effectively diagnosed and treated via contrast-enhanced computed tomography and angiographic embolization. This case highlights the possibility of this potential delayed complication from a common injury such as a rib fracture. Keywords: Angiography, Chest wall, Delayed complication, Rib fracture, Thoracic injury

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

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Samir Joshi

2015-01-01

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

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

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

2015-01-01

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

Can introduction of an uncemented, hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures be recommended?

DEFF Research Database (Denmark)

Hansen, Søren Kring; Brix, Michael; Birkelund, Lasse

2010-01-01

The role of uncemented fully hydroxyapatite coated hemiarthroplasties for the treatment of displaced femoral neck fractures remains unclear. We investigated if complications, reoperations and mortality differed from that of cemented hemiarthroplasties. The study groups consisted of 78 cemented...... and 97 uncemented, hydroxyapatite coated hemiarthroplasties with minimum 1 year follow-up. The dislocation rate was 3% in both groups (p=0.84). Proximal femoral fracturing occurred in 1% in the cemented group and in 4% in the uncemented group (p=0.26). Reoperations were performed following 4......% of procedures in the cemented group and following 2% of procedures in the uncemented group (p=0.48). Mortality rates did not differ statistically significant between groups. Outcomes were comparable. Introduction of an uncemented hydroxyapatite coated hemiarthroplasty for treatment of displaced femoral neck...

Displaced proximal humeral fractures: an Indian experience with locking plates

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Aggarwal Sameer

2010-08-01

Full Text Available Abstract Background The treatment of displaced proximal humerus fractures, especially in elderly, remains controversial. The objective of this study was to evaluate functional outcome of locking plate used for fixation of these fractures after open reduction. We also attempted to evaluate the complications and predictors of loss of fixation for such an implant. Methods Over two and a half years, 56 patients with an acute proximal humerus fracture were managed with locking plate osteosynthesis. 47 of these patients who completed a minimum follow up of 1 year were evaluated using Constant score calculation. Statistical analysis was done using SPSS 16 and a p value of less than 0.05 was taken as statistically significant. Results The average follow up period was around 21.5 months. Outcomes were excellent in 17%, good in 38.5%, moderate in 34% while poor in 10.5%. The Constant score was poorer for AO-OTA type 3 fractures as compared to other types. The scores were also inferior for older patients (> 65 years old. Complications included screw perforation of head, AVN, subacromial impingement, loss of fixation, axillary nerve palsy and infection. A varus malalignment was found to be a strong predictor of loss of fixation. Conclusion Locking plate osteosynthesis leads to satisfactory functional outcomes in all the patients. Results are better than non locking plates in osteoporotic fractures of the elderly. However the surgery has steep learning curve and various complications could be associated with its use. Nevertheless we believe that a strict adherence to the principles of locking plate use can ensure good result in such challenging fractures.

Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures.

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Scheer, Johan H; Adolfsson, Lars E

2012-06-01

The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures. Twenty adult patients with an Arbeitsgemeinschaft für Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included. Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture. They were all openly explored from an ulnopalmar approach and TFCC injuries were documented. Eleven patients also underwent arthroscopy and intra-articular pathology was recorded. All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common. Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining. The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy. Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Surgical management for displaced pediatric proximal humeral fractures: a cost analysis

OpenAIRE

Shore, Benjamin J.; Hedequist, Daniel J.; Miller, Patricia E.; Waters, Peter M.; Bae, Donald S.

2015-01-01

Purpose The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). Methods: A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leav...

Coupled Modeling of Flow, Transport, and Deformation during Hydrodynamically Unstable Displacement in Fractured Rocks

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Jha, B.; Juanes, R.

2015-12-01

Coupled processes of flow, transport, and deformation are important during production of hydrocarbons from oil and gas reservoirs. Effective design and implementation of enhanced recovery techniques such as miscible gas flooding and hydraulic fracturing requires modeling and simulation of these coupled proceses in geologic porous media. We develop a computational framework to model the coupled processes of flow, transport, and deformation in heterogeneous fractured rock. We show that the hydrocarbon recovery efficiency during unstable displacement of a more viscous oil with a less viscous fluid in a fractured medium depends on the mechanical state of the medium, which evolves due to permeability alteration within and around fractures. We show that fully accounting for the coupling between the physical processes results in estimates of the recovery efficiency in agreement with observations in field and lab experiments.

Investigation into the Individualized Treatment of Traditional Chinese Medicine through a Series of N-of-1 Trials

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Yang, Peilan; Wang, Jie; Wu, Yingen; Zi, Suna; Tang, Jie; Wang, Zhenwei

2018-01-01

Purpose To compare the efficacy of individualized herbal decoction with standard decoction for patients with stable bronchiectasis through N-of-1 trials. Methods We conducted a single center N-of-1 trials in 17 patients with stable bronchiectasis. Each N-of-1 trial contains three cycles. Each cycle is divided into two 4-week intervention including individualized decoction and fixed decoction (control). The primary outcome was patient self-reported symptoms scores on a 1–7 point Likert scale. Secondary outcomes were 24-hour sputum volume and CAT scores. Results Among 14 completed trials, five showed that the individualized decoction was statistically better than the control decoction on symptom scores (P traditional Chinese medicine individual diagnosis and treatment. PMID:29552084

Brachial Plexus Injury in a 6-Year-Old Boy with 100% Displaced Proximal Humeral Metaphyseal Fracture: A Case Presentation.

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Jovanovich, Elizabeth Nora; Howard, James F

2017-12-01

Posttraumatic brachial plexopathies can occur following displaced proximal humeral fractures, causing profound functional deficits. Described here is an unusual case of a displaced proximal humeral metaphyseal fracture in a young child. The patient underwent closed reduction and serial casting, but hand weakness and forearm sensory loss persisted. Needle electromyography localized the injury to the mid/proximal arm near the fracture site, resulting in damage to the posterior and medial cords of the brachial plexus with profound involvement of the radial, ulnar, and median nerves and sparing of the axillary nerve. After months of occupational therapy, hand strength improved, with a nearly full return of function. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Surgical management for displaced pediatric proximal humeral fractures: a cost analysis.

Science.gov (United States)

Shore, Benjamin J; Hedequist, Daniel J; Miller, Patricia E; Waters, Peter M; Bae, Donald S

2015-02-01

The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leaving the pins exposed (PPE) versus leaving the pins buried (PPB). Finally, sensitivity analyses were performed, assessing the cost-effectiveness of each technique when infection rates and cost of deep infections were varied. A total of 84 patients with displaced PPHF underwent surgical stabilization. A total of 35 cases were treated with IMN, 32 with PPE, and 17 with PPB. The age, sex, and preoperative fracture angulation were similar across all groups. A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02). Surgical time and estimated blood loss was higher in the IMN group (p exposed implants approached 55 %. Leaving pins exposed after surgical fixation of PPHF is more cost-effective than either burying pins or using intramedullary fixation.

Evaluation of person-level heterogeneity of treatment effects in published multiperson N-of-1 studies: systematic review and reanalysis.

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Raman, Gowri; Balk, Ethan M; Lai, Lana; Shi, Jennifer; Chan, Jeffrey; Lutz, Jennifer S; Dubois, Robert W; Kravitz, Richard L; Kent, David M

2018-05-26

Individual patients with the same condition may respond differently to similar treatments. Our aim is to summarise the reporting of person-level heterogeneity of treatment effects (HTE) in multiperson N-of-1 studies and to examine the evidence for person-level HTE through reanalysis. Systematic review and reanalysis of multiperson N-of-1 studies. Medline, Cochrane Controlled Trials, EMBASE, Web of Science and review of references through August 2017 for N-of-1 studies published in English. N-of-1 studies of pharmacological interventions with at least two subjects. Citation screening and data extractions were performed in duplicate. We performed statistical reanalysis testing for person-level HTE on all studies presenting person-level data. We identified 62 multiperson N-of-1 studies with at least two subjects. Statistical tests examining HTE were described in only 13 (21%), of which only two (3%) tested person-level HTE. Only 25 studies (40%) provided person-level data sufficient to reanalyse person-level HTE. Reanalysis using a fixed effect linear model identified statistically significant person-level HTE in 8 of the 13 studies (62%) reporting person-level treatment effects and in 8 of the 14 studies (57%) reporting person-level outcomes. Our analysis suggests that person-level HTE is common and often substantial. Reviewed studies had incomplete information on person-level treatment effects and their variation. Improved assessment and reporting of person-level treatment effects in multiperson N-of-1 studies are needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Calculation of displacements on fractures intersecting canisters induced by earthquakes: Aberg, Beberg and Ceberg examples

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LaPointe, P.R.; Cladouhos, T. [Golder Associates Inc. (Sweden); Follin, S. [Golder Grundteknik KB (Sweden)

1999-01-01

This study shows how the method developed in La Pointe and others can be applied to assess the safety of canisters due to secondary slippage of fractures intersecting those canisters in the event of an earthquake. The method is applied to the three generic sites Aberg, Beberg and Ceberg. Estimation of secondary slippage or displacement is a four-stage process. The first stage is the analysis of lineament trace data in order to quantify the scaling properties of the fractures. This is necessary to insure that all scales of fracturing are properly represented in the numerical simulations. The second stage consists of creating stochastic discrete fracture network (DFN) models for jointing and small faulting at each of the generic sites. The third stage is to combine the stochastic DFN model with mapped lineament data at larger scales into data sets for the displacement calculations. The final stage is to carry out the displacement calculations for all of the earthquakes that might occur during the next 100,000 years. Large earthquakes are located along any lineaments in the vicinity of the site that are of sufficient size to accommodate an earthquake of the specified magnitude. These lineaments are assumed to represent vertical faults. Smaller earthquakes are located at random. The magnitude of the earthquake that any fault could generate is based upon the mapped surface trace length of the lineaments, and is calculated from regression relations. Recurrence rates for a given magnitude of earthquake are based upon published studies for Sweden. A major assumption in this study is that future earthquakes will be similar in magnitude, location and orientation as earthquakes in the geological and historical records of Sweden. Another important assumption is that the displacement calculations based upon linear elasticity and linear elastic fracture mechanics provides a conservative (over-)estimate of possible displacements. A third assumption is that the world

FRACTURES OF THE FIFTH METATARSAL RESULTS OF THE EARLY OPERATIVE TREATMENT OF ACUTE DISPLACED FRACTURES

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Slaviša Mihaljević

2004-04-01

Full Text Available Background. Fracture of the proximal 5th metatarsal bone (MTB reach almost 2% of all fractures of the foot. Conservative treatment is method of choice in almost all cases. Selected cases can benefit from acute surgery especially if the proximal fragment is severe displaced or the excessive articular step off is present.Materials and methods. In a 4 year period 14 patients were operated due to the acute fracture of proximal 5th MTB. All patients were treated in less than 2 weeks after the injury. 10 patients had base avulsion fracture in zone I and 4 had Jones fracture in zone II with dislocation of fragments? 5 mm, articular step off of 2 mm and 30% of articulation surface. We used tension bend wire in 9 cases (64%, partially threaded cancellous screw in 4 cases (28% and bone sutures in 1 case (7%. Postoperatively all patients used crutches with nonweight bearing for 4 weeks and afterwards partial weight bearing till the end of the treatment. All patients were practicing active exercises for ankle, foot and toes. The results were evaluated according to the Maryland Foot Score (MFS at least 20 months after injury.Results. 13 patients (93% were included in follow up. 12 patients were evaluated as excellent and only one as a good. All 13 patients have no or slight pain with no change in ADL or work ability. 9 patients (69% reached full functional result and 4 (31% patients had slight limitation during distance walk. Patients reached full weight bearing in average 7 weeks (5–13.Conclusions. Early operative treatment of selected cases allows fast return to preoperative activity without long term functional sequel. Both operative procedures, screw fixation and tension wire, yielded comparable and excellent end result.

The PREEMPT study - evaluating smartphone-assisted n-of-1 trials in patients with chronic pain: study protocol for a randomized controlled trial.

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Barr, Colin; Marois, Maria; Sim, Ida; Schmid, Christopher H; Wilsey, Barth; Ward, Deborah; Duan, Naihua; Hays, Ron D; Selsky, Joshua; Servadio, Joseph; Schwartz, Marc; Dsouza, Clyde; Dhammi, Navjot; Holt, Zachary; Baquero, Victor; MacDonald, Scott; Jerant, Anthony; Sprinkle, Ron; Kravitz, Richard L

2015-02-27

Chronic pain is prevalent, costly, and clinically vexatious. Clinicians typically use a trial-and-error approach to treatment selection. Repeated crossover trials in a single patient (n-of-1 trials) may provide greater therapeutic precision. N-of-1 trials are the most direct way to estimate individual treatment effects and are useful in comparing the effectiveness and toxicity of different analgesic regimens. The goal of the PREEMPT study is to test the 'Trialist' mobile health smartphone app, which has been developed to make n-of-1 trials easier to accomplish, and to provide patients and clinicians with tools for individualizing treatments for chronic pain. A randomized controlled trial is being conducted to test the feasibility and effectiveness of the Trialist app. A total of 244 participants will be randomized to either the Trialist app intervention group (122 patients) or a usual care control group (122 patients). Patients assigned to the Trialist app will work with their clinicians to set up an n-of-1 trial comparing two pain regimens, selected from a menu of flexible options. The Trialist app provides treatment reminders and collects data entered daily by the patient on pain levels and treatment side effects. Upon completion of the n-of-1 trial, patients review results with their clinicians and develop a long-term treatment plan. The primary study outcome (comparing Trialist to usual care patients) is pain-related interference with daily functioning at 26 weeks. Trialist will allow patients and clinicians to conduct personalized n-of-1 trials. In prior studies, n-of-1 trials have been shown to encourage greater patient involvement with care, which has in turn been associated with better health outcomes. mHealth technology implemented using smartphones may offer an efficient means of facilitating n-of-1 trials so that more patients can benefit from this approach. ClinicalTrials.gov: NCT02116621 , first registered 15 April 2014.

Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients

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Bhava RJ Satish

2013-01-01

Conclusion: Closed reduction and cannulated cancellous screw fixation gives satisfactory functional results in large group of elderly patients. The four quadrant parallel peripheral (FQPP screw fixation technique gives good stability, allows controlled collapse, avoids fixation failure and achieves predictable bone healing in displaced femoral neck fracture in patients ≥50 years of age.

Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children.

Science.gov (United States)

Rizk, Ahmed Shawkat

2015-06-01

Supracondylar humeral fractures are one of the most common skeletal injuries in children. In cases of displacement and instability, the standard procedure is early closed reduction and percutaneous Kirschner wire fixation. However, between 10 and 20 % of patients present late. According to the literature, patients with neglected fractures are those patients who presented for treatment after 14 days of injury. The delay is either due to lack of medical facilities or social and financial constraints. The neglected cases are often closed injuries with no vascular compromise. However, the elbow may still be tense and swollen with abrasions or crusts. In neglected cases, especially after early appearance of callus, there is no place for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with surgical approaches that disrupt the extensor mechanism with less satisfactory functional outcome due to triceps weakness and elbow stiffness. The aim of this study is to evaluate the outcome of delayed open reduction using the triceps-sparing approach and Kirschner wire fixation for treatment of neglected, displaced supracondylar and distal humeral fractures in children. This prospective study included 15 children who had neglected displaced supracondylar and distal humeral fractures. All patients were completely evaluated clinically and radiologically before intervention, after surgery and during the follow-up. The follow-up period ranged from 8 to 49 months, with a mean period of 17 months. Functional outcome was evaluated according to the Mayo Elbow Performance Index (MEPI) and Mark functional criteria. All fractures united in a mean duration of 7.2 weeks (range 5-10 weeks) with no secondary displacement or mal-union. Excellent results were found at the last follow-up in 13 of the 15 patients studied (86.66 %), while good results were found in two patients (13.33 %) according to the MEPI scale. According to the Mark

A Conservative Method for Treating Severely Displaced Pediatric Mandibular Fractures: An Effective Alternative Technique

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Sahand Samieirad

2016-06-01

Full Text Available Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral man‌dibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and morbidity associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients

High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases.

Science.gov (United States)

Regier, Marc; Petersen, Jan Philipp; Hamurcu, Ahmet; Vettorazzi, Eik; Behzadi, Cyrus; Hoffmann, Michael; Großterlinden, Lars G; Fensky, Florian; Klatte, Till Orla; Weiser, Lukas; Rueger, Johannes M; Spiro, Alexander S

2016-03-01

The incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). Because MRI may overdiagnose or overestimate the extent of OCLs in an acute trauma setting the aim of this study was to determine the incidence of OCLs after ORIF of displaced ankle fractures using MRI at medium-term follow-up, and to analyse if the severity of fracture or the clinical outcome correlates with the incidence of OCLs. Following institutional review board approval a total of 100 patients (mean age, 41.3 years; range, 17.9-64.3 years) with a displaced ankle fracture who had undergone ORIF according to the AO principles were included in this study. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used to quantify the clinical outcome and MR images were evaluated for OCLs of the talus and distal tibia after a mean of 34.5 months (range, 17.5-54.1 months). OCLs were found in 40.4% of the patients. Logistic regression revealed a significant correlation between the severity of fracture and the incidence of OCLs. Patients with a trimalleolar fracture (p=0.04) or an ankle fracture dislocation (p=0.003) had a significantly higher risk for developing an OCL compared to those with a type B fracture. Logistic regression also demonstrated a significant correlation between the clinical outcome (AOFAS score) and the incidence of OCLs (p=0.01). The risk for developing an OCL increases up to 5.6% when the AOFAS score decreases by one point. OCLs were frequently found in association with acute ankle fractures at medium-term follow-up, and the severity of fracture was associated with an increased number of OCLs. Considering the disadvantages of MRI including the high cost and limited availability, the results of this study may help to explain why anatomic surgical realignment of displaced

Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries

NARCIS (Netherlands)

Mulders, M. A. M.; van Eerten, P. V.; Goslings, J. C.; Schep, N. W. L.

2017-01-01

Background: Although secondary displacement following closed reduction and plaster immobilisation is high, several guidelines still recommend non-operative treatment for displaced distal radius fractures with an adequate closed reduction. Purpose: The purpose of this study was to evaluate functional

Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach

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S Hussain

2014-07-01

Full Text Available This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn’s criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing.

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Lee, J R; Kim, H-J; Lee, K-B

2016-04-01

The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement. The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures. We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more). The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6). Non-union develops significantly more frequently in

Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery: Importance of Gap Compared with Step Displacement.

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Verbeek, Diederik O; van der List, Jelle P; Tissue, Camden M; Helfet, David L

2018-06-06

Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following acetabular fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. Patients who had acetabular fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of step of step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual

"Me's me and you's you": Exploring patients' perspectives of single patient (n-of-1 trials in the UK

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Woolhead Gillian

2007-03-01

Full Text Available Abstract Background The n-of-1 trial offers a more methodologically sound approach to determining optimum treatment for an individual patient than "trials of therapy" routinely conducted in clinical practice. However, such methodology is rarely used in the UK. This pilot study explores the acceptability of n-of-1 trials to patients in the UK. Methods Patients with osteoarthritis of the knee were recruited to their own 12-week n-of-1 trial comparing either two knee supports or an NSAID with simple analgesic. Patients were interviewed at the start and completion of their trial to explore reasons for participation, understanding of the trial design and experiences of participation. Daily diaries were completed to inform future treatment. Results Nine patients participated (5 supports, 4 drugs. Patients were keen to participate, believing that the trial may lead to personal gains such as improved symptom control and quality of life. However, recruitment to the pharmacological comparison was more difficult since this could also entail risk. All patients were eager to complete the trial, even when difficulties were encountered. Completing the daily diary provided some patients with greater insight into their condition, which allowed them to improve their self-management. The n-of-1 trial design was viewed as a 'logical' design offering an efficient method of reaching a personalised treatment decision tailored to suit individual needs and preferences. Conclusion This pilot study suggests that patients perceive the n-of-1 trial as an acceptable approach to the individualisation of treatment. In addition, further benefits over and above any gained from the interventions can be derived from involvement in such a study.

Primary total hip replacement for displaced subcapital fractures of the femur.

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Taine, W H; Armour, P C

1985-03-01

The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.

The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures.

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Zhiyong Li

Full Text Available OBJECTIVE: This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. METHODS: From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females with a mean age of 44.8 years (range, 20-64 years. There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females with a mean age of 46.3 years (range, 23-64 years. There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. RESULTS: In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months. All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100. In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months. The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68 and 16.2% (11/68, respectively, significantly higher than those in study group (both P<0.05. The mean Harris score in control group was 83.8 (41-100, significantly lower than that in study group (P<0.05. CONCLUSION: Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.

Delayed fixation of displaced bilateral, atraumatic, femoral neck fractures in a patient with pregnancy related osteomalacia.

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Docker, Charles; Starks, Ian; Wade, Roger; Wynn-Jones, Charles

2011-06-01

We present the case of a woman diagnosed with simultaneous displaced intracapsular femoral neck fractures following the birth of her second child. No traumatic event was identified. Diagnosis was delayed as the cause of her pain was thought to be non-skeletal in origin. Radiological and serological investigations were diagnostic of osteomalacia. Surgical fixation of her fractures was further delayed due to profound hypocalcaemia. Despite the delays, fixation with bilateral dynamic hip screws resulted in union with no evidence of avascular necrosis at 2 years follow-up. We believe this to be the first report of atraumatic bilateral femoral neck fractures and it shows that a good result can be achieved even in the presence of delayed fixation.

Atrophy of the brachialis muscle after a displaced clavicle fracture in an Ironman triathlete: case report

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Knechtle Patrizia

2011-10-01

Full Text Available Abstract Clavicle fractures are frequent injuries in athletes and midshaft clavicle fractures in particular are well-known injuries in Ironman triathletes. In 2000, Auzou et al. described the mechanism leading to an isolated truncular paralysis of the musculocutaneous nerve after a shoulder trauma. It is well-known that nerve palsies can lead to an atrophy of the associated muscle if they persist for months or even longer. In this case report we describe a new case of an Ironman triathlete suffering from a persistent isolated atrophy of the brachialis muscle. The atrophy occurred following a displaced midshaft clavicle fracture acquiring while falling off his bike after hitting a duck during a competition.

Are Albumin levels a good predictor of mortality in elderly patients with neck of femur fractures?

OpenAIRE

Harrison, S.J.; Leeder, D.J.; Stephenson, John; Sidhom, S.A.

2015-01-01

Background\\ud Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (

Predictors associated with nonunion and symptomatic malunion following non-operative treatment of displaced midshaft clavicle fractures-a systematic review of the literature

DEFF Research Database (Denmark)

Jørgensen, Ann Louise; Troelsen, Anders; Ban, Ilija

2014-01-01

PURPOSE: The aim of this study was to survey existing literature in order to identify all reported predictors associated with nonunion or symptomatic malunion in adult patients with displaced midshaft clavicle fractures treated non-operatively. METHOD: A systematic literature search in Medline...... was carried out in order to identify publications in English, reporting on predictors for nonunion and malunion in adults with displaced midshaft clavicle fractures. After applying inclusion and exclusion criteria, eight publications were included in this systematic review. RESULTS: A total of 2,117 midshaft...... factors associated with nonunion were identified, six of these (displacement, comminution, shortening, age, gender and smoking) were reported as predictors for nonunion. Outcome definitions varied among the studies. CONCLUSION: The included publications varied greatly in design, sample size, and quality...

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

OpenAIRE

Samir Joshi; Rajesh Kshirsagar; Akshay Mishra; Rahul Shah

2015-01-01

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

COHORT STUDY OF DISPLACED SUPRACONDYLAR FRACTURE TREATED IN TERTIARY CARE INSTITUTE IN PONDICHERY WITH RADIOLOGICAL ASSISTANCE WITH MEDIAL ‘K’ WIRE FIRST FROM 2008-2016

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Aravindan Kalamegam

2017-10-01

Full Text Available BACKGROUND Supracondylar fracture in children when it is displaced, it is very difficult to reduce the fracture. That too after reduction, maintaining the reduction is very difficult. While reducing the fracture in closed reduction with lateral pinning first the result is not predictably good. Cross pinning will be giving mechanically stable fixation than lateral pinning alone. Lateral pinning alone imparts less rotational stability of fracture. Our aim of study is to prevent rotational instability by putting medial pinning first by avoiding the ulnar nerve injury using radiological assistance followed by lateral pinning. MATERIALS AND METHODS One hundred and six cases of displaced supracondylar fracture were included in study. The mean age of the patient was 7 yrs. (3-12 yrs., the male and female patient ratio was 72:34 and left side was involved in 63 patients whereas right side in 43 patients. The most common mode of trauma was fall from height on outstretched hand with elbow in extension. All the 106 patients were consecutively admitted. Patient had extension type of injury with 63 patients had Gartland type III fracture and 43 had Gartland type II fracture. Posteromedial displacement was noted in 63 patients whereas posterolateral displacement noted in 43 patients. In all cases, medial K wire was first inserted after closed reduction, then after stabilising the fractured rotation using image guidance. Lateral K-wire was removed on 3 weeks (21 days and follow up was done at 6 weeks and 12 weeks when they were evaluated according to Flynn’s criteria. RESULTS Results were graded according to Flynn’s criteria. CONCLUSION Medial K wire technique provides stable fixation and rotational stability has been correlated according to this technique.

Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

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Narender Kumar Magu

2014-01-01

Full Text Available Background: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term "small head or inadequate size femoral head" objectively for its prognostic significance. Materials and Methods: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. Results: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm. Proximal fragment volume of >43 cu cm was termed adequate size (type I and of ≤43 cu cm as small femoral head (type II. Fractures which united (n = 54 had a relatively large average head size (59 cu cm when compared to fractures that did not (n = 16, which had a small average head size (49 cu cm and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05. Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05. Conclusion: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures.

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Khan, S K; Karuppaiah, K; Bajwa, A S

2012-07-01

Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified 'poor consent' as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p = 0.0001). This study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using preprinted consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

Displaced humeral lateral condyle fractures in children: should we bury the pins?

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Das De, Soumen; Bae, Donald S; Waters, Peter M

2012-09-01

The purpose of this investigation was to determine if leaving Kirschner wires exposed is more cost-effective than burying them subcutaneously after open reduction and internal fixation (ORIF) of humeral lateral condyle fractures. A retrospective cohort study of all lateral condyle fractures treated over a 10-year period at a single institution was performed. Data on surgical technique, fracture healing, and complications were analyzed, as well as treatment costs. A decision analysis model was then constructed to compare the strategies of leaving the pins exposed versus buried. Finally, sensitivity analyses were performed, assessing cost-effectiveness when infection rates and costs of treating deep infections were varied. A total of 235 children with displaced fractures were treated with ORIF using Kirschner wires. Pins were left exposed in 41 cases (17.4%) and buried in 194 cases (82.6%); the age, sex, injury mechanisms, and fracture patterns were similar in both the groups. The median time to removal of implants was shorter with exposed versus buried pins (4 vs. 6 wk, Pfracture union or loss of reduction rates. The rate of superficial infection was higher with exposed pins (9.8% vs. 3.1%), but this was not statistically significant (P=0.076). There were no deep infections with exposed pins, whereas the rate of deep infection was 0.5% with buried pins (P=1.00). Buried pins were associated with additional complications, including symptomatic implants (7.2%); pins protruding through the skin (16%); internal pin migration necessitating additional surgery (1%); and skin necrosis (1%). The decision analysis revealed that leaving pins exposed resulted in an average cost savings of $3442 per patient. This strategy remained cost-effective even when infection rates with exposed pins approached 40%. Leaving the pins exposed after ORIF of lateral condyle fractures is safe and more cost-effective than burying the pins subcutaneously. Retrospective cohort study (level III).

Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation.

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Chen, Wei; Liu, Bo; Lv, Hongzhi; Su, Yanling; Chen, Xiao; Zhu, Yanbin; Du, Chenguang; Zhang, Xiaolin; Zhang, Yingze

2017-09-01

Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis. From December 2012 to September 2013, patients with unilateral DIACFs were enrolled and received a treatment consisting of percutaneous leverage and minimally invasive fixation. After surgery, patients in the study group started exercising on days two to three, using partial weight bearing starting week three, and full weight bearing starting week 12. Patients in the control group followed a conventional post-operative protocol of partial weight bearing after week six and full weight bearing after the bone healed. Computed tomography (CT) scanning was performed at post-operative day one, week four, week eight, and week 12 to reconstruct coronal, sagittal, and axial images, on which the maximal residual displacements of the fractures were measured. Function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th post-operative month. Twenty-eight patients in the study group and 32 in the control group were followed up for more than 12 months; their data were collected and used for the final analysis. Repeated-measures analysis of variance (ANOVA) of the maximal residual displacements of the fracture measured on CT images revealed significant differences between the study and the control groups. There were interaction effects between group and time point. Except for the first time point, the differences between the groups at all studied time points were significant. In the study group, the differences between all studied time points were significant. Strong correlations were observed between

Deep tissue imaging of microfracture and non-displaced fracture of bone using the second and third near-infrared therapeutic windows

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

2014-03-01

Near-infrared (NIR) light in the wavelengths of 700 nm to 2,000 nm has three NIR optical, or therapeutic, windows, which allow for deeper depth penetration in scattering tissue media. Microfractures secondary to repetitive stress, particularly in the lower extremities, are an important problem for military recruits and athletes. They also frequently occur in the elderly, or in patients taking bisphosphonates or denosumab. Microfractures can be early predictors of a major bone fracture. Using the second and third NIR therapeutic windows, we investigated the results from images of chicken bone and human tibial bone with microfractures and non-displaced fractures with and without overlying tissues of various thicknesses. Images of bone with microfractures and non-displaced fractures with tissue show scattering photons in the third NIR window with wavelengths between 1,650 nm and 1,870 nm are diminished and absorption is increased slightly from and second NIR windows. Results from images of fractured bones show the attenuation length of light through tissue in the third optical window to be larger than in the second therapeutic window. Use of these windows may aid in the detection of bone microfractures, and thus reduce the incidence of major bone fracture in susceptible groups.

Treatment of intraarticular displaced fractures of the calcaneus bone using nail blocked calcanail

OpenAIRE

Weiss, Marcin; Dolata, Tomasz; Weiss, Waldemar; Maksymiak, Martyna; Kałużny, Krystian; Kałużna, Anna; Zukow, Walery; Hagner‑Derengowska, Magdalena

2018-01-01

Weiss Marcin, Dolata Tomasz, Weiss Waldemar, Maksymiak Martyna, Kałużny Krystian, Kałużna Anna, Zukow Walery, Hagner‑Derengowska Magdalena. Treatment of intraarticular displaced fractures of the calcaneus bone using nail blocked calcanail. Journal of Education, Health and Sport. 2018;8(4):338-345. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1226782 http://ojs.ukw.edu.pl/index.php/johs/article/view/5439 https://pbn.nauka.gov.pl/sedno-webapp/works/863609 ...

Treatment of Displaced Sacroiliac Fracture Using the Lateral Window for Short Plate Buttress Reduction and Percutaneous Sacroiliac Screw Fixation.

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Colin Murphy

2016-04-01

Full Text Available Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.

Relationships between fractures

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Peacock, D. C. P.; Sanderson, D. J.; Rotevatn, A.

2018-01-01

Fracture systems comprise many fractures that may be grouped into sets based on their orientation, type and relative age. The fractures are often arranged in a network that involves fracture branches that interact with one another. Interacting fractures are termed geometrically coupled when they share an intersection line and/or kinematically coupled when the displacements, stresses and strains of one fracture influences those of the other. Fracture interactions are characterised in terms of the following. 1) Fracture type: for example, whether they have opening (e.g., joints, veins, dykes), closing (stylolites, compaction bands), shearing (e.g., faults, deformation bands) or mixed-mode displacements. 2) Geometry (e.g., relative orientations) and topology (the arrangement of the fractures, including their connectivity). 3) Chronology: the relative ages of the fractures. 4) Kinematics: the displacement distributions of the interacting fractures. It is also suggested that interaction can be characterised in terms of mechanics, e.g., the effects of the interaction on the stress field. It is insufficient to describe only the components of a fracture network, with fuller understanding coming from determining the interactions between the different components of the network.

Study of the X-Ray Diagnosis of Unstable Pelvic Fracture Displacements in Three-Dimensional Space and its Application in Closed Reduction.

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Shi, Chengdi; Cai, Leyi; Hu, Wei; Sun, Junying

2017-09-19

ABSTRACTS Objective: To study the method of X-ray diagnosis of unstable pelvic fractures displaced in three-dimensional (3D) space and its clinical application in closed reduction. Five models of hemipelvic displacement were made in an adult pelvic specimen. Anteroposterior radiographs of the pelvis were analyzed in PACS. The method of X-ray diagnosis was applied in closed reductions. From February 2012 to June 2016, 23 patients (15 men, 8 women; mean age, 43.4 years) with unstable pelvic fractures were included. All patients were treated by closed reduction and percutaneous cannulate screw fixation of the pelvic ring. According to Tile's classification, the patients were classified into type B1 in 7 cases, B2 in 3, B3 in 3, C1 in 5, C2 in 3, and C3 in 2. The operation time and intraoperative blood loss were recorded. Postoperative images were evaluated by Matta radiographic standards. Five models of displacement were made successfully. The X-ray features of the models were analyzed. For clinical patients, the average operation time was 44.8 min (range, 20-90 min) and the average intraoperative blood loss was 35.7 (range, 20-100) mL. According to the Matta standards, 7 cases were excellent, 12 cases were good, and 4 were fair. The displacements in 3D space of unstable pelvic fractures can be diagnosed rapidly by X-ray analysis to guide closed reduction, with a satisfactory clinical outcome.

Testing self-regulation interventions to increase walking using factorial randomized N-of-1 trials.

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Sniehotta, Falko F; Presseau, Justin; Hobbs, Nicola; Araújo-Soares, Vera

2012-11-01

To investigate the suitability of N-of-1 randomized controlled trials (RCTs) as a means of testing the effectiveness of behavior change techniques based on self-regulation theory (goal setting and self-monitoring) for promoting walking in healthy adult volunteers. A series of N-of-1 RCTs in 10 normal and overweight adults ages 19-67 (M = 36.9 years). We randomly allocated 60 days within each individual to text message-prompted daily goal-setting and/or self-monitoring interventions in accordance with a 2 (step-count goal prompt vs. alternative goal prompt) × 2 (self-monitoring: open vs. blinded Omron-HJ-113-E pedometer) factorial design. Aggregated data were analyzed using random intercept multilevel models. Single cases were analyzed individually. The primary outcome was daily pedometer step counts over 60 days. Single-case analyses showed that 4 participants significantly increased walking: 2 on self-monitoring days and 2 on goal-setting days, compared with control days. Six participants did not benefit from the interventions. In aggregated analyses, mean step counts were higher on goal-setting days (8,499.9 vs. 7,956.3) and on self-monitoring days (8,630.3 vs. 7,825.9). Multilevel analyses showed a significant effect of the self-monitoring condition (p = .01), the goal-setting condition approached significance (p = .08), and there was a small linear increase in walking over time (p = .03). N-of-1 randomized trials are a suitable means to test behavioral interventions in individual participants.

An Overview of Scientific and Space Weather Results from the Communication/Navigation Outage Forecasting System (C/NOFS) Mission

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Pfaff, R.; de la Beaujardiere, O.; Hunton, D.; Heelis, R.; Earle, G.; Strauss, P.; Bernhardt, P.

2012-01-01

The Communication/Navigation Outage Forecasting System (C/NOFS) Mission of the Air Force Research Laboratory is described. C/NOFS science objectives may be organized into three categories: (1) to understand physical processes active in the background ionosphere and thermosphere in which plasma instabilities grow; (2) to identify mechanisms that trigger or quench the plasma irregularities responsible for signal degradation; and (3) to determine how the plasma irregularities affect the propagation of electromagnetic waves. The satellite was launched in April, 2008 into a low inclination (13 deg), elliptical (400 x 850 km) orbit. The satellite sensors measure the following parameters in situ: ambient and fluctuating electron densities, AC and DC electric and magnetic fields, ion drifts and large scale ion composition, ion and electron temperatures, and neutral winds. C/NOFS is also equipped with a GPS occultation receiver and a radio beacon. In addition to the satellite sensors, complementary ground-based measurements, theory, and advanced modeling techniques are also important parts of the mission. We report scientific and space weather highlights of the mission after nearly four years in orbit

Radiographic classification for fractures of the fifth metatarsal base

International Nuclear Information System (INIS)

Mehlhorn, Alexander T.; Zwingmann, Joern; Hirschmueller, Anja; Suedkamp, Norbert P.; Schmal, Hagen

2014-01-01

Avulsion fractures of the fifth metatarsal base (MTB5) are common fore foot injuries. Based on a radiomorphometric analysis reflecting the risk for a secondary displacement, a new classification was developed. A cohort of 95 healthy, sportive, and young patients (age ≤ 50 years) with avulsion fractures of the MTB5 was included in the study and divided into groups with non-displaced, primary-displaced, and secondary-displaced fractures. Radiomorphometric data obtained using standard oblique and dorso-plantar views were analyzed in association with secondary displacement. Based on this, a classification was developed and checked for reproducibility. Fractures with a longer distance between the lateral edge of the styloid process and the lateral fracture step-off and fractures with a more medial joint entry of the fracture line at the MTB5 are at higher risk to displace secondarily. Based on these findings, all fractures were divided into three types: type I with a fracture entry in the lateral third; type II in the middle third; and type III in the medial third of the MTB5. Additionally, the three types were subdivided into an A-type with a fracture displacement <2 mm and a B-type with a fracture displacement ≥ 2 mm. A substantial level of interobserver agreement was found in the assignment of all 95 fractures to the six fracture types (κ = 0.72). The secondary displacement of fractures was confirmed by all examiners in 100 %. Radiomorphometric data may identify fractures at risk for secondary displacement of the MTB5. Based on this, a reliable classification was developed. (orig.)

Radiographic classification for fractures of the fifth metatarsal base

Energy Technology Data Exchange (ETDEWEB)

Mehlhorn, Alexander T.; Zwingmann, Joern; Hirschmueller, Anja; Suedkamp, Norbert P.; Schmal, Hagen [University of Freiburg Medical Center, Department of Orthopaedic Surgery, Freiburg (Germany)

2014-04-15

Avulsion fractures of the fifth metatarsal base (MTB5) are common fore foot injuries. Based on a radiomorphometric analysis reflecting the risk for a secondary displacement, a new classification was developed. A cohort of 95 healthy, sportive, and young patients (age ≤ 50 years) with avulsion fractures of the MTB5 was included in the study and divided into groups with non-displaced, primary-displaced, and secondary-displaced fractures. Radiomorphometric data obtained using standard oblique and dorso-plantar views were analyzed in association with secondary displacement. Based on this, a classification was developed and checked for reproducibility. Fractures with a longer distance between the lateral edge of the styloid process and the lateral fracture step-off and fractures with a more medial joint entry of the fracture line at the MTB5 are at higher risk to displace secondarily. Based on these findings, all fractures were divided into three types: type I with a fracture entry in the lateral third; type II in the middle third; and type III in the medial third of the MTB5. Additionally, the three types were subdivided into an A-type with a fracture displacement <2 mm and a B-type with a fracture displacement ≥ 2 mm. A substantial level of interobserver agreement was found in the assignment of all 95 fractures to the six fracture types (κ = 0.72). The secondary displacement of fractures was confirmed by all examiners in 100 %. Radiomorphometric data may identify fractures at risk for secondary displacement of the MTB5. Based on this, a reliable classification was developed. (orig.)

Conservative management of displaced horizontal root fracture

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Sanjeev Kunhappan

2011-01-01

Full Text Available Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Radicular fractures in permanent teeth are uncommon, being only 0.5-7% of the cases. Horizontal root fractures are more frequently observed in the maxillary anterior region of young male patients and vary in severity from enamel fractures to avulsions. Fracture occurs often in the middle-third of the root followed by apical and coronal third. The present case report describes a clinical case of a horizontal root fracture located at the middle third of a maxillary left-central incisor treated endodontically after approximating fracture segment with the help of orthodontic appliance. After 6 months follow-up, the tooth was asymptomatic with normal periodontal health.

On the Distribution of Ion Density Depletion Along Magnetic Field Lines as Deduced Using C-NOFS

Science.gov (United States)

Dao, E.; Kelley, M. C.; Hysell, D. L.; Retterer, J. M.; Su, Y.-J.; Pfaff, Robert F.; Roddy, P. A.; Ballenthin, J. O.

2012-01-01

To investigate ion density depletion along magnetic field lines, we compare in situ-measured ion density fluctuations as seen from C/NOFS and compare them to the field-line-integrated depletion of the whole bubble as inferred from electric field measurements. Results show that, within C/NOFS' range, local measurement of the normalized density depletion, (Delta)n/n(sub 0), near the apex may be far less than at other points on the same field line. We argue that the distribution of (Delta)n/n(sub 0) is a weighted distribution concentrated at latitudes of the Appleton anomalies and becomes more heavily weighted the closer the field-aligned bubble rises to the peak of the anomalies. A three-dimensional simulation of an ionospheric bubble verifies our arguments.

Effect of osteosynthesis, primary hemiarthroplasty, and non-surgical management for displaced four-part fractures of the proximal humerus in elderly

DEFF Research Database (Denmark)

Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

2009-01-01

BACKGROUND: Fractures of the proximal humerus are common injuries and account for 4-5 percent of all fractures, second only to hip and wrist fractures. The incidence is positively correlated with age and osteoporosis, and is likely to increase. Displaced four-part fractures are among the most...... severe injuries, accounting for 2-10 percent of proximal humeral fractures. The optimal intervention is disputed. Two previous randomised trials were very small and involved a noticeable risk of bias, and systematic reviews consequently conclude that there is inadequate basis for evidence-based treatment...... ten national shoulder units within a two-year period. We plan to include 162 patients. A central randomisation unit will allocate patients. All patients will receive a standardised three-month rehabilitation program of supervised physiotherapy regardless of treatment allocation. Patients...

Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?

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Königshausen, M; Kübler, L; Godry, H; Citak, M; Schildhauer, T A; Seybold, D

2012-02-01

The surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature. Seventy-three patients with displaced proximal humeral fractures were treated surgically with the polyaxial locking Suture Plate™ (Arthrex(®)) between 03/2007 and 06/2009. Fifty-two of the patients (mean age, 69.9 ± 12.1) were included in a radiographical and clinical examination using the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). The follow-up examinations were on average 13.9 ± 4.5 months (10-27 months) after surgical treatment. The mean CS of the patients was 66.0 ± 13.7 points, the age- and gender-related CS was 90.9% ± 20.0% and the mean DASH score was 23.8 ± 19.8 points for the injured side. The patients with a nearly anatomical reduction of their fracture (n = 13) reached a significantly higher CS (75.1 ± 8.5; p = 0.004) and DASH-score (13.6 ± 11.6; p = 0.043) and none of these patients had a complication. The complications were identified in 12 (23.1%) cases, 5 of which involved loss of reduction. All of these 5 cases were lacking of initial medial column support and 4 of which were type C2.3 AO-Classification. The data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good

Identifying cost-effective treatment with raloxifene in postmenopausal women using risk algorithms for fractures and invasive breast cancer.

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Ivergård, M; Ström, O; Borgström, F; Burge, R T; Tosteson, A N A; Kanis, J

2010-11-01

The National Osteoporosis Foundation (NOF) recommends considering treatment in women with a 20% or higher 10-year probability of a major fracture. However, raloxifene reduces both the risk of vertebral fractures and invasive breast cancer so that raloxifene treatment may be clinically appropriate and cost-effective in women who do not meet a 20% threshold risk. The aim of this study was to identify cost-effective scenarios of raloxifene treatment compared to no treatment in younger postmenopausal women at increased risk of invasive breast cancer and fracture risks below 20%. A micro-simulation model populated with data specific to American Caucasian women was used to quantify the costs and benefits of 5-year raloxifene treatment. The population evaluated was selected based on 10-year major fracture probability as estimated with FRAX® being below 20% and 5-year invasive breast cancer risk as estimated with the Gail risk model ranging from 1% to 5%. The cost per QALY gained ranged from US $22,000 in women age 55 with 5% invasive breast cancer risk and 15-19.9% fracture probability, to $110,000 in women age 55 with 1% invasive breast cancer risk and 5-9.9% fracture probability. Raloxifene was progressively cost-effective with increasing fracture risk and invasive breast cancer risk for a given age cohort. At lower fracture risk in combination with lower invasive breast cancer risk or when no preventive raloxifene effect on invasive breast cancer was assumed, the cost-effectiveness of raloxifene worsened markedly and was not cost-effective given a willingness-to-pay of US $50,000. At fracture risk of 15-19.9% raloxifene was cost-effective also in women at lower invasive breast cancer risk. Raloxifene is potentially cost-effective in cohorts of young postmenopausal women, who do not meet the suggested NOF 10-year fracture risk threshold. The cost-effectiveness is contingent on their 5-year invasive breast cancer risk. The result highlights the importance of considering

A case report of a completely displaced stress fracture of the femoral shaft in a middle-aged male athlete - A precursor of things to come?

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Larsen, Peter; Elsoe, Rasmus; Rathleff, Michael S

2016-05-01

Displaced stress fractures of the femoral shaft are very uncommon. The proportion of middle-aged and older age groups participating in long-distance running, triathlon and other high intensity sports is increasing. As a consequence stress fracture of the femoral shaft may be on the rise in the future. The patient was 43 years old male caucasian triathlete. The authors met the patient after he was admitted with a displaced femoral shaft fracture. The fracture occurred during running at the national championship in ½ Ironman. The patient reported that his symptoms had gradually developed over the last month before the fracture with pain localized anterior to the thigh. The patient interpreted the symptoms as local muscle damage. A clinical examination was conducted by a physiotherapist and the symptoms were interpreted as a simple muscle injury in the quadriceps. When presented with a patient with non-traumatic, diffuse anterior thigh pain in an individual of this age, who is participating in high-level endurance running; clinicians should consider the possibility that the cause of the symptoms may be a femoral shaft stress fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

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Tiren Davut

2012-01-01

Full Text Available Abstract Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%. Nine patients (32% developed impingement symptoms and in 7 patients (25% subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14% developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11% had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.

Science.gov (United States)

Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Houwert, Roderick M

2017-01-01

Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality. A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire. A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation. Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Early Weightbearing After Operatively Treated Ankle Fractures: A Biomechanical Analysis.

Science.gov (United States)

Tan, Eric W; Sirisreetreerux, Norachart; Paez, Adrian G; Parks, Brent G; Schon, Lew C; Hasenboehler, Erik A

2016-06-01

No consensus exists regarding the timing of weightbearing after surgical fixation of unstable traumatic ankle fractures. We evaluated fracture displacement and timing of displacement with simulated early weightbearing in a cadaveric model. Twenty-four fresh-frozen lower extremities were assigned to Group 1, bimalleolar ankle fracture (n=6); Group 2, trimalleolar ankle fracture with unfixed small posterior malleolar fracture (n=9); or Group 3, trimalleolar ankle fracture with fixed large posterior malleolar fracture (n=9) and tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5 weeks of full weightbearing. Displacement was measured by differential variable reluctance transducer. The average motion at all fracture sites in all groups was significantly less than 1 mm (P fracture was 0.1±0.1 mm and 0.4±0.4 mm, respectively. Group 2 displacement of the lateral, medial, and posterior malleolar fracture was 0.6±0.4 mm, 0.5±0.4 mm, and 0.5±0.6 mm, respectively. Group 3 displacement of the lateral, medial, and posterior malleolar fracture was 0.1±0.1 mm, 0.5±0.7 mm, and 0.5±0.4 mm, respectively. The majority of displacement (64.0% to 92.3%) occurred in the first 50 000 cycles. There was no correlation between fracture displacement and bone mineral density. No significant fracture displacement, no hardware failure, and no new fractures occurred in a cadaveric model of early weightbearing in unstable ankle fracture after open reduction and internal fixation. This study supports further investigation of early weightbearing postoperative protocols after fixation of unstable ankle fractures. © The Author(s) 2016.

Finite element analysis to determine the stress distribution, displacement and safety factor on a microplate for the fractured jaw case

Science.gov (United States)

Pratama, Juan; Mahardika, Muslim

2018-03-01

Microplate is a connecting plate that can be used for jaw bone fixation. In the last two decades, microplate has been used so many times to help reconstruction of fractured jaw bone which is called mandibular bone or mandible bone. The plate is used to provide stable fixation of the fractured bone tissue during healing and reconstruction process. In this study Finite Element Analysis was used to predict the stress concentration and distribution on a microplate, displacement on the microplate and also to determine the safety factor of the microplate based on maximum allowable stress value, and finally to ascertain whether microplate is safe to use or not. The microplate was produced from punching process using titanium grade 1 (pure titanium) as material with a thickness of 500 µm. The results of the research indicated that the microplate was safe to use according to the maximum stress around the hole, displacement around the hole and also the safety factor of the microplate.

Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.

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Su, Yanling; Chen, Wei; Zhang, Tao; Wu, Xingwang; Wu, Zhanpo; Zhang, Yingze

2013-09-24

Controversy exits over the role of Böhler's angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler's angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler's angle and functional outcome. Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler's angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler's angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler's angle by ratio was calculated by dividing the difference value of Böhler's angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler's angle, difference value of Böhler's angle between bilateral calcaneus, and change in Böhler's angle by ratio each has a significant correlation with Sanders classification (rs=-0.178, P=0.003; rs=-0.174, P=0.004; rs=-0.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements

Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System.

Science.gov (United States)

Yang, Xu; Wu, Qinfen; Lai, Chin-Hui; Wang, Xin

2017-10-01

We present a modified tension band technique combined with cable cerclage using Cable Grip System for the treatment of displaced inferior patellar pole fractures and report the knee functional outcome. The patients who had had operative treatment of a displaced inferior patellar pole fracture (AO/OTA 34-A1) between December 2013 and December 2015 were studied retrospectively. Eleven consecutive patients had had open reduction and internal fixation with the modified technique using Cable Grip System, of whom, five males and six females with an average age of 60.9 years (range, 29-81 years). All fractures occurred from direct fall onto the knee. The average time from injury to surgery was 6.1days (range, 2-12days). The range of motion (ROM) was measured in degrees by goniometry at postoperative intervals of 1, 2, 4, 12, and 48 weeks; Knee function was evaluated using the Rasmussen scores at final follow-up. No patients had nonunion, loss of reduction, migration of wire, irritation from the implant and fixation breakage during the follow-up period. Recovery of ROM was achieved at 12 weeks, with the average ROM at 1 week was 72° (range, 65°-78°), 86.4° (range, 78°-92°) at 2 weeks, 115.5° (range, 103°-122°) at 4 weeks, 129.6° (range, 122°-133°) at 12 weeks, 134.5° (range, 129°-139°) at 48 weeks after the operation. Concerning the knee function outcome assessment, all patients showed excellent results at final follow-up. The average Rasmussen scores was 27.9 out of 30 (range, 27-29). The modified tension band technique combined with cable cerclage using Cable Grip System for displaced inferior patellar pole fractures can provide stable fixation with excellent results in knee function, allows for immediate mobilization and early weight-bearing, which is a simple and valuable technique in routine clinical practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

Science.gov (United States)

Christie, J; Howie, C R; Armour, P C

1988-03-01

One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures

DEFF Research Database (Denmark)

Eschen, Jacob; Kring, Søren; Brix, Michael

2012-01-01

discouraged their use. There is limited evidence for the use of modern uncemented femoral stems in the treatment of DFNF, and we wished to investigate the clinical and radiographic performance of an uncemented hydroxyapatite coated hemiarthroplasty at 2-year follow-up. Patients and methods: We included 97...... consecutive patients who had an uncemented, hydroxyapatite coated hemiarthroplasty (Corail, Depuy) inserted during a 1-year period. Due to unwillingness or cognitive impairment (n = 6) and death before follow-up (n = 44), a total of 47 patients (39 females) with a mean age of 81 years were available. Results......-up. Conclusion: The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used to treat displaced intracupsular femoral neck fractures with good clinical and radiographic outcomes at short term follow-up....

[Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture].

Science.gov (United States)

Popelka, O; Skála-Rosenbaum, J; Bartoška, R; Waldauf, P; Krbec, M; Džupa, V

2015-01-01

The aim of the study was to investigate the occurrence of avascular necrosis (AVN) of the femoral head following the osteosynthesis of intracapsular fracture of the femoral neck in relation to the time interval between injury and surgery and the type of fracture. The data of patients with intracapsular fractures of the femoral neck surgically treated in the period from 2001 to 2011 were reviewed. Of 1555 patients treated for this fracture, 125 (7%) underwent osteosynthesis. The evaluated group included 115 patients who came for examination at one-year follow-up. There were 59 (52%) women and 56 (48%) men. Dynamic hip screw (DHS) osteosynthesis with an anti-rotation screw was performed in 103 patients and lag-screw osteosynthesis involving three parallel cannulated cancellous screws was employed in 12 patients. The patients were allocated to groups according to the injury-to-surgery interval and to sub-groups on the basis of the Garden classification of femoral fracture stage. In the group of 58 patients treated within 6 h of injury, AVN developed in 10 (17%). When the type of fracture was considered, 4% of the non-displaced fractures and 30% of the displaced fractures developed AVN. The patients with Garden stage I and II (non-displaced) fractures treated within 6 h of injury had a significantly lower risk of AVN development than those with Garden stage III or IV (displaced) fractures. The group treated between 6 and 24 post-injury hours comprised 21 patients, of whom four (19%) had AVN. In non-displaced and displaced fracture sub-groups, 25% of the patients in the former and 16% in the latter had AVN. The stage of displacement had no effect on AVN development. The two groups together (patients treated by 24 h) had a significantly lower AVN incidence than the patients treated after 24 h (p = 0.0025). In this group of 36 patients, 16 had AVN (44%) and the fracture stage made no significant difference (p = 0.6985; nondisplacement sub-group, 41%; displacement sub

Fascia iliaca block, for fractured femur, in Emergency Departments

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M.A. Majeed*

2013-12-01

Discussion: We have traditionally been using opiates for severe pain but they don’t come without side effects, especially the elderly group takes most of the blow. As discussed above, NOF fracture makes a significant number of patients presenting to ED. Therefore having a non-opiates based pain relief like FIB, makes it very useful. The above papers suggest a beneficial role of ultrasound guided FIB in femoral fractures either as an alternative or adjunct to the routinely used analgesia. Evidence suggests that the placement of local anaesthetic in the wrong plane will reduce the success of any regional anaesthetic technique. The use of ultrasound guidance will permit the identification of the fascia iliaca and neurovascular bundle. It will also provide help in the needle guidance and direct observation of local anaesthetic spread in real time. Therefore the chances of effective block are extremely high when done under ultrasound guidance.

Fractures of the proximal fifth metatarsal: percutaneous bicortical fixation.

Science.gov (United States)

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

2011-06-01

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

UNISOR on-line nuclear orientation facility (UNISOR/NOF)

International Nuclear Information System (INIS)

Girit, I.C.; Alton, G.D.; Bingham, C.R.; Carter, H.K.; Simpson, M.L.; Cole, J.D.; Croft, W.L.; Hamilton, J.H.; Jones, E.F.; Gore, P.M.; Kormicki, J.; Xie, H.; Kern, B.D.; Krane, K.S.; Xu, Y.S.; Mantica, P.F. Jr.; Zimmermann, B.E.; Nettles, W.G.; Zganjar, E.F.; Kortelahti, M.O.; Newbolt, W.B.

1988-01-01

The UNISOR on-line nuclear orientation facility (UNISOR/NOF) consists of a 3 He- 4 He dilution refrigerator on line to the isotope separator. Nuclei are implanted directly into a target foil which is soldered to the bottom accessed cold finger of the refrigerator. A 1.5 T superconducting magnet polarizes the ferromagnetic target foils and determines the axis of symmetry. Up to eight gamma detectors can be positioned around the refrigerator, each 9 cm from the target. A unique feature of this system is that the k=4 term in the directional distribution function can be directly and unambigously deduced so that a single solution for the mixing ratio can be found. The first on-line experiment at this facility reported here was a study of the decay of the 191 Hg and 193 Hg isotopes. (orig.)

Teeth in the Line of Fracture: To Retain or Remove?

Science.gov (United States)

Samson, Jimson; John, Reena; Jayakumar, Shalini

2010-01-01

The purpose of this study was to analyze mandibular fracture site, relationship of the fracture line to the periodontium, vitality of teeth, displacement of the fracture segments and their implications, and determine whether to retain or remove the teeth in the fracture line. Fifty patients with 62 fractures were involved in this study. An electric pulp tester was used to measure the pulpal response. The degree of fracture displacement and the relationship of the fracture line to the periodontium were evaluated using panoramic radiographs. Fractures of the parasymphysis region constituted a majority of 60.87% in the gross displacement category. Four of 50 patients showed no response presurgically and minimal response postoperatively on pulp vitality testing. Patients with teeth in the fracture line showing no response on pulp vitality testing should be advised extraction to avoid further complications. PMID:22132255

A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report

Directory of Open Access Journals (Sweden)

Okamoto Shinichi

2010-03-01

Full Text Available Abstract This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.

MR imaging of occult fractures of the knee

International Nuclear Information System (INIS)

Mink, J.H.; Deutsch, A.L.

1988-01-01

The authors encountered 65 radiographically occult fractures that they classified into five types. Bone bruises were a result of direct trauma or were associated with ligamentous injury. They were characterized by geographic foci of decreased signal on short repetition time (TR), short echo time (TE) sequences. Stress fractures were linear or globular foci of low signal on short TR, short TE sequences. Osteochondral fractures were displaced or impacted types; the latter were often associated with an anterior cruciate ligament tear. Tibial fractures were minimally displaced, vertically oriented fractures extending into the plateaus. Femoral fractures were Y-shaped, extending across the supracondylar region

Basic principles of fracture treatment in children.

Science.gov (United States)

Ömeroğlu, Hakan

2018-04-01

This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

Effect of osteosynthesis, primary hemiarthroplasty, and non-surgical management for displaced four-part fractures of the proximal humerus in elderly: a multi-centre, randomised clinical trial

DEFF Research Database (Denmark)

Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

2009-01-01

BACKGROUND: Fractures of the proximal humerus are common injuries and account for 4-5 percent of all fractures, second only to hip and wrist fractures. The incidence is positively correlated with age and osteoporosis, and is likely to increase. Displaced four-part fractures are among the most...... severe injuries, accounting for 2-10 percent of proximal humeral fractures. The optimal intervention is disputed. Two previous randomised trials were very small and involved a noticeable risk of bias, and systematic reviews consequently conclude that there is inadequate basis for evidence-based treatment...... ten national shoulder units within a two-year period. We plan to include 162 patients. A central randomisation unit will allocate patients. All patients will receive a standardised three-month rehabilitation program of supervised physiotherapy regardless of treatment allocation. Patients...

Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

Science.gov (United States)

Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

2017-01-01

[Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, presence of lesser trochanteric displacement, discharge destination, and walking ability were investigated. The relationship between these factors and the period from surgery to discharge was analyzed with logistic regression analysis. [Results] Age and lesser trochanteric displacement were significantly higher in the over-85-day group, and walking ability before fracture and at discharge were significantly lower in the over-85-day group. Logistic regression analysis showed that lesser trochanteric displacement and age were predictors of the length from surgery to discharge. Lesser trochanteric displacement were observed in 87.5% of these. Immediate displacement after surgery occurred in 57.8% of lesser trochanteric fractures, while 26.3% displaced 1 to 3 weeks after surgery. [Conclusion] This study revealed that lesser trochanteric displacement, higher age, and lower walking ability before fracture and at discharge were associated with longer hospitalizations in patients with femoral trochanteric fractures. Lesser trochanteric displacement were observed in 87.5% of lesser trochanteric fractures. These displacements occurred within 3 weeks after surgery in 84.1% of cases. PMID:29200639

Financial aspects of arthroplasty options for intra-capsular neck of femur fractures: a cost analysis study to review the financial impacts of implementing NICE guidelines in the NHS organisations.

Science.gov (United States)

Horriat, S; Hamilton, P D; Sott, A H

2015-02-01

To review the financial aspects of implementing the latest NICE guideline for neck of femur fracture (CG124), which recommends offering Total Hip Replacement (THR) as an alternative to hemiarthroplasty (HA) for patients, who are independently mobile before injury, not cognitively impaired and well enough to tolerate the operation. Between April 2011 and April 2013 data collected from our Hip Fracture database (NHFD) showed that by following the latest NICE guideline (CG124), out of 840 patients, 176 patients (21%) should be considered for THR rather than HA. Individual procedure costs were calculated by considering cost of implants and consumables (extracted from providers' published catalogues) added to the cost of running operating theatre for each operation. We then used the national tariff for each procedure using relevant HRG codes to calculate the total cost and the income to the Trust. Our data indicated that by implementing the latest NICE guideline (CG124), 37.1% of patients with intra-capsular fracture neck of femur (IC-NOF fracture) would be eligible for THR rather than HA. Although performing cemented THR was the more expensive procedure, our calculation shows that despite increased cost of performing the operation, Trusts can increase their net income by £300-600 (depending on their market force factor) per patient using correct HRG coding and National Tariff. Utilising 2012-13 National Tariff, performing a cemented THR instead of a HA for patients with IC-NOF fracture, as recommended by the latest NICE guideline (CG124) can increase the Trust's revenue per patient in a predictable way. This practice not only results in potentially better patient outcomes but also can increase financial reward and potential for reinvestment in all hip fracture units in the UK. Copyright © 2014 Elsevier Ltd. All rights reserved.

Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

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Kang-Young Choi

2012-07-01

Full Text Available The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture.

Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

Directory of Open Access Journals (Sweden)

Kang-Young Choi

2012-07-01

Full Text Available The incidence of condylar fractures is high,but the management of fractures of the mandibularcondyle continues to be controversial. Historically, maxillomandibular fixation, externalfixation, and surgical splints with internal fixation systems were the techniques commonlyused in the treatment of the fractured mandible. Condylar fractures can be extracapsularor intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on theage of the patient, the co-existence of other mandibular or maxillary fractures, whether thecondylar fracture is unilateral or bilateral, the level and displacement of the fracture, thestate of dentition and dental occlusion, and the surgeonnds on the age of the patient, theco-existence of othefrom which it is difficult to recover aesthetically and functionally;anappropriate treatment is required to reconstruct the shape and achieve the function oftheuninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, andcomplication prevention are required. In particular, as mandibular condyle fracture may causelong-term complications such as malocclusion, particularly open bite, reduced posterior facialheight, and facial asymmetry in addition to chronic pain and mobility limitation, great cautionshould be taken. Accordingly, the authors review a general overview of condyle fracture.

Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

Science.gov (United States)

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

2012-01-01

The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture. PMID:22872830

Electric Field and Plasma Density Observations of Irregularities and Plasma Instabilities in the Low Latitude Ionosphere Gathered by the C/NOFS Satellite

Science.gov (United States)

Pfaff, Robert F.; Freudenreich, H.; Rowland, D.; Klenzing, J.; Liebrecht, C.

2012-01-01

The Vector Electric Field Investigation (VEFI) on the C/NOFS equatorial satellite provides a unique data set which includes detailed measurements of irregularities associated with the equatorial ionosphere and in particular with spread-F depletions. We present vector AC electric field observations gathered on C/NOFS that address a variety of key questions regarding how plasma irregularities, from meter to kilometer scales, are created and evolve. The talk focuses on occasions where the ionosphere F-peak has been elevated above the C/NOFS satellite perigee of 400 km as solar activity has increased. In particular, during the equinox periods of 2011, the satellite consistently journeyed below the F-peak whenever the orbit was in the region of the South Atlantic anomaly after sunset. During these passes, data from the electric field and plasma density probes on the satellite have revealed two types of instabilities which had not previously been observed in the C/NOFS data set: The first is evidence for 400-500km-scale bottomside "undulations" that appear in the density and electric field data. In one case, these large scale waves are associated with a strong shear in the zonal E x B flow, as evidenced by variations in the meridional (outward) electric fields observed above and below the F-peak. These undulations are devoid of smaller scale structures in the early evening, yet appear at later local times along the same orbit associated with fully-developed spread-F with smaller scale structures. This suggests that they may be precursor waves for spread-F, driven by a collisional shear instability, following ideas advanced previously by researchers using data from the Jicamarca radar. A second result is the appearance of km-scale irregularities that are a common feature in the electric field and plasma density data that also appear when the satellite is near or below the F-peak at night. The vector electric field instrument on C/NOFS clearly shows that the electric field

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.

Fresh fractures of the scaphoid : A rationale method of treatment

Directory of Open Access Journals (Sweden)

Chari P

2006-01-01

Full Text Available Background : Scaphoid, among all carpal bones, is very vulnerable for fracture due to its unique shape and situation with greater articular surface. All scaphoid fractures are being treated with below elbow POP thumb spica casts keeping hand in ball throwing position. A few scaphoid fractures through the waist take longer time to unite, if not end in nonunion. These fractures were found to be displaced unimpacted trans-scaphoid fractures through the waist. Method : The effect of various positions of hand, wrist and forearm over unimpacted displaced scaphoid fractures through the waist were studied on dissected hand specimens and in patients with skiagrams. It was observed that possible radial deviation of hand over neutrally held wrist and forearm would result in anatomical reduction with impaction between the fragments. Added compression effect at site of fracture, necessary for early fracture healing, is produced by passively abducting the first metacarpal bone. Results : Of 68 scaphoid fractures under study, 24 and 41 were displaced and undisplaced ones through the waist respectively. All of them united in eight to ten weeks time as any fracture, when immobilised undisturbed with anatomic reduction and added compression between the fragments except one displaced fracture which took eight more weeks of immobilization for union and revascularilization of proximal fragment. Conclusion : This study showed that all scaphoid fractures in particular those through waist when rigidly immobilized unite as any fracture in eight to ten weeks provided the proximal fragment maintains proper blood supply. Otherwise it would further eight week of immobilization for the proximal fragment to get revascularize following union.

Does femoral offset recover and affect the functional outcome of patients with displaced femoral neck fracture following hemiarthroplasty?

Science.gov (United States)

Ji, Hyung-Min; Won, Seok-Hyung; Han, Jun; Won, Ye-Yeon

2017-06-01

Restoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. One hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. The mean preoperative offset was 37.4±2.5 increased by 12.7±9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS (B=4.576; β=0.235; 95% confidence interval of B: 0.534 to 8.135). FO was not properly restored in 23

Internal Fixation of Cervical Fractures in Three Horses.

Science.gov (United States)

Rossignol, Fabrice; Brandenberger, Olivier; Mespoulhes-Rivière, Céline

2016-01-01

To describe the surgical treatment outcome of cervical fractures in 3 horses. Case report. Three client-owned horses with cervical vertebral fractures. Three horses were refered for neck stiffness, pain, and ataxia after a cervical trauma because of a fall. Radiographic examination showed an oblique displaced fracture of the caudal aspect of the body of the second cervical vertebra (C2) in horse 1, an oblique displaced fracture of the caudal aspect of C4 involving the disc between C4 and C5 in horse 2, and a displaced transverse fracture of the body of the axis (C2) extending to the lateral arches and involving the vertebral canal in horse 3. In horse 1, the fracture was reduced and stabilized using a 14-hole narrow DCP plate, applied ventrally, and fixed with cancellous screws. A cervical fusion was performed. In horses 2 and 3, fracture fixation was performed using a 5-hole narrow LCP and 5 mm locking screws. All horses showed improvement and returned to full activity. The fracture healed in all horses. Internal fixation of cervical fracture in these horses was associated with minimal complications, and was associated with healing and a highly functional outcome in all horses. The LCP was preferred and would be recommended for ventral stabilization of selected cases of vertebral fractures. © Copyright 2015 by The American College of Veterinary Surgeons.

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches.

Science.gov (United States)

Xue, Youdi; Zhang, Hui; Pei, Fuxing; Tu, Chongqi; Song, Yueming; Fang, Yue; Liu, Lei

2014-01-01

Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36. Twenty-eight patients were followed up for an average of 25 months (range 18-50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12-24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the

Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

OpenAIRE

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

2012-01-01

The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of ...

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 f...

Primary drainage in geological fractures: Effects of aperture variability and wettability

Science.gov (United States)

Yang, Z.; Méheust, Y.; Neuweiler, I.

2017-12-01

Understanding and controlling fluid-fluid displacement in porous and fractured media is a key asset for many practical applications, such as the geological storage of CO2, hydrocarbon recovery, groundwater remediation, etc. We numerically investigate fluid-fluid displacement in rough-walled fractures with a focus on the combined effect of wettability, the viscous contrast between the two fluids, and fracture surface topography on drainage patterns and interface growth. A model has been developed to simulate the dynamic displacement of one fluid by another immiscible one in a rough geological fracture; the model takes both capillary and viscous forces into account. Capillary pressures at the fluid-fluid interface are calculated based on the Young-Laplace equation using the two principal curvatures (aperture-induced curvature and in-plane curvature) [1], while viscous forces are calculated by continuously solving the fluid pressure field in the fracture. The aperture field of a fracture is represented by a spatially correlated random field, with a power spectral density of the fracture wall topographies scaling as a power law, and a cutoff wave-length above which the Fourier modes of the two walls are identical [2]. We consider flow scenarios with both rectangular and radial configurations. Results show that the model is able to produce displacement patterns of compact displacement, capillary fingering, and viscous fingering, as well as the transitions between them. Both reducing the aperture variability and increasing the contact angle (from drainage to weak imbibition) can stabilize the displacement due to the influence of the in-plane curvature, an effect analogous to that of the cooperative pore filling in porous media. These results suggest that for geometries typical of geological fractures we can extend the phase diagram in the parameter space of capillary number and mobility ratio by another dimension to take into account the combined effect of wettability

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures

DEFF Research Database (Denmark)

Bahrs, Christian; Schmal, Hagen; Lingenfelter, Erich

2008-01-01

tool. METHODS: Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability....... RESULTS: An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology. CONCLUSION: Although the MTM-classification covers...

An investigation of ionospheric upper transition height variations at low and equatorial latitudes deduced from combined COSMIC and C/NOFS measurements

Science.gov (United States)

Yang, Changjun; Zhao, Biqiang; Zhu, Jie; Yue, Xinan; Wan, Weixing

2017-10-01

In this study we propose the combination of topside in-situ ion density data from the Communication/Navigation Outage Forecast System (C/NOFS) along with the electron density profile measurement from Constellation Observing System for Meteorology, Ionosphere & Climate (COSMIC) satellites Radio Occultation (RO) for studying the spatial and temporal variations of the ionospheric upper transition height (hT) and the oxygen ion (O+) density scale height. The latitudinal, local time and seasonal distributions of upper transition height show more consistency between hT re-calculated by the profile of the O+ using an α-Chapman function with linearly variable scale height and that determined from direct in-situ ion composition measurements, than with constant scale height and only the COSMIC data. The discrepancy in the values of hT between the C/NOFS measurement and that derived by the combination of COSMIC and C/NOFS satellites observations with variable scale height turns larger as the solar activity decreases, which suggests that the photochemistry and the electrodynamics of the equatorial ionosphere during the extreme solar minimum period produce abnormal structures in the vertical plasma distribution. The diurnal variation of scale heights (Hm) exhibits a minimum after sunrise and a maximum around noon near the geomagnetic equator. Further, the values of Hm exhibit a maximum in the summer hemisphere during daytime, whereas in the winter hemisphere the maximum is during night. Those features of Hm consistently indicate the prominent role of the vertical electromagnetic (E × B) drift in the equatorial ionosphere.

Stress fractures

International Nuclear Information System (INIS)

Berquist, T.H.; Cooper, K.L.; Pritchard, D.J.

1985-01-01

The diagnosis of a stress fracture should be considered in patients presented with pain after a change in activity, especially if the activity is strenuous and the pain is in the lower extremities. Since evidence of the stress fracture may not be apparent for weeks on routine radiographs, proper use of other imaging techniques will allow an earlier diagnosis. Prompt diagnosis is especially important in the femur, where displacement may occur

Detection of neurological deficits by computed tomography in sacral fracture patients

International Nuclear Information System (INIS)

Nakai, Daisuke; Numazaki, Shin; Katsumura, Tetsu; Tamaru, Tomohiko; Sugiyama, Mitsugi; Nakamura, Jun-ichiro; Saitoh, Tomoyuki

2006-01-01

The purpose of this study is to evaluate the correlation between sacral fractures and neurological deficits as complications. From November 2002 to February 2005, 12 patients (15 fractures) were found to have sacral fractures without other spinal injuries or brain injuries and were evaluated by plain CT scans immediately after trauma. This group included 6 males and 6 females, whose age ranged from 17 to 67 years with mean of 39.9±17.4. All patients were classified according to AO (Arbeitsgemeinschaft fuer Osteosynthesefragen) classification (pelvic ring fracture) and Denis's classification. Displacements of sacral fractures were evaluated by plain CT scans for all patients. We defined displacements using the key slice in CT scans that included the first foramen in the sacrum. Five cases, including 2 with bi-lateral sacral fractures, were complicated with neurological deficits. There was one case with a neurological deficit of 7 Type B fractures (14%) and 4 cases with neurological deficits of 5 Type C fractures (80%) in the AO classification. There were 6 fractures with neurological deficits of 12 Zone II fractures (50%) and one fracture with neurological deficits of one Zone III fractures (100%) in Denis's classification. There was a significant correlation between the extent in the displacement of the sacral fractures and neurological deficits. For more than 3 mm displacements in the medial or lateral or anterior directions, neurological deficits increased significantly. In emergency medicine, it is difficult to evaluate the neurological findings of patients with impaired consciousness. Our evaluation using CT scan is valuable as a predictor of neurological deficits and for an optimal reduction in sacral fractures in patients with in impaired consciousness. (author)

Numerical Study of the Influence of Cavity on Immiscible Liquid Transport in Varied-Wettability Fractures

Directory of Open Access Journals (Sweden)

Zhi Dou

2015-01-01

Full Text Available Field evidence indicates that cavities often occur in fractured rocks, especially in a Karst region. Once the immiscible liquid flows into the cavity, the cavity has the immiscible liquid entrapped and results in a low recovery ratio. In this paper, the immiscible liquid transport in cavity-fractures was simulated by Lattice Boltzmann Method (LBM. The interfacial and surface tensions were incorporated by Multicomponent Shan-Chen (MCSC model. Three various fracture positions were generated to investigate the influence on the irreducible nonwetting phase saturation and displacement time. The influences of fracture aperture and wettability on the immiscible liquid transport were discussed and analyzed. It was found that the cavity resulted in a long displacement time. Increasing the fracture aperture with the corresponding decrease in displacement pressure led to the long displacement time. This consequently decreased the irreducible nonwetting phase saturation. The fracture positions had a significant effect on the displacement time and irreducible saturation. The distribution of the irreducible nonwetting phase was strongly dependent on wettability and fracture position. Furthermore, this study demonstrated that the LBM was very effective in simulating the immiscible two-phase flow in the cavity-fracture.

Modified tension band wiring of medial malleolar ankle fractures.

Science.gov (United States)

Georgiadis, G M; White, D B

1995-02-01

Twenty-two displaced medial malleolar ankle fractures that were treated surgically using the modified tension band method of Cleak and Dawson were retrospectively reviewed at an average follow-up of 25 months. The technique involves the use of a screw to anchor a figure-of-eight wire. There were no malreductions and all fractures healed. Problems with the technique included technical errors with hardware placement, medial ankle pain, and asymptomatic wire migration. Despite this, modified tension band wiring remains an acceptable method for fixation of selected displaced medial malleolar fractures. It is especially suited for small fracture fragments and osteoporotic bone.

Testing an integrated behavioural and biomedical model of disability in N-of-1 studies with chronic pain.

Science.gov (United States)

Quinn, Francis; Johnston, Marie; Johnston, Derek W

2013-01-01

Previous research has supported an integrated biomedical and behavioural model explaining activity limitations. However, further tests of this model are required at the within-person level, because while it proposes that the constructs are related within individuals, it has primarily been tested between individuals in large group studies. We aimed to test the integrated model at the within-person level. Six correlational N-of-1 studies in participants with arthritis, chronic pain and walking limitations were carried out. Daily measures of theoretical constructs were collected using a hand-held computer (PDA), the activity was assessed by self-report and accelerometer and the data were analysed using time-series analysis. The biomedical model was not supported as pain impairment did not predict activity, so the integrated model was supported partially. Impairment predicted intention to move around, while perceived behavioural control (PBC) and intention predicted activity. PBC did not predict activity limitation in the expected direction. The integrated model of disability was partially supported within individuals, especially the behavioural elements. However, results suggest that different elements of the model may drive activity (limitations) for different individuals. The integrated model provides a useful framework for understanding disability and suggests interventions, and the utility of N-of-1 methodology for testing theory is illustrated.

A methodology to estimate earthquake effects on fractures intersecting canister holes

Energy Technology Data Exchange (ETDEWEB)

La Pointe, P.; Wallmann, P.; Thomas, A.; Follin, S. [Golder Assocites Inc. (Sweden)

1997-03-01

A literature review and a preliminary numerical modeling study were carried out to develop and demonstrate a method for estimating displacements on fractures near to or intersecting canister emplacement holes. The method can be applied during preliminary evaluation of candidate sites prior to any detailed drilling or underground excavation, utilizing lineament maps and published regression relations between surface rupture trace length and earthquake magnitude, rupture area and displacements. The calculated displacements can be applied to lineament traces which are assumed to be faults and may be the sites for future earthquakes. Next, a discrete fracture model is created for secondary faulting and jointing in the vicinity of the repository. These secondary fractures may displace due to the earthquake on the primary faults. The three-dimensional numerical model assumes linear elasticity and linear elastic fracture mechanics which provides a conservative displacement estimate, while still preserving realistic fracture patterns. Two series of numerical studies were undertaken to demonstrate how the methodology could be implemented and how results could be applied to questions regarding site selection and performance assessment. The first series illustrates how earthquake damage to a hypothetical repository for a specified location (Aespoe) could be estimated. A second series examined the displacements induced by earthquakes varying in magnitude from 6.0 to 8.2 as a function of how close the earthquake was in relation to the repository. 143 refs, 25 figs, 7 tabs.

A methodology to estimate earthquake effects on fractures intersecting canister holes

International Nuclear Information System (INIS)

La Pointe, P.; Wallmann, P.; Thomas, A.; Follin, S.

1997-03-01

A literature review and a preliminary numerical modeling study were carried out to develop and demonstrate a method for estimating displacements on fractures near to or intersecting canister emplacement holes. The method can be applied during preliminary evaluation of candidate sites prior to any detailed drilling or underground excavation, utilizing lineament maps and published regression relations between surface rupture trace length and earthquake magnitude, rupture area and displacements. The calculated displacements can be applied to lineament traces which are assumed to be faults and may be the sites for future earthquakes. Next, a discrete fracture model is created for secondary faulting and jointing in the vicinity of the repository. These secondary fractures may displace due to the earthquake on the primary faults. The three-dimensional numerical model assumes linear elasticity and linear elastic fracture mechanics which provides a conservative displacement estimate, while still preserving realistic fracture patterns. Two series of numerical studies were undertaken to demonstrate how the methodology could be implemented and how results could be applied to questions regarding site selection and performance assessment. The first series illustrates how earthquake damage to a hypothetical repository for a specified location (Aespoe) could be estimated. A second series examined the displacements induced by earthquakes varying in magnitude from 6.0 to 8.2 as a function of how close the earthquake was in relation to the repository. 143 refs, 25 figs, 7 tabs

Earthquake damage to underground facilities and earthquake related displacement fields

International Nuclear Information System (INIS)

Pratt, H.R.; Stephenson, D.E.; Zandt, G.; Bouchon, M.; Hustrulid, W.A.

1982-01-01

The potential seismic risk for an underground facility is considered in the evaluation of its location and design. The possible damage resulting from either large-scale displacements or high accelerations should be considered in evaluating potential sites of underground facilities. Scattered through the available literature are statements to the effect that below a few hundred meters shaking and damage in mines is less than at the surface; however, data for decreased damage underground have not been completely reported or explained. In order to assess the seismic risk for an underground facility, a data base was established and analyzed to evaluate the potential for seismic disturbance. Substantial damage to underground facilities is usually the result of displacements primarily along pre-existing faults and fractures, or at the surface entrance to these facilities. Evidence of this comes from both earthquakes as a function of depth is important in the evaluation of the hazard to underground facilities. To evaluate potential displacements due to seismic effects of block motions along pre-existing or induced fractures, the displacement fields surrounding two types of faults were investigated. Analytical models were used to determine relative displacements of shafts and near-surface displacement of large rock masses. Numerical methods were used to determine the displacement fields associated with pure strike-slip and vertical normal faults. Results are presented as displacements for various fault lengths as a function of depth and distance. This provides input to determine potential displacements in terms of depth and distance for underground facilities, important for assessing potential sites and design parameters

Scaphoid Fracture

Directory of Open Access Journals (Sweden)

Esther Kim, BS

2018-04-01

Full Text Available History of present illness: A 25-year-old, right-handed male presented to the emergency department with left wrist pain after falling from a skateboard onto an outstretched hand two-weeks prior. He otherwise had no additional concerns, including no complaints of weakness or loss of sensation. On physical exam, there was tenderness to palpation within the anatomical snuff box. The neurovascular exam was intact. Plain films of the left wrist and hand were obtained. Significant findings: The anteroposterior (AP plain film of this patient demonstrates a full thickness fracture through the middle third of the scaphoid (red arrow, with some apparent displacement (yellow lines and subtle angulation of the fracture fragments (blue line. Discussion: The scaphoid bone is the most commonly fractured carpal bone accounting for 70%-80% of carpal fractures.1 Classically, it is sustained following a fall onto an outstretched hand (FOOSH. Patients should be evaluated for tenderness with palpation over the anatomical snuffbox, which has a sensitivity of 100% and specificity of 40%.2 Plain films are the initial diagnostic modality of choice and have a sensitivity of 70%, but are commonly falsely negative in the first two to six weeks of injury (false negative of 20%.3 The Mayo classification organizes scaphoid fractures as involving the proximal, mid, and distal portions of the scaphoid bone with mid-fractures being the most common.3 The proximal scaphoid is highly susceptible to vascular compromise because it depends on retrograde blood flow from the radial artery. Therefore, disruption can lead to serious sequelae including osteonecrosis, arthrosis, and functional impairment. Thus, a low threshold should be maintained for neurovascular evaluation and surgical referral. Patients with non-displaced scaphoid fractures should be placed in a thumb spica splint.3 Patients with even suspected scaphoid fractures should be placed in a thumb spica splint and re

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.

Investigation of translaminar fracture in fibrereinforced composite laminates---applicability of linear elastic fracture mechanics and cohesive-zone model

Science.gov (United States)

Hou, Fang

With the extensive application of fiber-reinforced composite laminates in industry, research on the fracture mechanisms of this type of materials have drawn more and more attentions. A variety of fracture theories and models have been developed. Among them, the linear elastic fracture mechanics (LEFM) and cohesive-zone model (CZM) are two widely-accepted fracture models, which have already shown applicability in the fracture analysis of fiber-reinforced composite laminates. However, there remain challenges which prevent further applications of the two fracture models, such as the experimental measurement of fracture resistance. This dissertation primarily focused on the study of the applicability of LEFM and CZM for the fracture analysis of translaminar fracture in fibre-reinforced composite laminates. The research for each fracture model consisted of two sections: the analytical characterization of crack-tip fields and the experimental measurement of fracture resistance parameters. In the study of LEFM, an experimental investigation based on full-field crack-tip displacement measurements was carried out as a way to characterize the subcritical and steady-state crack advances in translaminar fracture of fiber-reinforced composite laminates. Here, the fiber-reinforced composite laminates were approximated as anisotropic solids. The experimental investigation relied on the LEFM theory with a modification with respect to the material anisotropy. Firstly, the full-field crack-tip displacement fields were measured by Digital Image Correlation (DIC). Then two methods, separately based on the stress intensity approach and the energy approach, were developed to measure the crack-tip field parameters from crack-tip displacement fields. The studied crack-tip field parameters included the stress intensity factor, energy release rate and effective crack length. Moreover, the crack-growth resistance curves (R-curves) were constructed with the measured crack-tip field parameters

New C2 synchondrosal fracture classification system

Energy Technology Data Exchange (ETDEWEB)

Rusin, Jerome A.; Ruess, Lynne [Department of Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); The Ohio State University College of Medicine and Public Health, Columbus, OH (United States); Daulton, Robert S. [Department of Radiology, Nationwide Children' s Hospital, Columbus, OH (United States)

2015-06-15

Excessive cervical flexion-extension accompanying mild to severe impact injuries can lead to C2 synchondrosal fractures in young children. To characterize and classify C2 synchondrosal fracture patterns. We retrospectively reviewed imaging and medical records of children who were treated for cervical spine fractures at our institution between 1995 and 2014. We reviewed all fractures involving the five central C2 synchondroses with regard to patient demographics, mechanism of injury, fracture pattern, associated fractures and other injuries, treatment plans and outcome. Fourteen children had fractures involving the central C2 synchondroses. There were nine boys and five girls, all younger than 6 years. We found four distinct fracture patterns. Eleven complete fractures were further divided into four subtypes (a, b, c and d) based on degree of anterior displacement of the odontoid segment and presence of distraction. Nine of these 11 children had fractures through both odontoneural synchondroses and the odontocentral synchondrosis; one had fractures involving both neurocentral synchondroses and the odontoneural synchondrosis; one had fractures through bilateral odontoneural and bilateral neurocentral synchondroses. Three children had incomplete fractures, defined as a fracture through a single odontoneural synchondrosis with or without partial extension into either the odontocentral or the adjacent neurocentral synchondroses. All complete fractures were displaced or angulated. Four had associated spinal cord injury, including two contusions (subtype c fractures) and two fatal transections (subtype d fractures). Most children were treated with primary halo stabilization. Subtype c fractures required surgical fixation. We describe four patterns of central C2 synchondrosal fractures, including two unique patterns that have not been reported. We propose a classification system to distinguish these fractures and aid in treatment planning. (orig.)

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Science.gov (United States)

Grawe, Brian

2018-01-01

Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all

Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

Science.gov (United States)

Wichlas, Florian; Tsitsilonis, Serafim; Kopf, Sebastian; Krapohl, Björn Dirk; Manegold, Sebastian

2017-01-01

Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

Optimizing the productivity of acid-fracture treatments in horizontal wells

Energy Technology Data Exchange (ETDEWEB)

Allen, E.

1995-12-31

Existing prediction methods are inadequate for unstable radial displacement, with prediction errors of up to 500%. This work provides a new theoretical basis for understanding unstable displacements in both Newtonian and non-Newtonian fluids, based on a detailed analysis of the fingering morphology and a new derivation using fractional flow theory for radial flow. Design guidelines are given to assist in optimizing the design of fingered acid-fracture treatments for horizontal wells in carbonate formations. Unstable radial displacement creates power-law (fractal) displacement patterns, for a wide range of mobility ratios, and the displacement efficiency can be expressed as a function of the mobility ratio M. The finger wavelength is a function of the Peclet number and the fracture aperture, and the detailed morphology can be understood in terms of the fluid theology. The size of the fingering zone can be predicted from the mobility ratio and Peclet number. A productivity index factor PIF can be used to compare different treatment scenarios, and thus optimise the productivity of acid-fracture treatments.

Distal radius fracture arthroscopic intraarticular displacement measurement after open reduction and internal fixation from a volar approach.

Science.gov (United States)

Ono, Hiroshi; Furuta, Kazuhiko; Fujitani, Ryotaro; Katayama, Takeshi; Akahane, Manabu

2010-07-01

The purpose of this study was to assess articular surface reduction arthroscopically after volar locked-plate fixation of distal radius fractures (DRFs) via fluoroscopyguided open reduction/internal fixation. We also aimed to develop preoperative radiographic criteria to help assist in determining which DRFs may need arthroscopic evaluation. A total of 31 consecutive patients with DRF were prospectively enrolled. Posteroanterior (PA) and lateral radiographs as well as axial, coronal, and sagittal CT scans were obtained just after attempted reduction of the DRF. The widest articular displacement at the radiocarpal joint surface of the distal radius (preopD) was then measured using a digital radiography imaging system. The DRF was reduced under fluoroscopy, and a volar locked plate was applied. The degree of residual articular displacement was then measured arthroscopically, and the maximum displacement (postopD) was measured with a calibrated probe. Of the 31 patients, 7 had an arthroscopically assessed maximum postopD of > or = 2 mm after internal fixation. The correlation coefficients between each preopD and postopD of all radiographs and CTs were statistically significant. The cutoff values were 0.5 mm for PA radiographs, 2.10 mm for lateral radiographs, 2.15 mm for axial CT scans, 3.15 mm for coronal CT scans, and 1.20 mm for sagittal CT scans. All cutoff values for PA and lateral radiographs and for axial, coronal, and sagittal CT scans were unsuitable as screening criteria for arthroscopic reduction of DRF because of their low sensitivities and specificities. The cutoff value of the new preopD (the sum of the preopDs determined by lateral radiography and coronal CT scan) was 5.80 mm, and its sensitivity and specificity were 100% and 83.3%, respectively. Because a new preopD cutoff value of 5.80 mm is a good indicator for residual articular displacement after internal fixation of >2 mm, it is also a good indicator for the need for arthroscopic evaluation after

Distal radius fracture arthroscopic intraarticular displacement measurement after open reduction and internal fixation from a volar approach

International Nuclear Information System (INIS)

Ono, Hiroshi; Furuta, Kazuhiko; Fujitani, Ryotaro; Katayama, Takeshi; Akahane, Manabu

2010-01-01

The purpose of this study was to assess articular surface reduction arthroscopically after volar locked-plate fixation of distal radius fractures (DRFs) via fluoroscopy-guided open reduction/internal fixation. We also aimed to develop preoperative radiographic criteria to help assist in determining which DRFs may need arthroscopic evaluation. A total of 31 consecutive patients with DRF were prospectively enrolled. Posteroanterior (PA) and lateral radiographs as well as axial, coronal, and sagittal CT scans were obtained just after attempted reduction of the DRF. The widest articular displacement at the radiocarpal joint surface of the distal radius (preopD) was then measured using a digital radiography imaging system. The DRF was reduced under fluoroscopy, and a volar locked plate was applied. The degree of residual articular displacement was then measured arthroscopically, and the maximum displacement (postopD) was measured with a calibrated probe. Of the 31 patients, 7 had an arthroscopically assessed maximum postopD of ≥2 mm after internal fixation. The correlation coefficients between each preopD and postopD of all radiographs and CTs were statistically significant. The cutoff values were 0.5 mm for PA radiographs, 2.10 mm for lateral radiographs, 2.15 mm for axial CT scans, 3.15 mm for coronal CT scans, and 1.20 mm for sagittal CT scans. All cutoff values for PA and lateral radiographs and for axial, coronal, and sagittal CT scans were unsuitable as screening criteria for arthroscopic reduction of DRF because of their low sensitivities and specificities. The cutoff value of the new preopD (the sum of the preopDs determined by lateral radiography and coronal CT scan) was 5.80 mm, and its sensitivity and specificity were 100% and 83.3%, respectively. Because a new preopD cutoff value of 5.80 mm is a good indicator for residual articular displacement after internal fixation of >2 mm, it is also a good indicator for the need for arthroscopic evaluation after

Study on imaging analysis using three-dimensional CT system for mandibular condylar fracture. Establishing quantitative classification

International Nuclear Information System (INIS)

Kurokawa, Hideto

1997-01-01

We examined 13 patients with fractures of the condylar process (7 men, 6 women) by using 3-dimensional images. A break-down of 15 examined joints revealed 11 patients with unilateral and 2 patients with bilateral fractures of the condylar process. Eight joints of healthy control individual (2 men and 2 women) were used as controls. Fractures of the condylar process and healthy controls were compared, which comparison led to the following conclusions: Bone fragments of deviated fractures may move slightly within the joint, preferentially internally and medially; following displaced fractures, internal and downward movement of bone fragments within the joint is observed; after the occurrence of deviated dislocation fractures, bone fragments protrude from the joint and clearly move internally and inferiorly, showing a rotation of the bone fragments; after the occurrence of displaced dislocation fractures, bone fragments also protrude from the joint and clearly move anteriorly and inferiorly; sometimes an internal rotation of the bone fragments is observed; and with linear fractures there is only minimal overall increase in, and characteristic changes are not observed. Regarding diagnosis, the classical classification of fractures of the condylar process does not provide a classification for linear fractures. Thus, this type has to be newly added to the common classification: Fissure fractures (type I), Deviated fractures (type II), Displaced fractures (type III), Deviated dislocation fractures (type IV), Displaced dislocation fractures (type V), Longitudinal (type VI). (author)

[Incarcerated epitrochlear fracture with a cubital nerve injury].

Science.gov (United States)

Moril-Peñalver, L; Pellicer-Garcia, V; Gutierrez-Carbonell, P

2013-01-01

Injuries of the medial epicondyle are relatively common, mostly affecting children between 7 and 15 years. The anatomical characteristics of this apophysis can make diagnosis difficult in minimally displaced fractures. In a small percentage of cases, the fractured fragment may occupy the retroepitrochlear groove. The presence of dysesthesias in the territory of the ulnar nerve requires urgent open reduction of the incarcerated fragment. A case of a seven-year-old male patient is presented, who required surgical revision due to a displaced medial epicondyle fracture associated with ulnar nerve injury. A review of the literature is also made. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

Science.gov (United States)

Disseldorp, Dominique J. G.; Poeze, Martijn; Hannemann, Pascal F. W.; Brink, Peter R. G.

2015-01-01

Background Open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. However, bone grafts are also associated with donor site morbidity, delayed union at bone–graft interfaces, size mismatch between graft and osteotomy defect, and additional operation time. Purpose The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Methods Between January 1993 and December 2013, 132 corrective osteotomies and plate fixations without bone grafting were performed for malunited distal radius fractures. The minimum follow-up time was 12 months. Primary study outcomes were time to complete bone healing and secondary fracture displacement. Preoperative and postoperative radiographs during follow-up were compared with each other, as well as with radiographs of the uninjured side. Results All 132 osteotomies healed. In two cases (1.5%), healing took more than 4 months, but reinterventions were not necessary. No cases of secondary fracture displacement or hardware failure were observed. Significant improvements in all radiographic parameters were shown after corrective osteotomy and plate fixation. Conclusion This study shows that bone grafts are not required for bone healing and prevention of secondary fracture displacement after corrective osteotomy and plate fixation of malunited distal radius fractures. Level of evidence Therapeutic, level IV, case series with no comparison group PMID:26261748

CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

Directory of Open Access Journals (Sweden)

Walter W. Virkus

2008-12-01

Full Text Available DESCRIPTION: A user-friendly, unique resource for the treatment of fractures designed in a casual questions and answers format which provides basic knowledge, current information and evidence based expert advices enhanced by images and diagrams and supported by ref-erences.PURPOSE: Designing this book the editor has aimed to prepare not only a source of current knowledge and opin-ions by experienced authors in fracture management for decision making in daily practice but also a brief refer-ence and useful educational resource in orthopedic trauma surgery.FEATURES: Three Sections are composed of 49 sub-jects in a form of the answers of frequently asked ques-tions richly illustrated by images and diagrams and in-cluding references at the end of each subject.The Section I is “UPPER EXTREMITIES” including: Neck fracture; Humerus shaft fracture; Management of radial nerve palsy associated with humeral fracture; Clavicle fractures; Elbow fractures in children; Fasciot-omy technic of the forearm; Distal radius fracture; Indica-tions of radial head replacement, Femur and humeral shaft fractures; Treatment of posterolateral elbow dislocation; The Section II is “LOWER EXTREMITIES” including : Femur fractures; Pelvic fractures; Life threatening pelvic fractures; Decision for surgical treatment in pelvic frac-tures; Treatment of anterior fracture of femoral head and hip joint incongruity; Management of a displaced femoral neck fracture in young patient in ER; Elder patients with displaced femoral head fracture; Patella and tibial plateau fractures; Criteria for compartment syndromes in the tibia; Tricks in nailing proximal and distal tibial fractures; Surgical management of distal tibia spiral fracture in middle aged women; Pilon fracture; Management of syn-desmotic screws in adult patient; The management of minimally displaced posterior malleol in three malleolar fractures; Postoperative management of bimalleolar frac-tures; Management of minimally

Natural history of medial clavicle fractures.

Science.gov (United States)

Salipas, Andrew; Kimmel, Lara A; Edwards, Elton R; Rakhra, Sandeep; Moaveni, Afshin Kamali

2016-10-01

Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. A retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV). Sixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n=53), with a median age of 53.5 years (interquartile range (IQR) 37.5-74.5 years). The most common mechanism of injury was motor vehicle accident (n=28). The in-hospital mortality rate was 4.4%. The fracture pattern was almost equally distributed between extra articular (n=35) and intra-articular (n=33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n=31). All fractures were initially managed non-operatively, with a broad arm sling. Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome. Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1-6 years). The mean ASES

Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville City, Southern Brazil.

Science.gov (United States)

Silva, Dalisbor Marcelo Weber; Borba, Victoria Zeghbi Cochenski; Kanis, John A

2017-12-09

Clinical risk factors for fracture in Southern Brazil are similar to those used in Fracture Risk Assessment Tool (FRAX®). Age-dependent intervention thresholds had higher accuracy than a fixed cut-off point. Access to bone mineral density testing is wanted for a large part of the Brazilian population. The FRAX® has an option to calculate the risk of fracture without this costly evaluation but relies on the clinical risk factors (CRFs) identified in the source cohorts used to generate FRAX. The aims of this study were to determine whether the CRFs used in FRAX are also risk indicators for individuals in Southern Brazil and to evaluate possible intervention thresholds for treatment in Brazil. We determined the CRFs for hip fractures in women and men aged 50 years and more with a hip fracture and controls in Joinville, Southern Brazil (April 1, 2010, and March 31, 2012). For intervention thresholds, we determined the accuracy of using the fixed thresholds of National Osteoporosis Foundation (NOF), USA, compared with the age-dependent thresholds of the National Osteoporosis Guideline Group (NOGG), UK. CRFs that were significant for hip fracture were very similar to FRAX, apart from chronic obstructive pulmonary disease and malabsorptive intestinal disease. FRAX based on the NOGG and NOF models had an accuracy of 64.2 and 58.7%, respectively. CRFs used in FRAX® were similar to those in the Southern Brazil. The NOGG model seems to be more accurate to discriminate patients with increased fracture risk in this population compared to the NOF model, but not significantly.

Single specimen fracture toughness determination procedure using instrumented impact test

International Nuclear Information System (INIS)

Rintamaa, R.

1993-04-01

In the study a new single specimen test method and testing facility for evaluating dynamic fracture toughness has been developed. The method is based on the application of a new pendulum type instrumented impact tester equipped with and optical crack mouth opening displacement (COD) extensometer. The fracture toughness measurement technique uses the Double Displacement Ratio (DDR) method, which is based on the assumption that the specimen is deformed as two rigid arms that rotate around an apparent centre of rotation. This apparent moves as the crack grows, and the ratio of COD versus specimen displacement changes. As a consequence the onset ductile crack initiation can be detected on the load-displacement curve. Thus, an energy-based fracture toughness can be calculated. In addition the testing apparatus can use specimens with the Double ligament size as compared with the standard Charpy specimen which makes the impact testing more appropriate from the fracture mechanics point of view. The novel features of the testing facility and the feasibility of the new DDR method has been verified by performing an extensive experimental and analytical study. (99 refs., 91 figs., 27 tabs.)

Loading rate effect on the fracture behaviour of highstrength concrete

Directory of Open Access Journals (Sweden)

Del Viso J.

2010-06-01

Full Text Available This research deals with the sensitivity of eight types of performancedesigned high-strength concrete to the loading rate. Variations in the composition of the concrete produce the desired performance, for instance having null shrinkage or being able to be pumped at elevated heights without segregation, but they also produce variations in the fracture properties that are reported in this paper. We performed tests at five loading rates spanning six orders of magnitude in the displacement rate, from 1.74 × 10-5 mm/s to 17.4 mm/s. Load-displacement curves show that their peak is higher as the displacement rate increases, whereas the corresponding displacement is almost constant. Fracture energy also increases, but only for loading rates higher than 0.01 mm/s. We use a formula based on a cohesive law with a viscous term to study the results. The correlation of the formula to the experimental results is good and it allows us to obtain the theoretical value for the fracture energy under strictly static conditions. In addition, both the fracture energy and the characteristic length of the concretes used in the study diminish as the compressive strength of their aggregates increases.

Origins of displacements caused by underground nuclear explosions

International Nuclear Information System (INIS)

Rinehart, John S.

1970-01-01

Elastic theory has been used to calculate the relative displacement that will occur between the two sides of a loose boundary when a plane wave strikes the boundary obliquely. The calculations suggest that the displacements produced along loose fractures and faults close in to the underground nuclear explosions are a direct consequence of reflection of the transient stress wave at this loose boundary. Quantitatively the results agree fairly well with the limited data that are available. (author)

Origins of displacements caused by underground nuclear explosions

Energy Technology Data Exchange (ETDEWEB)

Rinehart, John S [ESSA Research Laboratories, and Department of Mechanical Engineering, University of Colorado, Boulder, CO (United States)

1970-05-15

Elastic theory has been used to calculate the relative displacement that will occur between the two sides of a loose boundary when a plane wave strikes the boundary obliquely. The calculations suggest that the displacements produced along loose fractures and faults close in to the underground nuclear explosions are a direct consequence of reflection of the transient stress wave at this loose boundary. Quantitatively the results agree fairly well with the limited data that are available. (author)

Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

International Nuclear Information System (INIS)

Geijer, Mats; Dunker, Dennis; Collin, David; Goethlin, Jan H.

2012-01-01

Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

Energy Technology Data Exchange (ETDEWEB)

Geijer, Mats (Center for Medical Imaging and Physiology, Skaane University Hospital, Lund University, Lund (Sweden)), Email: mats@geijer.info; Dunker, Dennis; Collin, David; Goethlin, Jan H. (Department of Radiology, Sahlgrenska University Hospital, Moelndal (Sweden))

2012-03-15

Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

Oblique Axis Body Fracture: An Unstable Subtype of Anderson Type III Odontoid Fractures—Apropos of Two Cases

Directory of Open Access Journals (Sweden)

Hirokazu Takai

2016-01-01

Full Text Available Purpose. Anderson type III odontoid fractures have traditionally been considered stable and treated conservatively. However, unstable cases with unfavorable results following conservative treatment have been reported. Methods. We present the cases of two patients who sustained minimally displaced Anderson type III fractures with a characteristic fracture pattern that we refer to as “oblique type axis body fracture.” Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic “oblique 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 uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion for this injury and suggest early operative stabilization.

Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

Directory of Open Access Journals (Sweden)

Patrick R. Keller

2018-01-01

Full Text Available Posttraumatic proximal radioulnar synostosis (PPRUS is a severe complication of radial head and neck fractures known to occur after severe injury or operative fixation. Cases of PPRUS occurring after minimally displaced, nonoperatively treated radial neck injuries are, by contrast, extremely rare. Here, we present a pediatric case of PPRUS that developed after a nonoperatively treated minimally displaced radial neck fracture with concomitant olecranon fracture. While more cases are needed to establish the association between this pattern of injury and PPRUS, we recommend that when encountering patients with a minimally displaced radial neck fracture and a concomitant elbow injury, the rare possibility of developing proximal radioulnar synostosis should be considered.

Difficulties encountered in preauricular approach over retromandibular approach in condylar fracture

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Perumal Jayavelu

2016-01-01

Full Text Available Fracture of mandible can be classified according to its anatomical location, in which condylar fracture is the most common one overall and is missed on clinical examination. Due to the unique geometry of the mandible and temporomandibular joint, without treatment the fractures can result in marked pain, dysfunction, and deformity. The condylar fracture may be further classified depending on the sides involved: unilateral/bilateral, depending on the height of fracture: intracapsular (within the head of condyle, extracapsular - head and neck (high condyle fracture, and subcondylar (low condyle fracture, and depending on displacement: nondisplaced, displaced (anteromedially, medially, and lateral, and dislocated. The clinical features include swelling and tenderness over the temporomandibular joint region, restricted mouth opening, and anterior open bite. A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery at Madha Dental College and Hospital; suffered fall trauma resulting in bilateral condyle fracture, dentoalveolar fracture in mandible with restricted mouth opening, and anterior open bite.

Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures

DEFF Research Database (Denmark)

Ban, Ilija; Birkelund, Lasse; Palm, Henrik

2012-01-01

Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the under......Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply...... to the underlying bone. We evaluated the results of applied circumferential wires, concentrating mainly on complications and reoperations....

The use of nylon cable ties to repair rib fractures in neonatal foals

OpenAIRE

Downs, Chris; Rodgerson, Dwayne

2011-01-01

Commercially available nylon cable ties were used as a method of internal fixation for displaced rib fractures in 8 equine neonates. The procedure was effective, well-tolerated, rapid, and inexpensive. The use of nylon cable ties as internal fixation for displaced rib fractures in foals is an effective surgical procedure.

The Vector Electric Field Instrument on the C/NOFS Satellite

Science.gov (United States)

Pfaff, R.; Kujawski, J.; Uribe, P.; Bromund, K.; Fourre, R.; Acuna, M.; Le, G.; Farrell, W.; Holzworth, R.; McCarthy, M.;

Hydraulic properties of 3D rough-walled fractures during shearing: An experimental study

Science.gov (United States)

Yin, Qian; Ma, Guowei; Jing, Hongwen; Wang, Huidong; Su, Haijian; Wang, Yingchao; Liu, Richeng

2017-12-01

This study experimentally analyzed the influence of shear processes on nonlinear flow behavior through 3D rough-walled rock fractures. A high-precision apparatus was developed to perform stress-dependent fluid flow tests of fractured rocks. Then, water flow tests on rough-walled fractures with different mechanical displacements were conducted. At each shear level, the hydraulic pressure ranged from 0 to 0.6 MPa, and the normal load varied from 7 to 35 kN. The results show that (i) the relationship between the volumetric flow rate and hydraulic gradient of rough-walled fractures can be well fit using Forchheimer's law. Notably, both the linear and nonlinear coefficients in Forchheimer's law decrease during shearing; (ii) a sixth-order polynomial function is used to evaluate the transmissivity based on the Reynolds number of fractures during shearing. The transmissivity exhibits a decreasing trend as the Reynolds number increases and an increasing trend as the shear displacement increases; (iii) the critical hydraulic gradient, critical Reynolds number and equivalent hydraulic aperture of the rock fractures all increase as the shear displacement increases. When the shear displacement varies from 0 to 15 mm, the critical hydraulic gradient ranges from 0.3 to 2.2 for a normal load of 7 kN and increases to 1.8-8.6 for a normal load of 35 kN; and (iv) the Forchheimer law results are evaluated by plotting the normalized transmissivity of the fractures during shearing against the Reynolds number. An increase in the normal load shifts the fitted curves downward. Additionally, the Forchheimer coefficient β decreases with the shear displacement but increases with the applied normal load.

Frontal plane fractures of the accessory carpal bone and implications for the carpal sheath of the digital flexor tendons.

Science.gov (United States)

Minshall, G J; Wright, I M

2014-09-01

Accurate radiological and ultrasonographic descriptions of frontal plane fractures of the accessory carpal bone (ACB) are lacking, and implications of these fractures for the carpal sheath and its contents have not previously been reported. Aims were as follows: 1) to describe the location and radiological features of frontal plane fractures of the ACB; 2) to document communication of displaced fractures with the carpal sheath and consequent injury to the deep digital flexor tendon (DDFT); 3) to describe ultrasonographic identification of lesions; and 4) to report tenoscopic evaluation and treatment. Retrospective case series. Analysis of frontal plane fractures of the ACB referred to a single hospital between 2006 and 2012, including review of radiographic, ultrasonographic and tenoscopic images. Nine fractures were identified, of which 8 displaced fractures all communicated with the carpal sheath. Comminuted fragments and/or protruding fracture margins lacerated the lateral margin of the enclosed DDFT. This was identifiable ultrasonographically and confirmed at tenoscopy in 7 cases. Treatment in these horses consisted of removal of torn tendon tissue together with fragmentation and protuberant fracture edges, and 7 of 7 cases returned to work. One horse with a nondisplaced fracture was managed with immobilisation; the fracture healed, and the horse returned to work. One horse with a displaced fracture was retired to stud. Frontal plane fractures of the ACB occur palmar to the groove in its lateral margin for the tendon of insertion of ulnaris lateralis. Comminuted fragments can displace distally within the carpal sheath to a mid-metacarpal level or abaxially to lie extrathecally, lateral to the parent bone. Displaced fractures communicate with the carpal sheath and traumatise the DDFT. © 2013 EVJ Ltd.

Three-dimensional linear fracture mechanics analysis by a displacement-hybrid finite-element model

International Nuclear Information System (INIS)

Atluri, S.N.; Kathiresan, K.; Kobayashi, A.S.

1975-01-01

This paper deals with a finite-element procedures for the calculation of modes I, II and III stress intensity factors, which vary, along an arbitrarily curved three-dimensional crack front in a structural component. The finite-element model is based on a modified variational principle of potential energy with relaxed continuity requirements for displacements at the inter-element boundary. The variational principle is a three-field principle, with the arbitrary interior displacements for the element, interelement boundary displacements, and element boundary tractions as variables. The unknowns in the final algebraic system of equations, in the present displacement hybrid finite element model, are the nodal displacements and the three elastic stress intensity factors. Special elements, which contain proper square root and inverse square root crack front variations in displacements and stresses, respectively, are used in a fixed region near the crack front. Interelement displacement compatibility is satisfied by assuming an independent interelement boundary displacement field, and using a Lagrange multiplier technique to enforce such interelement compatibility. These Lagrangean multipliers, which are physically the boundary tractions, are assumed from an equilibrated stress field derived from three-dimensional Beltrami (or Maxwell-Morera) stress functions that are complete. However, considerable care should be exercised in the use of these stress functions such that the stresses produced by any of these stress function components are not linearly dependent

Fracture surface energy of the Punchbowl fault, San Andreas system.

Science.gov (United States)

Chester, Judith S; Chester, Frederick M; Kronenberg, Andreas K

2005-09-01

Fracture energy is a form of latent heat required to create an earthquake rupture surface and is related to parameters governing rupture propagation and processes of slip weakening. Fracture energy has been estimated from seismological and experimental rock deformation data, yet its magnitude, mechanisms of rupture surface formation and processes leading to slip weakening are not well defined. Here we quantify structural observations of the Punchbowl fault, a large-displacement exhumed fault in the San Andreas fault system, and show that the energy required to create the fracture surface area in the fault is about 300 times greater than seismological estimates would predict for a single large earthquake. If fracture energy is attributed entirely to the production of fracture surfaces, then all of the fracture surface area in the Punchbowl fault could have been produced by earthquake displacements totalling <1 km. But this would only account for a small fraction of the total energy budget, and therefore additional processes probably contributed to slip weakening during earthquake rupture.

Early age fracture properties of microstructurally-designed mortars

DEFF Research Database (Denmark)

Di Bella, Carmelo; Michel, Alexander; Stang, Henrik

2017-01-01

This paper compares the fracture properties as well as crack initiation and propagation of real and equivalent mortars. The development of the elastic modulus, tensile strength, and fracture energy at different hydration stages were determined by inverse analysis of load-displacement curves...... the two mortars. At early age, the moisture content has a considerable influence on the tensile strength and the fracture energy....

Fracture of the supraglenoid tubercle: treatment and results in five horses

International Nuclear Information System (INIS)

Pankowski, R.L.; Grant, B.D.; Sande, R.; Nickels, F.A.

1986-01-01

Five horses with fractures of the supraglenoid tubercle (tuber scapulae) were presented from 6 weeks to 1 year after injury. Clinical signs included lameness characterized by a shortened cranial phase of the stride and shoulder muscle atrophy. Radiographically, the fractures differed in the degree of cranioventral displacement of the fragment as well as the extent of joint involvement. Three horses were treated by resection of the fractured tubercle, including one using a new grid approach to the area of the fracture. Two of these horses have returned to athletic activity and one was euthanized due to postoperative infection. One horse with minimal displacement and joint involvement was treated with rest and raced successfully. One horse seen with a fracture of 1 year duration also was treated with rest and was a pasture sound broodmare

Intrathoracic fracture-dislocation of the humerus - case report and literature review

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Wilson Carlos Sola Junior

Full Text Available ABSTRACT Shoulder fracture-dislocations are uncommon. Those associated with intrathoracic dislocation are very rare conditions, resulting from high-energy trauma; usually, the affected limb is in an abduction position. In Brazil, there is only one report of a teenager with displacement of the epiphysis into the chest cavity; the present is the first adult patient report of intrathoracic dislocation of the humerus. The authors present the case of a patient female, aged 56 years, who was hit by motorcycle and thrown approximately 5 meters away. She was rescued on site with thoracic, pelvic, and right upper limb trauma. Her chest was drained due to pneumothorax and multiple fractures of ribs; she was diagnosed with fracture-dislocation in four parts, with intrathoracic dislocation of the humeral head. Displaced forearm bones fracture was also diagnosed; the olecranon, scaphoid, and ischiopubic fractures were not displaced. The patient underwent a joint procedure with a cardiothoracic surgery team to remove the humeral head through thoracotomy and chest drainage; subsequently, a partial arthroplasty of the humerus was performed, with graft from the humeral head and fixation of forearm fractures. Conservative treatment was chosen for the other fractures. After three months, all fractures were healed with gradual functional improvement. The patient remained in physiotherapy and orthopedic monitoring, having been discharged from the thoracic surgery; in a severe depressive episode, the patient committed suicide after 11 months of the trauma.

Medial epiphyseal fracture-detachment of the sternoclavicular joint with posterior displacement in a judo athlete - equivalent of posterior sternoclavicular dislocation

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Rui Pimenta

2013-04-01

Full Text Available Posterior sternoclavicular dislocation is a rare traumatic injury that presents a potential risk of injury to mediastinal structures. The diagnosis is fundamentally clinical and treatment is done on an emergency basis. The authors report the clinical case of a young judo athlete with post-traumatic medial epiphyseal fracture-detachment, with posterior displacement (lesion equivalent to posterior sternoclavicular dislocation at pediatric ages. He underwent open reduction and ligament repair by means of a mini-anchor.The radiological and clinical outcome was excellent, and the athlete returned to his sports activity without limitations. We discuss the particular features of this pathological condition, along with the different therapeutic approaches and their complications

Time dependent fracture and cohesive zones

Science.gov (United States)

Knauss, W. G.

1993-01-01

This presentation is concerned with the fracture response of materials which develop cohesive or bridging zones at crack tips. Of special interest are concerns regarding crack stability as a function of the law which governs the interrelation between the displacement(s) or strain across these zones and the corresponding holding tractions. It is found that for some materials unstable crack growth can occur, even before the crack tip has experienced a critical COD or strain across the crack, while for others a critical COD will guarantee the onset of fracture. Also shown are results for a rate dependent nonlinear material model for the region inside of a craze for exploring time dependent crack propagation of rate sensitive materials.

In Situ Observation of Hard Surrounding Rock Displacement at 2400-m-Deep Tunnels

Science.gov (United States)

Feng, Xia-Ting; Yao, Zhi-Bin; Li, Shao-Jun; Wu, Shi-Yong; Yang, Cheng-Xiang; Guo, Hao-Sen; Zhong, Shan

2018-03-01

This paper presents the results of in situ investigation of the internal displacement of hard surrounding rock masses within deep tunnels at China's Jinping Underground Laboratory Phase II. The displacement evolution of the surrounding rock during the entire excavation processes was monitored continuously using pre-installed continuous-recording multi-point extensometers. The evolution of excavation-damaged zones and fractures in rock masses were also observed using acoustic velocity testing and digital borehole cameras, respectively. The results show four kinds of displacement behaviours of the hard surrounding rock masses during the excavation process. The displacement in the inner region of the surrounding rock was found to be greater than that of the rock masses near the tunnel's side walls in some excavation stages. This leads to a multi-modal distribution characteristic of internal displacement for hard surrounding rock masses within deep tunnels. A further analysis of the evolution information on the damages and fractures inside the surrounding rock masses reveals the effects of excavation disturbances and local geological conditions. This recognition can be used as the reference for excavation and supporting design and stability evaluations of hard-rock tunnels under high-stress conditions.

Analysis of hydromechanical well tests in fractured sedimentary rock at the NAWC site, New Jersey

Science.gov (United States)

Murdoch, L.C.; Hisz, D.B.; Ebenhack, J.F.; Fowler, D.E.; Tiedeman, C.R.; Germanovich, L.N.

2009-01-01

Hydromechanical well tests involve measuring and interpreting displacements along with hydraulic heads that result when a hydraulic stress is applied to a well. The motivation behind this type of test is that the displacement measurements provide information about the constitutive properties and structure of the aquifer that go beyond what can be derived from pressure signals alone. We used a borehole extensometer to measure transient displacements with a resolution of +/- 25 nm during well tests in fractured mudstone and sandstone at the former Naval Air Warfare Center in West Trenton, New Jersey. One well showed opening displacements on the order of 300nm during slug tests with maximum head changes of 7 m. Inversion of the transient signals suggest that a conductive fracture (aperture = 380 ??m, normal stiffness = 8??10 8 Pa/m) was largely responsible for the pressure signal, but the displacement signal appears to have resulted from both the fracture and deformation of the enveloping sandstone (E = 5 GPa, permeability = 0.6 md). At another well, an anomalous but repeatable signal was characterized by closing displacements during increasing pressure. This displacement signal can be explained by a hydraulically active fracture below the extensometer that became pressurized and compressed the overly sediments. Poroelastic theoretical analyses were inverted to estimate parameters and verify interpretations. Copyright 2009 ARMA, American Rock Mechanics Association.

Evaluation of client progress in music therapy : An illustration of an N-of-1 design in individual short-term improvisational music therapy with clients with depression

NARCIS (Netherlands)

Aalbers, Sonja; Spreen, Marinus; Bosveld-van Haandel, Linda; Bogaerts, S.

2017-01-01

This article introduces music therapy clinicians to a research design that can be easily implemented in clinical practice to evaluate and monitor the impact of interventions on individual clients: the systemic N-of-1 design. In this single-case design, the client’s network, consisting of

CT findings predictive of neurological deficits in throracolumbar burst fractures

Energy Technology Data Exchange (ETDEWEB)

Moon, Tae Yong; Jeong, Hee Seok; Jeong, Yeo Jin [Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Lee, In Sook [Dept. of Radiology, Pusan National University Hospital, Busan (Korea, Republic of)

2016-09-15

To determine the computed tomography (CT) findings predictive of neurological deficits in thoracolumbar spine injuries. One hundred two patients with thoracolumbar spinal burst fractures, after excluding the patients with brain and cervical cord injuries and unconsciousness, who underwent consecutive spine 128-multidetector CT scan formed the study group. The neurological findings were clinically classified as no deficit (n = 58), complete deficit with paraplegia (n = 22), and incomplete deficit with either motor or sensory impairment (n = 22). The following four CT imaging parameters were analyzed: the level of the main burst fracture as the cord (n = 44) and the cauda equina (n = 58) levels; the extent of canal encroachment as central canal ratios (CCRs) below 0.5 (n = 43) and above 0.5 (n = 59); the degree of laminar fracture as no fracture (n = 33), linear fracture (n = 7), separated fracture (n = 27), and displaced fracture (n = 35); fractured vertebra counted as single (n = 53) and multiple (n = 49). Complete neurological deficit was associated with injuries at the cord level (p = 0.000) and displaced laminar fractures (p = 0.000); incomplete neurological deficit was associated with CCRs below 0.5 (p = 0.000) and multiple vertebral injuries (p = 0.002). CT scan can provide additional findings predictive of neurological deficits in thoracolumbar spinal burst fractures.

New capillary number definition for displacement of residual nonwetting phase in natural fractures

NARCIS (Netherlands)

Alquaimi, B.; Rossen, W.R.

2017-01-01

We propose a new capillary number for flow in fractures starting with a force balance on a trapped ganglion in a fracture. The new definition is validated with laboratory experiments using five distinctive model fractures. Capillary desaturation curves were generated experimentally using

Bilateral iatrogenic maxillary fractures after dental treatment in two aged horses

OpenAIRE

Widmer, A; Fürst, A; Bettschart-Wolfensberger, R; Makara, M; Geyer, H; Kummer, M

2010-01-01

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fr...

Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study.

Science.gov (United States)

Chen, Pengbo; Lu, Hua; Shen, Hao; Wang, Wei; Ni, Binbin; Chen, Jishizhan

2017-02-23

Lateral column tibial plateau fracture fixation with a locking screw plate has higher mechanical stability than other fixation methods. The objectives of the present study were to introduce two newly designed locking anatomic plates for lateral tibial plateau fracture and to demonstrate their characteristics of the fixation complexes under the axial loads. Three different 3D finite element models of the lateral tibial plateau fracture with the bone plates were created. Various axial forces (100, 500, 1000, and 1500 N) were applied to simulate the axial compressive load on an adult knee during daily life. The equivalent maps of displacement and stress were output, and relative displacement was calculated along the fracture lines. The displacement and stresses in the fixation complexes increased with the axial force. The equivalent displacement or stress map of each fixation under different axial forces showed similar distributing characteristics. The motion characteristics of the three models differed, and the max-shear stress of trabecula increased with the axial load. These two novel plates could fix lateral tibial plateau fractures involving anterolateral and posterolateral fragments. Motions after open reduction and stable internal fixation should be advised to decrease the risk of trabecular microfracture. The relative displacement of the posterolateral fragments is different when using anterolateral plate and posterolateral plate, which should be considered in choosing the implants for different posterolateral plateau fractures.

Stress fractures of the femora in soldiers

International Nuclear Information System (INIS)

Meurman, K.O.A.; Somer, K.; Lamminen, A.

1981-01-01

Amongst 936 stress fractures found in soldiers, there were 58 in the femora (6%); of these 31 were in the neck and 27 in the shaft. Two were bilateral, and two patients had other stress fractures. Three displacements were found in the necks. In the shaft, 20 fractures were proximal, four were in the middle third and three in the distal third. In the latter group, it is necessary to differentiate from a sarcoma. CT is a new aid in this respect. Sport in highly motivated individuals appears to contribute particularly to fractures of the shaft. The symptoms from these fractures are relatively mild. (orig.) [de

Stress fractures of the femora in soldiers

Energy Technology Data Exchange (ETDEWEB)

Meurman, K O.A.; Somer, K; Lamminen, A

1981-05-01

Amongst 936 stress fractures found in soldiers, there were 58 in the femora (6%); of these 31 were in the neck and 27 in the shaft. Two were bilateral, and two patients had other stress fractures. Three displacements were found in the necks. In the shaft, 20 fractures were proximal, four were in the middle third and three in the distal third. In the latter group, it is necessary to differentiate from a sarcoma. CT is a new aid in this respect. Sport in highly motivated individuals appears to contribute particularly to fractures of the shaft. The symptoms from these fractures are relatively mild.

Trochantric severity score a useful tool to assess outcomes after intertrochantric fractures

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Sandeep Thomas George

2017-01-01

CONCLUSION: Trochantric severity score is a useful tool to assess the outcome of management of intertrochanteric fractures. Sliding hip screw may not be an ideal implant for, trochantric fractures with inadequate lateral wall thickness (failure rate of 63%, reverse oblique type of trochanter fractures (failure rates of 50%, and displaced comminuted fractures (failure rate of 13%.

UK DRAFFT - A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

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Brown Jaclyn

2011-09-01

Full Text Available Abstract Background Fractures of the distal radius are extremely common injuries in adults. However, the optimal management remains controversial. In general, fractures of the distal radius are treated non-operatively if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic. However, if this is not possible, then operative fixation is required. There are several operative options but the two most common in the UK, are Kirschner-wire fixation (K-wires and volar plate fixation using fixed-angle screws (locking-plates. The primary aim of this trial is to determine if there is a difference in the Patient-Reported Wrist Evaluation one year following K-wire fixation versus locking-plate fixation for adult patients with a dorsally-displaced fracture of the distal radius. Methods/design All adult patients with an acute, dorsally-displaced fracture of the distal radius, requiring operative fixation are potentially eligible to take part in this study. A total of 390 consenting patients will be randomly allocated to either K-wire fixation or locking-plate fixation. The surgery will be performed in trauma units across the UK using the preferred technique of the treating surgeon. Data regarding wrist function, quality of life, complications and costs will be collected at six weeks and three, six and twelve months following the injury. The primary outcome measure will be wrist function with a parallel economic analysis. Discussion This pragmatic, multi-centre trial is due to deliver results in December 2013. Trial registration Current Controlled Trials ISRCTN31379280 UKCRN portfolio ID 8956

The Solar Neighborhood. XXXIX. Parallax Results from the CTIOPI and NOFS Programs: 50 New Members of the 25 parsec White Dwarf Sample

International Nuclear Information System (INIS)

Subasavage, John P.; Harris, Hugh C.; Dahn, Conard C.; Jao, Wei-Chun; Lépine, Sébastien; Henry, Todd J.; Ianna, Philip A.; Bergeron, P.; Dufour, P.; Dunlap, Bart H.; Barlow, Brad N.; Margheim, Steven J.

2017-01-01

We present 114 trigonometric parallaxes for 107 nearby white dwarf (WD) systems from both the Cerro Tololo Inter-American Observatory Parallax Investigation (CTIOPI) and the U. S. Naval Observatory Flagstaff Station (NOFS) parallax programs. Of these, 76 parallaxes for 69 systems were measured by the CTIOPI program and 38 parallaxes for as many systems were measured by the NOFS program. A total of 50 systems are confirmed to be within the 25-pc horizon of interest. Coupled with a spectroscopic confirmation of a common proper-motion companion to a Hipparcos star within 25 pc as well as confirmation parallax determinations for two WD systems included in the recently released Tycho Gaia Astrometric Solution catalog, we add 53 new systems to the 25-pc WD sample—a 42% increase. Our sample presented here includes four strong candidate halo systems, a new metal-rich DAZ WD, a confirmation of a recently discovered nearby short-period ( P  = 2.85 hr) double degenerate, a WD with a new astrometric perturbation (long period, unconstrained with our data), and a new triple system where the WD companion main-sequence star has an astrometric perturbation ( P  ∼ 1.6 year).

The Solar Neighborhood. XXXIX. Parallax Results from the CTIOPI and NOFS Programs: 50 New Members of the 25 parsec White Dwarf Sample

Energy Technology Data Exchange (ETDEWEB)

Subasavage, John P.; Harris, Hugh C.; Dahn, Conard C. [U.S. Naval Observatory, 10391 West Naval Observatory Road, Flagstaff, AZ 86005-8521 (United States); Jao, Wei-Chun; Lépine, Sébastien [Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302-4106 (United States); Henry, Todd J.; Ianna, Philip A. [RECONS Institute, Chambersburg, PA 17201 (United States); Bergeron, P.; Dufour, P. [Département de Physique, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, Québec H3C 3J7 (Canada); Dunlap, Bart H. [University of North Carolina at Chapel Hill, Dept. of Physics and Astronomy, Chapel Hill, NC 27599 (United States); Barlow, Brad N. [Department of Physics, High Point University, One University Parkway, High Point, NC 27268 (United States); Margheim, Steven J., E-mail: jsubasavage@nofs.navy.mil [Gemini Observatory, Southern Operations Center, Casilla 603, La Serena (Chile)

2017-07-01

We present 114 trigonometric parallaxes for 107 nearby white dwarf (WD) systems from both the Cerro Tololo Inter-American Observatory Parallax Investigation (CTIOPI) and the U. S. Naval Observatory Flagstaff Station (NOFS) parallax programs. Of these, 76 parallaxes for 69 systems were measured by the CTIOPI program and 38 parallaxes for as many systems were measured by the NOFS program. A total of 50 systems are confirmed to be within the 25-pc horizon of interest. Coupled with a spectroscopic confirmation of a common proper-motion companion to a Hipparcos star within 25 pc as well as confirmation parallax determinations for two WD systems included in the recently released Tycho Gaia Astrometric Solution catalog, we add 53 new systems to the 25-pc WD sample—a 42% increase. Our sample presented here includes four strong candidate halo systems, a new metal-rich DAZ WD, a confirmation of a recently discovered nearby short-period ( P  = 2.85 hr) double degenerate, a WD with a new astrometric perturbation (long period, unconstrained with our data), and a new triple system where the WD companion main-sequence star has an astrometric perturbation ( P  ∼ 1.6 year).

Evaluation and Management of Proximal Humerus Fractures

Directory of Open Access Journals (Sweden)

Ekaterina Khmelnitskaya

2012-01-01

Full Text Available Proximal humerus fractures are common injuries, especially among older osteoporotic women. Restoration of function requires a thorough understanding of the neurovascular, musculotendinous, and bony anatomy. This paper addresses the relevant anatomy and highlights various management options, including indication for arthroplasty. In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Of these, the proximal humerus locking plate is the most widely used. Arthroplasty is generally reserved for comminuted 4-part fractures, head-split fractures, or fractures with significant underlying arthritic changes. Reverse total shoulder arthroplasty is reserved for patients with a deficient rotator cuff, or highly comminuted tuberosities.

A position statement of the Traumatology Society of Slovenia on the treatment of fragility fractures of the pelvic ring

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Drago Brilej

2016-11-01

Full Text Available Because of the ageing crisis in western world the fragility fractures of the pelvic ring joint the big four group of typical fractures in osteoporotic elderly patients: fractures of the proximal femur, fractures of the proximal humerus, fractures of the distal radius and thoracic and lumbar low energy spinal fractures. All these fractures are the result of low energy with the typical fall of the patient from the standing height. The Slovenian recommendations include Rommens classification for non-displaced and displaced fractures of the anterial and posterial pelvic ring with the operative indications. The recommendations were launched at the Slovenian society of trauma surgeons meeting in November 7th, 2015.

Elastic plastic fracture mechanics

International Nuclear Information System (INIS)

Simpson, L.A.

1978-07-01

The application of linear elastic fracture mechanics (LEFM) to crack stability in brittle structures is now well understood and widely applied. However, in many structural materials, crack propagation is accompanied by considerable crack-tip plasticity which invalidates the use of LEFM. Thus, present day research in fracture mechanics is aimed at developing parameters for predicting crack propagation under elastic-plastic conditions. These include critical crack-opening-displacement methods, the J integral and R-curve techniques. This report provides an introduction to these concepts and gives some examples of their applications. (author)

Suture Anchor Fixation for Fifth Metatarsal Tuberosity Avulsion Fractures: A Case Series and Review of Literature.

Science.gov (United States)

Hong, Choon Chiet; Nag, Kushal; Yeow, Huifen; Lin, Adrian Zhigao; Tan, Ken Jin

2018-05-17

Fifth metatarsal tuberosity avulsion fractures are common. Despite good outcomes with nonoperative treatment, acute fractures with displacement, intra-articular involvement, comminution, or painful nonunion have been reported to benefit from early open reduction and internal fixation, especially in athletes. No consensus has been reached regarding the best surgical fixation technique. We present a case series of 4 patients with displaced fifth metatarsal tuberosity avulsion fractures and an innovative technique of fixation for the tuberosity avulsion fractures using a suture anchor. Copyright © 2018 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Characterization of the low latitude plasma density irregularities observed using C/NOFS and SCINDA data

Science.gov (United States)

Andima, Geoffrey; Amabayo, Emirant B.; Jurua, Edward; Cilliers, Pierre J.

2018-01-01

Complex electrodynamic processes over the low latitude region often result in post sunset plasma density irregularities which degrade satellite communication and navigation. In order to forecast the density irregularities, their occurrence time, duration and location need to be quantified. Data from the Communication/Navigation Outage Forecasting System (C/NOFS) satellite was used to characterize the low latitude ion density irregularities from 2011 to 2013. This was supported by ground based data from the SCIntillation Network Decision Aid (SCINDA) receivers at Makerere (Geographic coordinate 32.6°E, 0.3°N, and dip latitude -9.3°N) and Nairobi (Geographic coordinate 36.8°E, -1.3°N, and dip latitude -10.8°N). The results show that irregularities in ion density have a daily pattern with peaks from 20:00 to 24:00 Local Time (LT). Scintillation activity at L band and VHF over East Africa peaked in 2011 and 2012 from 20:00 to 24:00 LT, though in many cases scintillation at VHF persisted longer than that at L band. A longitudinal pattern in ion density irregularity occurrence was observed with peaks over 135-180°E and 270-300°E. The likelihood of ion density irregularity occurrence decreased with increasing altitude. Analysis of C/NOFS zonal ion drift velocities showed that the largest nighttime and daytime drifts were in 270-300°E and 300-330°E longitude regions respectively. Zonal irregularity drift velocities over East Africa were for the first time estimated from L-band scintillation indices. The results show that the velocity of plasma density irregularities in 2011 and 2012 varied daily, and hourly in the range of 50-150 m s-1. The zonal drift velocity estimates from the L-band scintillation indices had good positive correlation with the zonal drift velocities derived from VHF receivers by the spaced receiver technique.

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

Science.gov (United States)

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

2017-12-01

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

Minimally invasive plate osteosynthesis of humeral shaft fractures: a technique to aid fracture reduction and minimize complications.

Science.gov (United States)

Shin, Sang-Jin; Sohn, Hoon-Sang; Do, Nam-Hoon

2012-10-01

To introduce a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for acute displaced humeral shaft fractures and to evaluate the clinical and radiological outcomes. : Prospective clinical series study. University hospital. Twenty-one patients with acute displaced humeral shaft fractures were treated by MIPO with a modified fracture reduction technique. A narrow 4.5/5.0-mm locking compression plate was applied to the anterior aspect of the humerus. Fracture reduction and manipulation were performed using a plate and drill bits. The operating time, time to union, humeral alignment, and functional outcome of the shoulder and elbow joints were evaluated using the University of California Los Angeles shoulder score and Mayo elbow performance score. No patient experienced a neurological complication. Bony union was obtained in 20/21 patients at a mean 17.5 weeks postoperatively. Eighteen patients had excellent and 3 patients had good results in the University of California Los Angeles score. The average Mayo elbow performance score was 97.5. Two patients were converted to an open reduction during operation due to a failure of MIPO. There was 1 nonunion and 1 malunion in this series. Although the MIPO technique for humeral shaft fractures is technically demanding, satisfactory clinical outcomes in terms of bony union and shoulder and elbow function can be obtained using the modified fracture reduction method. Potential postoperative complications, such as malreduction and nonunion, must be considered. Appropriate surgical indications, a thorough understanding of the neurovascular anatomy and skillful surgical technique, are needed to reduce potential complications.

A ductile fracture mechanics methodology for predicting pressure vessel and piping failure

International Nuclear Information System (INIS)

Landes, J.D.; Zhou, Z.

1991-01-01

This paper reports on a ductile fracture methodology based on one used more generally for the prediction of fracture behavior that was applied to the prediction of fracture behavior in pressure vessel and piping components. The model uses the load versus displacement record from a fracture toughness test to develop inputs for predicting the behavior of the structural component. The principle of load separation is used to convert the test record into two pieces of information, calibration functions which describe the structural deformation behavior and fracture toughness which describes the response of a crack-like flaw to the loading. These calibration functions and fracture toughness values which relate to the test specimen are then transformed to those appropriate to the structure. Often in this step computation procedures could be used but are not always necessary. The calibration functions and fracture for the structure are recombined to predict a load versus displacement behavior for the structure. The input for the model was generated from tests of compact specimen geometries; this geometry is often used for fracture toughness testing. The predictions were done for five model structures

Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

International Nuclear Information System (INIS)

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

2016-01-01

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

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

Science.gov (United States)

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

2013-09-01

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

Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures.

Science.gov (United States)

Liu, W; Xiao, J; Ji, F; Xie, Y; Hao, Y

2015-04-01

The optimal treatment of midshaft clavicle fractures remains controversial. Nonunion is usually considered to be an uncommon complication following a nonoperatively treated clavicle fracture. Not every midshaft clavicular fractures shares the same risk of developing nonunion after nonoperative treatment. The present study was performed to identify the intrinsic and extrinsic independent factors that are independently predictive of nonunion in patients with midshaft clavicular fractures after nonoperative treatment. We performed a retrospective study of a series of 804 patients (391 men and 413 women with a median age of 51.3 years) with a radiographically confirmed midshaft clavicle fracture, which was treated nonoperatively. There were 96 patients who underwent nonunion. Putative intrinsic (patient-related) and extrinsic (injured-related) risk factors associated with nonunion were determined with the use of bivariate and multivariate statistical analyses. By bivariate analysis, the risk of nonunion was significantly increased by several intrinsic risk factors including age, sex, and smoking and extrinsic risk factors including displacement of the fracture and the presence of comminution (P<0.05 for all). On multivariate analysis, smoking (OR=4.16, 95% CI: 1.01-14.16), fracture displacement (OR=7.81, 95% CI: 2.27-25.38) and comminution of fracture (OR=3.86, 95% CI: 1.16-13.46) were identified as independent predictive factors. The risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures are multifactorial. Smoking, fracture displacement and comminution of fracture are independent predictors for an individual likelihood of nonunion. Further studies are still required to evaluate these factors in the future. Level III, case-control study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Anatomy of fractures of the inferior scapular angle].

Science.gov (United States)

Bartoníček, J; Tuček, M; Malík, J

2018-01-01

The aim of this study is to describe the anatomy of fractures of the inferior angle and the adjacent part of the scapular body, based on 3D CT reconstructions. In a series of 375 scapular fractures, we identified a total of 20 fractures of the inferior angle of the scapular body (13 men, 7 women), with a mean patient age of 50 years (range 3373). In all fractures, 3D CT reconstructions were obtained, allowing an objective evaluation of the fracture pattern with a focus on the size and shape of the inferior angle fragment, propagation of the fracture line to the lateral and medial borders of the infraspinous part of the scapular body, fragment displacement and any additional fracture of the ipsilateral scapula and the shoulder girdle. We identified a total of 5 types of fracture involving the distal half of the infraspinous part of the scapular body. The first type, recorded in 5 cases, affected only the apex of the inferior angle, with a small part of the adjacent medial border. The second type, occurring in 4 cases, involved fractures separating the entire inferior angle. The third type, represented by 4 cases, was characterized by a fracture line starting medially close above the inferior angle and passing proximolaterally. The separated fragment had a shape of a big drop, carrying also the distal half of the lateral pillar in addition to the inferior angle. In the fourth type identified in 5 fractures, the separated fragment was formed both by the inferior angle and a variable part of the medial border. The fifth type, being by its nature a transition to the fracture of the infraspinous part of the body, was recorded in 2 cases, with the same V-shaped fragment. Fractures of the inferior angle and the adjacent part of the scapular body are groups of fractures differing from other infraspinous fractures of the scapular body. Although these fractures are highly variable in terms of shape, they have the same course of fracture line and the manner of displacement

N-of-1-pathways MixEnrich: advancing precision medicine via single-subject analysis in discovering dynamic changes of transcriptomes.

Science.gov (United States)

Li, Qike; Schissler, A Grant; Gardeux, Vincent; Achour, Ikbel; Kenost, Colleen; Berghout, Joanne; Li, Haiquan; Zhang, Hao Helen; Lussier, Yves A

2017-05-24

Transcriptome analytic tools are commonly used across patient cohorts to develop drugs and predict clinical outcomes. However, as precision medicine pursues more accurate and individualized treatment decisions, these methods are not designed to address single-patient transcriptome analyses. We previously developed and validated the N-of-1-pathways framework using two methods, Wilcoxon and Mahalanobis Distance (MD), for personal transcriptome analysis derived from a pair of samples of a single patient. Although, both methods uncover concordantly dysregulated pathways, they are not designed to detect dysregulated pathways with up- and down-regulated genes (bidirectional dysregulation) that are ubiquitous in biological systems. We developed N-of-1-pathways MixEnrich, a mixture model followed by a gene set enrichment test, to uncover bidirectional and concordantly dysregulated pathways one patient at a time. We assess its accuracy in a comprehensive simulation study and in a RNA-Seq data analysis of head and neck squamous cell carcinomas (HNSCCs). In presence of bidirectionally dysregulated genes in the pathway or in presence of high background noise, MixEnrich substantially outperforms previous single-subject transcriptome analysis methods, both in the simulation study and the HNSCCs data analysis (ROC Curves; higher true positive rates; lower false positive rates). Bidirectional and concordant dysregulated pathways uncovered by MixEnrich in each patient largely overlapped with the quasi-gold standard compared to other single-subject and cohort-based transcriptome analyses. The greater performance of MixEnrich presents an advantage over previous methods to meet the promise of providing accurate personal transcriptome analysis to support precision medicine at point of care.

Extension type fracture of the ankylotic thoracic spine with gross displacement causing esophageal rupture

NARCIS (Netherlands)

Groen, F. R J; Delawi, D.; Kruyt, M. C.; Oner, F. C.

2016-01-01

Purpose: This study aimed at discussing the relevance of the type B3 fracture of the new AOSpine classification. Methods: Hyperextension fractures of the spine are rare in the general population, but common in the ankylotic spine. We present a case of a severe spinal fracture with concomitant

Fractures of the bilateral distal radius and scaphoid: a case report

Directory of Open Access Journals (Sweden)

Ozkan Korhan

2008-03-01

Full Text Available Abstract Introduction Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Case presentation A patient with bilateral comminuted, displaced distal fractures of the radius and bilateral fractures of the scaphoid was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating. Conclusion Rigid internal fixation of distal radius and scaphoid fractures is mandatory to start early active rehabilitation of the wrist without the need for wrist immobilization with a plaster or external skeletal fixation.

Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures.

Science.gov (United States)

Shi, Dan; Patil, Pavan Manohar; Gupta, Ritika

2015-04-01

To document facial nerve (FN) injuries after surgical treatment of mandibular condylar fractures using the retromandibular transparotid approach and to identify risk factors associated with these injuries. A retrospective study of patients surgically treated for mandibular condylar fractures using the retromandibular transparotid approach over seven years was conducted. The primary study variable was the postoperative change in FN function after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement/dislocation and number of miniplates placed at the fracture site. Appropriate statistics were computed. Ninety patients with 102 fractures were analysed. Thirty two fractures (31%) were located in the condylar neck and 70 fractures (69%) were subcondylar (located below the sigmoid notch). The condylar segment was undisplaced in twelve cases (12%), displaced medially in thirty five (34%), laterally displaced in thirty (29%) and dislocated in 25 (24.5%). In 18 fractures (18%), postoperative examination revealed various degrees of damage to the FN. All nerve injuries recovered completely in 8-24 weeks. In a multivariate model, condylar neck fractures, fracture dislocation and operator inexperience were associated with a statistically significant risk of postoperative deterioration of FN function (P ≤ 0.05). The majority of facial nerve injuries after surgical treatment of condylar fractures by the retromandibular transparotid approach are transient in nature. Condylar neck fractures, fracture dislocation and operator inexperience were associated with an increased risk for FN injury. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

DEFF Research Database (Denmark)

Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

2007-01-01

BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome....... We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw. METHODS: Two hundred and fourteen consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding...... compression hip screw with a four-hole side-plate between 2002 and 2004. The fractures were classified on preoperative radiographs according to the AO/OTA classification system. The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were...

Using Behavioral Analytics to Increase Exercise: A Randomized N-of-1 Study.

Science.gov (United States)

Yoon, Sunmoo; Schwartz, Joseph E; Burg, Matthew M; Kronish, Ian M; Alcantara, Carmela; Julian, Jacob; Parsons, Faith; Davidson, Karina W; Diaz, Keith M

2018-04-01

This intervention study used mobile technologies to investigate whether those randomized to receive a personalized "activity fingerprint" (i.e., a one-time tailored message about personal predictors of exercise developed from 6 months of observational data) increased their physical activity levels relative to those not receiving the fingerprint. A 12-month randomized intervention study. From 2014 to 2015, 79 intermittent exercisers had their daily physical activity assessed by accelerometry (Fitbit Flex) and daily stress experience, a potential predictor of exercise behavior, was assessed by smartphone. Data collected during the first 6 months of observation were used to develop a person-specific "activity fingerprint" (i.e., N-of-1) that was subsequently sent via email on a single occasion to randomized participants. Pre-post changes in the percentage of days exercised were analyzed within and between control and intervention groups. The control group significantly decreased their proportion of days exercised (10.5% decrease, purban adults. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface.

Science.gov (United States)

Peter, Robin E

2015-01-01

The number of acetabular fractures in the geriatric population requiring open reduction and internal fixation is increasing. Fractures with medial or anterior displacement are the most frequent types, and via the ilio-inguinal approach buttress plates have proved helpful to maintain the quadrilateral surface or medial acetabular wall. Seven to ten hole 3.5 mm reconstruction plates may be used as buttress plates, placed underneath the usual pelvic brim plate. This retrospective study presents our results with this technique in 13 patients at a minimum follow-up of 12 months (average, 31 months). 85% of the patients had a good result. The early onset of post-traumatic osteoarthritis necessitated total hip arthroplasty in two patients (15%) at 12 and 18 months follow-up, respectively. This treatment option should be considered in the surgeon's armamentarium when fixing these challenging cases. Copyright © 2015 Elsevier Ltd. All rights reserved.

External fixation of tibial pilon fractures and fracture healing.

Science.gov (United States)

Ristiniemi, Jukka

2007-06-01

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

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

Science.gov (United States)

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

2010-01-01

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

Classifications of Acute Scaphoid Fractures: A Systematic Literature Review.

Science.gov (United States)

Ten Berg, Paul W; Drijkoningen, Tessa; Strackee, Simon D; Buijze, Geert A

2016-05-01

Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification systems, clarifying their subgroups and analyzing their popularity by comparing citation indexes. The intention was to improve data comparison between studies using heterogeneous fracture descriptions. Methods We performed a systematic review of the literature based on a search of medical literature from 1950 to 2015, and a manual search using the reference lists in relevant book chapters. Only original descriptions of classifications of acute scaphoid fractures in adults were included. Popularity was based on citation index as reported in the databases of Web of Science (WoS) and Google Scholar. Articles that were cited <10 times in WoS were excluded. Results Our literature search resulted in 308 potentially eligible descriptive reports of which 12 reports met the inclusion criteria. We distinguished 13 different (sub) classification systems based on (1) fracture location, (2) fracture plane orientation, and (3) fracture stability/displacement. Based on citations numbers, the Herbert classification was most popular, followed by the Russe and Mayo classifications. All classification systems were based on plain radiography. Conclusions Most classification systems were based on fracture location, displacement, or stability. Based on the controversy and limited reliability of current classification systems, suggested research areas for an updated classification include three-dimensional fracture pattern etiology and fracture fragment mobility assessed by dynamic imaging.

Tracer dispersion in two-dimensional rough fractures.

Science.gov (United States)

Drazer, G; Koplik, J

2001-05-01

Tracer diffusion and hydrodynamic dispersion in two-dimensional fractures with self-affine roughness are studied by analytic and numerical methods. Numerical simulations were performed via the lattice-Boltzmann approach, using a boundary condition for tracer particles that improves the accuracy of the method. The reduction in the diffusive transport, due to the fractal geometry of the fracture surfaces, is analyzed for different fracture apertures. In the limit of small aperture fluctuations we derive the correction to the diffusive coefficient in terms of the tortuosity, which accounts for the irregular geometry of the fractures. Dispersion is studied when the two fracture surfaces are simply displaced normally to the mean fracture plane and when there is a lateral shift as well. Numerical results are analyzed using the Lambda parameter, related to convective transport within the fracture, and simple arguments based on lubrication approximation. At very low Péclet number, in the case where fracture surfaces are laterally shifted, we show using several different methods that convective transport reduces dispersion.

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

Science.gov (United States)

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

2011-03-01

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

An unusual fracture of the talus in a snowboarder.

Science.gov (United States)

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

2005-08-01

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

Bilateral radial neck fractures – A Case Report

Directory of Open Access Journals (Sweden)

ABY Ng

2007-11-01

Full Text Available Radial head and neck fractures are the most frequently seen elbow fractures. The usual cause of this injury is a fall onto an outstretched hand with a partly flexed elbow. We report here an unusual case of bilateral non-displaced radial neck fractures in a patient who presented with complaints of pain in both elbows following a simple fall. This case highlights the need for a high index of suspicion in the diagnosis of multiple injuries, no matter how `trivial` the mechanism of injury.

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...... for this injury and suggest early operative stabilization....

Transmasseteric anterior parotid approach for condylar fractures: experience of 129 cases.

Science.gov (United States)

Narayanan, Vinod; Ramadorai, Ashok; Ravi, Poornima; Nirvikalpa, Natarajan

2012-07-01

We have evaluated the transmasseteric anterior parotid (TMAP) approach in the treatment of 163 condylar fractures in 129 patients. Ninety-five patients presented with unilateral, and 34 with bilateral, fractures. The inclusion criteria were patient's choice for open reduction and internal fixation, displaced unilateral condylar fractures with occlusal derangement, and displaced bilateral condylar fractures with anterior open bite. Mean (SD) maximum interincisal opening after 3 months was 44(5)mm. There were no differences in lateral movements during the reviews 6 weeks and 3 months postoperatively. Protrusive movement at the end of 3 months was 7(2)mm. All patients achieved functional occlusion identical to the pretraumatic occlusion and good reduction of the condyles. No patient developed temporary or permanent facial palsy, sialocele, salivary fistula, or Frey syndrome. The mean (SD) operating time was 46(11)min. The TMAP approach avoids the complications of incision of the parotid gland, minimises the risk of facial nerve palsy, and offers excellent access to the fractured condyle. Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis.

Science.gov (United States)

Sharma, Gaurav; Gn, Kiran Kumar; Khatri, Kavin; Singh, Ravijot; Gamanagatti, Shivanand; Sharma, Vijay

2017-02-01

In this study we describe the morphology of the posteromedial fragment in pertrochanteric fractures using 3D CT scans and answer two questions 1) Do differences exist between the 3D CT appearances of posteromedial fragments and the depictions made in the AO classification 2) Does the posteromedial fragment affect stability in pertrochanteric fractures, in terms of fracture collapse? Preoperative CT scans of eight 31-A1 and fifty 31-A2 fractures were analysed. The presence of PM fragment, its fragmentation, greater trochanter (GT) involvement, lesser trochanter (LT) fragment size (in terms of its posterior and medial extent as well as LT length), LT fragment displacement (in terms of medial displacement and rotation) were determined. All fractures were treated with a DHS. Fracture collapse was determined on postoperative radiographs. The relationship between fracture collapse and patient factors including age, gender, fracture type (A1 versus A2), characteristics of the posteromedial fragment, and the presence of a lateral wall fracture were determined. Three out of eight 31-A1 fractures demonstrated a separate GT fragment (three part fracture). Out of the 50 31-A2 fractures, 12 had a single PM fragment, which included the LT and GT in continuity. The more common four part fractures seem to form by further fragmentation of this basic form. In A2 fractures, the GT was almost always broken and the broken fragment comprised a mean 56% of normal GT. The LT fragment involved an average of 74% of the posterior wall, and an average of 36% of the medial wall of the proximal femur. Larger LT fragments were less displaced as compared to smaller fragments. Univariate regression analyses revealed that fracture collapse was significantly correlated with fracture type (A1 versus A2, p 0.036), GT size (p 0.002) and the presence of a lateral wall fracture (pfragmentation of the posteromedial fragment, nor the size of the lesser trochanter fragment was found to predict stability in

Fracture Energy of Plain Concrete Beams at Different Rates of Loading

DEFF Research Database (Denmark)

Ulfkjær, J. P.; Hansen, Lars Pilegaard; Madsen, S. H.

. The beams are tested in a closed loop servo controlled materials testing system. The experimental results for these preliminary tests show that the bending tensile strength is increasing with the displacement rate and that the fracture energy is constant at lower displacement rates and then increasing...

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

Science.gov (United States)

Malik, Mudasir; Halwai, Manzoor Ahmad

2014-10-01

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

Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs.

Science.gov (United States)

Nortunen, Simo; Leskelä, Hannu-Ville; Haapasalo, Heidi; Flinkkilä, Tapio; Ohtonen, Pasi; Pakarinen, Harri

2017-03-15

This study aimed to identify factors from standard radiographs that contributed to the stability of the ankle mortise in patients with isolated supination-external rotation fractures of the lateral malleolus (OTA/AO 44-B). Non-stress radiographs of the mortise and lateral views, without medial clear space widening or incongruity, were prospectively collected for 286 consecutive patients (mean age, 45 years [range, 16 to 85 years]), including 144 female patients (mean age, 50 years [range, 17 to 85 years]) and 142 male patients (mean age, 40 years [range, 16 to 84 years]) from 2 trauma centers. The radiographs were analyzed for fracture morphology by 2 orthopaedic surgeons, who were blinded to each other's measurements and to the results of external rotation stress radiographs (the reference for stability). Factors significantly associated with ankle mortise stability were tested in multiple logistic regression. Receiver operating characteristic analyses were performed for continuous variables to determine optimal thresholds. A sensitivity of >90% was used as the criterion for an optimal threshold. According to external rotation stress radiographs, 217 patients (75.9%) had a stable injury, defined as that with a medial clear space of ankle mortise were female sex (odds ratio [OR], 2.5 [95% confidence interval (CI), 1.4 to 4.6]), a posterior diastasis of fracture fragments (OR, 7.3 [95% CI, 2.1 to 26.3]). When the posterior diastasis was fracture fragments were present, the probability of a stable ankle mortise was 0.98 for 48 female patients (16.8%) and 0.94 for 37 male patients (12.9%). Patients with noncomminuted lateral malleolar fractures (85 patients [29.7%]) could be diagnosed with a stable ankle mortise without further stress testing, when the fracture line widths were <2 mm on lateral radiographs. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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

Science.gov (United States)

Chrcanovic, Bruno Ramos

2012-09-01

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

Capillary-driven flow in a fracture located in a porous medium

International Nuclear Information System (INIS)

Martinez, M.J.

1988-09-01

Capillary-driven immiscible displacement of air by water along an isolated fracture located in a permeable medium is induced by an abrupt change in water saturation at the fracture inlet. The fracture is idealized as either a smooth slot with permeable walls or a high-permeability later. The penetration distance of moisture in the fracture permeability ratio and length scales for the problem. The models are applied to materials representative of the Yucca Mountain region of the Nevada Test Site. Fracture moisture-penetration histories are predicted for several units in Yucca Mountain and for representative fracture apertures. 18 refs., 20 figs., 6 tabs

Preoperative sup(99m)Tc-MDP scintimetry of femoral neck fractures

International Nuclear Information System (INIS)

Holmberg, S.; Thorngren, K.-G.

1984-01-01

Preoperative sup(99m)Tc-MDP-scintimetry was performed in 117 patients with femoral neck fractures. Scintimetry was shown to be superior to visual evaluation. The ratio was calculated of the uptake in the femoral head of the fractured side over that in the unfractured side, with compensation for the increased trochanteric femoral activity found on the fractured side. A ratio above 0.90 correlated well with uneventful healing in both undisplaced and displaced fractures. Preoperative scintimetry is of great value in the choice of primary treatment of femoral neck fractures. (author)

Spontaneous stress fractures of the femoral neck

International Nuclear Information System (INIS)

Dorne, H.L.; Lander, P.H.

1985-01-01

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

Fictitious Crack Model of Concrete Fracture

DEFF Research Database (Denmark)

Brincker, Rune; Dahl, H.

1989-01-01

The substructure method introduced by Petersson is reformulated for the three-point bending specimen in order to obtain complete load-displacement relations without significant truncation. The problem of instability caused by the linearization of the softening in the fracture zone is discussed, a...

Effect of reverse cyclic loading on the fracture resistance curve of nuclear piping material

International Nuclear Information System (INIS)

Weon, Jong Il; Seok, Chang Sung

1999-01-01

Fracture resistance (J-R) curves, which are used for the elastic-plastic fracture mechanics analyses, are known to be dependent on the cyclic loading history. The objective of this paper is to study the effect of reverse cyclic loading on J-R curves in CT specimens. The effect of two parameters was observed on the J-R curves during the reverse cyclic loading. One was the minimum-to-maximum load ratio (R) and the other was the incremental plastic displacement (δ cycle /δ i ), which is related to the amount of crack growth that occurs in a cycle. Fracture resistance test on CT specimens with varying load ratio and incremental plastic displacement were performed. For the SA 516 Gr. 70 steel, the results showed that the J-R curves were decreased with decreasing the load ratio and the incremental plastic displacement. When the load ratio was set to -1, the results of the J-R curves and the J i value were about 40-50 percent of those for the monotonic loading condition. Also on condition that the incremental plastic displacement reached 1/40, the J-R curves and the J i value were about 50-60 percent of those for the incremental plastic displacement of 1/10

Isolated Fracture of the Coracoid Process

Directory of Open Access Journals (Sweden)

Ali Güleç

2014-01-01

Full Text Available Coracoid fractures are rarely seen fractures. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular joint or glenohumeral joint, scapula corpus, clavicula, humerus fracture, or rotator cuff tear. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. In this paper, a 34-year-old male manual labourer presented to the emergency department with complaints of pain and restricted movement in the left shoulder following a traffic accident. On direct radiographs and computerised tomography images a fragmented fracture was observed on the base of the coracoid process. In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After open reduction, fixation was made with a 3.5 mm cannulated screw and washer. At the postoperative 6th week, bone union was determined. The patient returned to his previous occupation pain-free and with a full range of joint movement. In conclusion, in the current case of isolated fragmented coracoid process fracture showing minimal displacement in a patient engaged in heavy manual work, surgery was preferred as it was thought that nonunion might be encountered particularly because of the effect of forces around the coracoid.

Monitoring roof beam lateral displacement at the waste isolation pilot plant

International Nuclear Information System (INIS)

Terrill, L.J.; Lewis, R.E.

1996-01-01

Lateral displacement in the immediate roof beam at the Waste Isolation Pilot Plant (WIPP) is a significant factor in assessment of excavation performance for the design of ground control systems. Information on roof beam lateral displacement, expansion, fracture formation, as well as excavation convergence, is gathered using a variety of manually and remotely read instruments. Visual observations are also used when possible. This paper describes the methods used to measure lateral displacement, or offset, at the WIPP. Offset magnitudes are determined by the degree of occlusion in drillholes that intersect the offset plane. The Borehole Lateral Displacement Sensor (BLDS) was developed for installation at WIPP to monitor offset at a high degree of accuracy at a short reading frequency. Offset measurements have historically been obtained by visual estimation of borehole occlusion. Use of the BLDS will enable relationships between time dependent roof beam lateral displacement and expansion to be established in much shorter periods than is possible using visual observations. The instrument will also allow remote monitoring of roof beam displacement in areas where visual estimations are not possible. Continued monitoring of roof beam displacement, convergence, and expansion, is integral to timely and pertinent assessments of WIPP excavation performance

Monitoring roof beam lateral displacement at the Waste Isolation Pilot Plant

International Nuclear Information System (INIS)

Terrill, L.J.; Lewis, R.E.

1996-01-01

Lateral displacement in the immediate roof beam at the Waste Isolation Pilot Plant (WIPP) is a significant factor in assessment of excavation performance for the design of ground control systems. Information on roof beam lateral displacement, expansion, fracture formation, as well as excavation convergence, is gathered using a variety of manually and remotely read instruments. Visual observations are also used when possible. This paper describes the methods used to measure lateral displacement, or offset, at the WIPP. Offset magnitudes are determined by the degree of occlusion in drillholes that intersect the offset plane. The Borehole Lateral Displacement Sensor (BLDS) was developed for installation at WIPP to monitor offset at a high degree of accuracy at a short reading frequency. Offset measurements have historically been obtained by visual estimation of borehole conclusion. Use of the BLDS will enable relationships between time dependent roof beam lateral displacement and expansion to be established in much shorter periods than is possible using visual observations. The instrument will also allow remote monitoring of roof beam displacement in areas where visual estimations are not possible. Continued monitoring of roof beam displacement, convergence, and expansion, is integral to timely and pertinent assessments of WIPP excavation performance

Use of orthodontic brackets for intermaxillary fixation for management of mandibular fracture in a pediatric patient

Directory of Open Access Journals (Sweden)

Rajeev Pandey

2017-01-01

Full Text Available Fracture of mandible is relatively less common in pediatric population when compared to adults. Management of pediatric mandibular fracture is a very complex issue and requires accurate and early treatment. Although the general principles of treatment remain the same as adult but various factors which influence the choice of management: age, dentition status, site involved, amount of displacement, number of fractures, and socioeconomic status. This case report describes a conservative way of management of moderately displaced mandibular fracture with the help of closed reduction achieved using intermaxillary fixation (IMF with help of elastics using orthodontic brackets. A 9-year-old male child was treated for body of mandible fracture using this technique. The IMF was removed after 3 weeks and adequate bone union was demonstrated clinically and radiographically.

Locking compression plate osteosynthesis of complicated mandibular fractures in six horses

OpenAIRE

Kümmerle, Jan M; Kummer, Martin R; Auer, Jörg A; Nitzl, Dagmar; Fürst, Anton

2009-01-01

Complicated mandibular fractures were recognised in one foal, one pony and four horses. The foal was two months old while the adult animals ranged in age from 12 to 24 years. Three horses had a unilateral horizontal ramus fracture. Two fractures were open and one was closed. Comminution was present in one of these patients while lthe other two horses had marked displacement of the fragments. Two suffered from comminuted fractures of the horizontal and vertical ramus of the mandible. One of th...

[Is the Hawkins sign able to predict necrosis in fractures of the neck of the astragalus?].

Science.gov (United States)

Rodríguez-Paz, S; Muñoz-Vives, J M; Froufe-Siota, M Á

2013-01-01

To assess if the Hawkins sign can predict whether or not astragalus fractures of the neck will develop avascular necrosis. It is also assessed whether the occurrence of this complication is related to the displacement of the fracture, soft tissue injury, or delay in the reduction or surgery. The results were compared with those found in the literature. A retrospective study was conducted on 23 talar neck fractures recorded over a a period of thirteen years. The following variables were analysed: displacement of the fracture, soft tissue injury, delay and type of treatment, complications, observation of the Hawkins sign, and functional outcome. There were 7 type I Hawkins fractures, 11 type II, and 4 type III and 1 type IV. Four cases developed avascular necrosis (2 Hawkins type II and 2 type III). Hawkins sign was observed in 12 cases, of which none developed necrosis. Four cases with negative Hawkins sign developed necrosis. No statistically significant differences were found when comparing the development of avascular necrosis with the displacement of the fracture, soft tissue injury, or delay in treatment. Differences were found when comparing the development of avascular necrosis with the Hawkins sign (P=.03). A positive Hawkins sign rules out that the fractured talus has developed avascular necrosis, but its absence does not confirm it. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Numerical simulation on ferrofluid flow in fractured porous media based on discrete-fracture model

Science.gov (United States)

Huang, Tao; Yao, Jun; Huang, Zhaoqin; Yin, Xiaolong; Xie, Haojun; Zhang, Jianguang

2017-06-01

Water flooding is an efficient approach to maintain reservoir pressure and has been widely used to enhance oil recovery. However, preferential water pathways such as fractures can significantly decrease the sweep efficiency. Therefore, the utilization ratio of injected water is seriously affected. How to develop new flooding technology to further improve the oil recovery in this situation is a pressing problem. For the past few years, controllable ferrofluid has caused the extensive concern in oil industry as a new functional material. In the presence of a gradient in the magnetic field strength, a magnetic body force is produced on the ferrofluid so that the attractive magnetic forces allow the ferrofluid to be manipulated to flow in any desired direction through the control of the external magnetic field. In view of these properties, the potential application of using the ferrofluid as a new kind of displacing fluid for flooding in fractured porous media is been studied in this paper for the first time. Considering the physical process of the mobilization of ferrofluid through porous media by arrangement of strong external magnetic fields, the magnetic body force was introduced into the Darcy equation and deals with fractures based on the discrete-fracture model. The fully implicit finite volume method is used to solve mathematical model and the validity and accuracy of numerical simulation, which is demonstrated through an experiment with ferrofluid flowing in a single fractured oil-saturated sand in a 2-D horizontal cell. At last, the water flooding and ferrofluid flooding in a complex fractured porous media have been studied. The results showed that the ferrofluid can be manipulated to flow in desired direction through control of the external magnetic field, so that using ferrofluid for flooding can raise the scope of the whole displacement. As a consequence, the oil recovery has been greatly improved in comparison to water flooding. Thus, the ferrofluid

Cartilaginous avulsion fracture of the tibial spine in a 5-year-old girl

International Nuclear Information System (INIS)

Kim, Jung Ryul; Song, Ji Hun; Lee, Ju Hong; Lee, Sang Yong; Yoo, Wan Hee

2008-01-01

Fractures of the tibial spine usually occur in children aged 8 to 14 years. Usually, radiographs will demonstrate a tibial spine fracture, with the degree of displacement. Tibial spine fractures in younger children have not been reported in the previously published literature. We report a tibial spine fracture that occurred in 5-year-old girl. The cartilaginous avulsion fracture of the tibial spine was not revealed by radiographs because it was limited to the cartilaginous portion of the proximal tibia. (orig.)

Comparison of outcomes following uncemented hemiarthroplasty and dynamic hip screw in the treatment of displaced subcapital hip fractures in patients aged greater than 70 years.

LENUS (Irish Health Repository)

El-Abed, Kaldoun

2012-02-03

As health care costs increase, evaluating treatment methods in femoral neck fractures to determine the most effective treatment paradigm will become increasingly important. The current study compared two methods of treatment in similar cohorts of displaced femoral neck fractures. One hundred and twenty two patients were randomly assigned to two groups: In Group A, 62 patients were treated with a hemiarthroplasty. In group B, 60 patients were treated with dynamic screw fixation. Patients were evaluated at a minimum 3 year follow-up. Using the Matta functional hip score, 42% of group A and 70% of group B had good to excellent results. This difference was significant (p = 0.004). A significant agreement between physician assessment using the Matta score, and patient perception of outcome using the SF-36 scale was demonstrated (r = 0.64). No statistical difference between groups for revision surgery existed. Both physician based and patient based outcome scores favour retention and internal fixation of the femoral head in this cohort of patients at a short-term follow-up.

Effect of reverse cyclic loading on the fracture resistance curve in C(T) specimen

International Nuclear Information System (INIS)

Sung Seok, C.; Jin Kim, Y.; Il Weon, J.

1999-01-01

Fracture resistance (J-R) curves, which are used for elastic-plastic fracture mechanics analyses, are known to be dependent on the cyclic loading history. The objective of this paper is to investigate the effect of reverse cyclic loading on the J-R curves in C(T) specimens. The effect of two parameters was observed on the J-R curves during the reverse cyclic loading. One was the minimum-to-maximum load ratio (R) and the other was the incremental plastic displacement (δ cycle /δ i ), which is related to the amount of crack growth that occurs in a cycle. Fracture resistance tests on C(T) specimens with varying the load ratio and the incremental plastic displacement were performed, and the test results showed that the J-R curves were decreased with decreasing the load ratio and decreasing the incremental plastic displacement. Direct current potential drop (DCPD) method was used for the detection of crack initiation and crack growth in typical laboratory J-R tests. The values of crack initiation J-integral (J I ) and crack initiation displacement (δ i ) were also obtained by using the DCPD method. (orig.)

Fracture Energy Estimation of DCB Specimens Made of Glass/Epoxy: An Experimental Study

Directory of Open Access Journals (Sweden)

V. Alfred Franklin

2013-01-01

Full Text Available This paper examines critical load and corresponding displacement of double cantilever beam (DCB composite specimens made of glass/epoxy of three different layups. Experiments were conducted on these laminates, and the fracture energy, GIc, was evaluated considering the root rotation at the crack tip. The present model requires the applied load-displacement history and crack extension to estimate fracture energy. Reduction schemes based on cubic and power law are also proposed to determine Young’s modulus and energy release rate and found good agreement with the published and test results.

Evaluation of throughwall crack pipes under displacement controlled loading

Energy Technology Data Exchange (ETDEWEB)

Zahoor, A.

1987-02-01

Tearing modulus solutions are developed for flawed throughwall pipes subjected to displacement controlled loading. Two cases of loading were considered: (1) a displacement controlled bending loading, and (2) a displacement controlled axial tension loading. A revised version of the EPRI J-integral estimation scheme is used in the development of the solutions. These solutions can be used for the entire range of elastic-plastic loading, from linear elastic, contained yielding, to large scale yielding of the crack section. Experimental data from pipes in bending were used to assess the accuracy of the compliant loading solutions. The evaluations were performed using elastic plastic J-integral (J) and tearing modulus (T) analysis methods. These solutions are shown to have good accuracy when used to predict the experimental results. The methodology and procedure can also be applied to part-throughwall cracks. These solutions have application to the leak before break fracture mechanics analyses.

Evaluation of throughwall crack pipes under displacement controlled loading

International Nuclear Information System (INIS)

Zahoor, A.

1987-01-01

Tearing modulus solutions are developed for flawed throughwall pipes subjected to displacement controlled loading. Two cases of loading were considered: (1) a displacement controlled bending loading, and (2) a displacement controlled axial tension loading. A revised version of the EPRI J-integral estimation scheme is used in the development of the solutions. These solutions can be used for the entire range of elastic-plastic loading, from linear elastic, contained yielding, to large scale yielding of the crack section. Experimental data from pipes in bending were used to assess the accuracy of the compliant loading solutions. The evaluations were performed using elastic plastic J-integral (J) and tearing modulus (T) analysis methods. These solutions are shown to have good accuracy when used to predict the experimental results. The methodology and procedure can also be applied to part-throughwall cracks. These solutions have application to the leak before break fracture mechanics analyses. (orig.)

Unusual Presentation of Pseudoaneurysm with Trochanteric Fracture Femur with Associated Long-Term Antiepileptic Therapy

Directory of Open Access Journals (Sweden)

Nipun Rana

2014-01-01

Full Text Available Arterial injury following impalement due to a trochanteric hip fracture-fragment per se has been documented rarely. We report a case of pseudoaneurysm of profunda femoris artery at the first perforator branch in a 48-year-old male, with trochanteric hip fracture following a fall during an epileptic episode. Persistent recalcitrant pain, globular swelling in the groin, unexplained drop in the haemoglobin level, and color doppler ultrasonography findings were salient features to the diagnosis. Additionally, we collected all reported cases of pseudoaneurysm associated with hip fractures. We reviewed the literature regarding the incidence, treatment, and prognosis for the same. Acute vascular injury was probably caused by the spikes of fractured lesser trochanter which was found to be displaced superomedially. All trochanteric fractures especially those with displaced lesser trochanter fragment should be closely watched for the possibility of vascular injury. Early diagnosis and treatment in a staged manner can prevent the catastrophic vascular event and hence the limb.

A computer aided measurement method for unstable pelvic fractures based on standardized radiographs

International Nuclear Information System (INIS)

Zhao, Jing-xin; Zhao, Zhe; Zhang, Li-cheng; Su, Xiu-yun; Du, Hai-long; Zhang, Li-ning; Zhang, Li-hai; Tang, Pei-fu

2015-01-01

To set up a method for measuring radiographic displacement of unstable pelvic ring fractures based on standardized X-ray images and then test its reliability and validity using a software-based measurement technique. Twenty-five patients that were diagnosed as AO/OTA type B or C pelvic fractures with unilateral pelvis fractured and dislocated were eligible for inclusion by a review of medical records in our clinical centre. Based on the input pelvic preoperative CT data, the standardized X-ray images, including inlet, outlet, and anterior-posterior (AP) radiographs, were simulated using Armira software (Visage Imaging GmbH, Berlin, Germany). After representative anatomic landmarks were marked on the standardized X-ray images, the 2-dimensional (2D) coordinates of these points could be revealed in Digimizer software (Model: Mitutoyo Corp., Tokyo, Japan). Subsequently, we developed a formula that indicated the translational and rotational displacement patterns of the injured hemipelvis. Five separate observers calculated the displacement outcomes using the established formula and determined the rotational patterns using a 3D-CT model based on their overall impression. We performed 3D reconstruction of all the fractured pelvises using Mimics (Materialise, Haasrode, Belgium) and determined the translational and rotational displacement using 3-matic suite. The interobserver reliability of the new method was assessed by comparing the continuous measure and categorical outcomes using intraclass correlation coefficient (ICC) and kappa statistic, respectively. The interobserver reliability of the new method for translational and rotational measurement was high, with both ICCs above 0.9. Rotational outcome assessed by the new method was the same as that concluded by 3-matic software. The agreement for rotational outcome among orthopaedic surgeons based on overall impression was poor (kappa statistic, 0.250 to 0.426). Compared with the 3D reconstruction outcome, the

Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

Directory of Open Access Journals (Sweden)

Stefanovic Branko

2017-06-01

Full Text Available Supracondylar humeral fractures (SCHF are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4% were boys and 17 (26.6% were girls. The most common age range (59.4% in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.

Evaluation of J and CTOD (Crack Tip Opening Displacement) fracture parameters for pipeline steels using Single Edge Notch Tension SE(T) specimens

Energy Technology Data Exchange (ETDEWEB)

Paredes Tobar, Lenin Marcelo; Ruggieri, Claudio [Universidade de Sao Paulo (USP), SP (Brazil). Escola Politecnica. Dept. de Engenharia Naval e Oceanica

2009-12-19

This work presents an evaluation procedure to determine the elastic-plastic J-integral and CTOD for pin-loaded and clamped single edge notch tension (SE(T)) specimens based upon the eta-method. The primary objective is to derive estimation equations applicable to determine J and CTOD fracture parameters for a wide range of a/W-ratios and material flow properties. Very detailed non-linear finite element analyses for plane-strain and full-thickness, 3-D models provide the evolution of load with increased crack mouth opening displacement which is required for the estimation procedure. The present analyses, when taken together with previous studies provide a fairly extensive body of results which serve to determine parameters J and CTOD for different materials using tension specimens with varying geometries. (author)

[Treatment of femoral neck fracture--preference to internal fixation].

Science.gov (United States)

Minato, Izumi

2011-03-01

In the guidelines for the treatment of femoral neck fracture, prosthetic replacement is recommended in displaced one and internal fixation is in undisplaced one. However, in the long view, survived femoral head after internal fixation can be superior to prosthesis which will deteriorate as time goes by. Surgical method should be considered not only by type of fracture but general status of the patient.

a Predictive Model of Permeability for Fractal-Based Rough Rock Fractures during Shear

Science.gov (United States)

Huang, Na; Jiang, Yujing; Liu, Richeng; Li, Bo; Zhang, Zhenyu

This study investigates the roles of fracture roughness, normal stress and shear displacement on the fluid flow characteristics through three-dimensional (3D) self-affine fractal rock fractures, whose surfaces are generated using the modified successive random additions (SRA) algorithm. A series of numerical shear-flow tests under different normal stresses were conducted on rough rock fractures to calculate the evolutions of fracture aperture and permeability. The results show that the rough surfaces of fractal-based fractures can be described using the scaling parameter Hurst exponent (H), in which H = 3 - Df, where Df is the fractal dimension of 3D single fractures. The joint roughness coefficient (JRC) distribution of fracture profiles follows a Gauss function with a negative linear relationship between H and average JRC. The frequency curves of aperture distributions change from sharp to flat with increasing shear displacement, indicating a more anisotropic and heterogeneous flow pattern. Both the mean aperture and permeability of fracture increase with the increment of surface roughness and decrement of normal stress. At the beginning of shear, the permeability increases remarkably and then gradually becomes steady. A predictive model of permeability using the mean mechanical aperture is proposed and the validity is verified by comparisons with the experimental results reported in literature. The proposed model provides a simple method to approximate permeability of fractal-based rough rock fractures during shear using fracture aperture distribution that can be easily obtained from digitized fracture surface information.

Conservative management of fracture scaphoid

Directory of Open Access Journals (Sweden)

Mittal V

2006-01-01

Full Text Available Background : Conservative management of fracture scaphoid with cast is still the most common modality of management, but the results following this protocol are not always satisfactory. Methods : Twenty five patients with fracture scaphoid were treated with a below elbow scaphoid cast and were followed up for minimum duration of one year. On follow up patients were examined clinicoradiologically and functional results were evaluated using the modification of the Mayo wrist scoring chart. Results : Nineteen fractures showed union, two were malunited and five went for nonunion. Two fractures developed avascular necrosis and three patients had wrist arthritis on follow up. Nineteen patients had excellent functional results, one had good results and six patients had poor results. Patients with delayed diagnosis had nonunion and poor functional results. Patients with premature removal of cast had comparatively inferior results Conclusion : For displaced unstable fracture, open reduction and internal fixation should be the preferred modality of treatment as cast treatment gives unacceptably high rate of malunion and nonunion with poor functional results.

Fracture Testing with Surface Crack Specimens. [especially the residual tensile strength test

Science.gov (United States)

Orange, T. W.

1974-01-01

Recommendations are given for the design, preparation, and static fracture testing of surface crack specimens. The recommendations are preceded by background information including discussions of stress intensity factors, crack opening displacements, and fracture toughness values associated with surface crack specimens. Cyclic load and sustained load tests are discussed briefly.

Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results.

Science.gov (United States)

Lewine, Eliza; Kim, Jaehon M; Miller, Patricia E; Waters, Peter M; Mahan, Susan T; Snyder, Brian; Hedequist, Daniel; Bae, Donald S

2018-02-01

The purpose of this investigation was to compare the presentation and postoperative results of children treated for open and closed, completely displaced type III supracondylar humerus fractures (SCFs). Thirty patients with open and 66 patients with closed, completely displaced type III SCFs were evaluated. Open fractures underwent irrigation and debridement, and all patients were treated by open or closed reduction and pin fixation. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical data regarding mechanism of injury, neurovascular status, associated injuries, postoperative range of motion, infections, and pain. Radiographs were evaluated to quantify displacement, Baumann's angle, humeral capitellar angle, position of the anterior humeral line, and adequacy of reduction. Outcomes were assessed using Flynn criteria. Mean clinical follow-up for the open and closed fracture groups was 8.9 and 5.7 months, respectively. Both groups were similar with respect to age, sex distribution, weight and body mass index, laterality of involvement, and mechanism of injury. At presentation, 35% of closed SCFs and 23% of open SCFs presented with abnormal neurovascular status. There was a higher prevalence of diminished/absent pulses or distal limb ischemia in patients with open injuries (27%) compared with closed fractures (18%). Conversely, severely displaced closed fractures were more commonly associated with nerve injury/palsy at presentation (35%) than those with open fractures (23%). Spontaneous nerve recovery was seen in 87% within 3 to 6 months. Postoperative loss of reduction and malunion were more common in the closed fracture group. However, 84% of patients achieved good-to-excellent results by Flynn criteria, with no appreciable difference based upon open versus closed fractures. With timely wound and fracture treatment, the clinical and radiographic results of children treated for open SCFs is similar to

Interventions for treating proximal humeral fractures in adults

DEFF Research Database (Denmark)

Handoll, Helen H G; Brorson, Stig

2015-01-01

supervised exercise in a swimming pool plus home exercise.Eight trials, involving 567 older participants, evaluated surgical intervention for displaced fractures. There was high quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two......BACKGROUND: Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. OBJECTIVES: To assess the effects (benefits...... and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference...

Single versus double row suture anchor fixation for greater tuberosity fractures - a biomechanical study.

Science.gov (United States)

Seppel, Gernot; Saier, Tim; Martetschläger, Frank; Plath, Johannes E; Guevara-Alvarez, Alberto; Henschel, Julia; Winkler, Martin; Augat, Peter; Imhoff, Andreas B; Buchmann, Stefan

2017-12-01

Fractures of the humeral greater tuberosity (GT) are a frequent injury progressively treated with arthroscopic suture anchor repair. Yet, no biomechanical study has been performed comparing fixation strength of arthroscopic single- (SR) vs. double row (DR) fixation. Standardized fractures of the greater tuberosity were created in 12 fresh frozen proximal humeri. After random assignation to the SR or DR group the fixed humeri were tested applying cyclic loading to the supraspinatus and infraspinatus tendon. Load to failure and fragment displacement were assessed by means of an electrodynamic material testing machine using an optical tracking system. Load to failure values were higher in the DR group (649 N; ±176) than in the SR group (490 N; ±145) however without statistical significance (p = .12). In greater tuberosity displacement of 3-5 mm surgical treatment is recommended. The fixing constructs in this study did not reach displacement landmarks of 3 or 5 mm before construct failure as shown in previous studies. Thus the applied traction force (N) at 1 mm displacement was analyzed. In the SR group the load at 1 mm displacement was 277 N; ±46 compared to 260 N; ±62 in the DR group (p = .65). The results suggest that both techniques are viable options for refixation of greater tuberosity fractures. Laboratory study.

Acetabular Fracture

Directory of Open Access Journals (Sweden)

Chad Correa

2017-09-01

Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

Plastic fracture mechanics prediction of fracture instability in a circumferentially cracked pipe in bending--1. J-integral analysis

International Nuclear Information System (INIS)

Zahoor, A.; Kanninen, M.F.

1980-01-01

A method of evaluating the J-integral for a circumferentially cracked pipe in bending is proposed. The method allows a J-resistance curve to be evaluated directly from the load-displacement record obtained in a pipe fracture experiment. This method also permits an analysis for fracture instability in a circumferential crack growth using a J-resistance curve and the tearing modulus parameter. The importance of using a J-resistance curve that is consistent with the type of constraint for a given application is emphasized. 18 refs

What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study

Directory of Open Access Journals (Sweden)

Arthur de Góes Ribeiro

2016-04-01

Full Text Available OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30° of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

Test methodology and technology of fracture toughness for small size specimens

Energy Technology Data Exchange (ETDEWEB)

Wakai, E.; Takada, F.; Ishii, T.; Ando, M. [Japan Atomic Energy Agency, Naga-gun, Ibaraki-ken (Japan); Matsukawa, S. [JNE Techno-Research Co., Kanagawa-ken (Japan)

2007-07-01

Full text of publication follows: Small specimen test technology (SSTT) is required to investigate mechanical properties in the limited availability of effective irradiation volumes in test reactors and accelerator-based neutron and charged particle sources. The test methodology guideline and the manufacture processes for very small size specimens have not been established, and we would have to formulate it. The technology to control exactly the load and displacement is also required in the test technology under the environment of high dose radiation produced from the specimens. The objective of this study is to examine the test technology and methodology of fracture toughness for very small size specimens. A new bend test machine installed in hot cell has been manufactured to obtain fracture toughness and DBTT (ductile - brittle transition temperature) of reduced-activation ferritic/martensitic steels for small bend specimens of t/2-1/3PCCVN (pre-cracked 1/3 size Charpy V-notch) with 20 mm length and DFMB (deformation and fracture mini bend specimen) with 9 mm length. The new machine can be performed at temperatures from -196 deg. C to 400 deg. C under unloading compliance method. Neutron irradiation was also performed at about 250 deg. C to about 2 dpa in JMTR. After the irradiation, fracture toughness and DBTT were examined by using the machine. Checking of displacement measurement between linear gauge of cross head's displacement and DVRT of the specimen displacement was performed exactly. Conditions of pre-crack due to fatigue in the specimen preparation were also examined and it depended on the shape and size of the specimens. Fracture toughness and DBTT of F82H steel for t/2-1/3PCCVN, DFMB and 0.18DCT specimens before irradiation were examined as a function of temperature. DBTT of smaller size specimens of DFMB was lower than that of larger size specimen of t/2-1/3PCCVN and 0.18DCT. The changes of fracture toughness and DBTT due to irradiation were also

C/NOFS Satellite Electric Field and Plasma Density Observations of Plasma Instabilities Below the Equatorial F-Peak -- Evidence for Approximately 500 km-Scale Spread-F "Precursor" Waves Driven by Zonal Shear Flow and km-Scale, Narrow-Banded Irregularities

Science.gov (United States)

Pfaff, R.; Freudenreich, H.; Klenzing, J.; Liebrecht, C.; Valladares, C.

2011-01-01

As solar activity has increased, the ionosphere F-peak has been elevated on numerous occasions above the C/NOFS satellite perigee of 400km. In particular, during the month of April, 2011, the satellite consistently journeyed below the F-peak whenever the orbit was in the region of the South Atlantic anomaly after sunset. During these passes, data from the electric field and plasma density probes on the satellite have revealed two types of instabilities which had not previously been observed in the C/NOFS data set (to our knowledge): The first is evidence for 400-500km-scale bottomside "undulations" that appear in the density and electric field data. In one case, these large scale waves are associated with a strong shear in the zonal E x B flow, as evidenced by variations in the meridional (outward) electric fields observed above and below the F-peak. These undulations are devoid of smaller scale structures in the early evening, yet appear at later local times along the same orbit associated with fully-developed spread-F with smaller scale structures. This suggests that they may be precursor waves for spread-F, driven by a collisional shear instability, following ideas advanced previously by researchers using data from the Jicamarca radar. A second new result (for C/NOFS) is the appearance of km-scale irregularities that are a common feature in the electric field and plasma density data that also appear when the satellite is below the F -peak at night. The vector electric field instrument on C/NOFS clearly shows that the electric field component of these waves is strongest in the zonal direction. These waves are strongly correlated with simultaneous observations of plasma density oscillations and appear both with, and without, evidence of larger-scale spread-F depletions. These km-scale, quasi-coherent waves strongly resemble the bottomside, sinusoidal irregularities reported in the Atmosphere Explorer satellite data set by Valladares et al. [JGR, 88, 8025, 1983

Tibial avulsion fracture of the posterior root of the medial meniscus in children

DEFF Research Database (Denmark)

Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

2012-01-01

of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures...

A clinico-radiologic study of bony remodeling of the fractured condyles in children

Energy Technology Data Exchange (ETDEWEB)

Cho, Jeong Shin; Park, Chang Seo [Department of Dentistry, The Graduate School, Yonsei University, Seoul (Korea, Republic of)

1995-08-15

Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

A clinico-radiologic study of bony remodeling of the fractured condyles in children

International Nuclear Information System (INIS)

Cho, Jeong Shin; Park, Chang Seo

1995-01-01

Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

The value of multislice helical CT in the diagnosis of the rib micro-fracture

International Nuclear Information System (INIS)

Wang Shuli; Wang Linsen; Sun Dingyuan; Deng Xin; Geng Xin; Li Jian; Liu Zhigang; Guo Lin; Jia Zhihong

2005-01-01

Objective: To evaluate the clinical value of MSCT with thin-section reconstruction and curved multiplanar reformation of rib micro-fracture. Methods: Thirty-eight patients suspected ribs fracture by clinical examination, which had negative appearance in X-ray film, were performed with MSCT scan with thin-section reconstructed and curved multiplanar reformation. The imaging of 5 mm, 1 mm thickness and curved reformatted imags were analysed by three groups of radiologists respectively. Results: Of the 38 patients, 26 patients were demonstrated ribs fracture with 1 mm thin-section reconstructed and curved multiplanar reformatted CT imaging, which were classified as complete fracture in 18 ribs and incomplete fracture in 41 ribs. The ends of the fractures displacement located within a distance of double-thickness of the cortex of the complete ribs fracture. With 5 mm thickness imaging, the accuracy of the diagnosis was 86.4%, 89.8% and 94.9% by three groups radiologists, respectively. Conclusion: The rib fracture is very common in clinic, the incomplete and non evident displacement complete ribs fracture are difficult to be diagnosed by plain radiography. The MSCT can produce a large range volume information scan. Thin-section reconstructed and curved multiplanar reformatted imaging should be the effective method in diagnosis of ribs fracture. The total rib pattern and location, extend of all the ribs fracture in this cases can be displayed in one scan by the curved multiplanar reformatted imaging. (authors)

Acquirement of true stress-strain curve using true fracture strain obtained by tensile test and FE analysis

International Nuclear Information System (INIS)

Lee, Kyoung Yoon; Kim, Tae Hyung; Lee, Hyung Yil

2009-01-01

In this work, we predict a true fracture strain using load-displacement curves from tensile test and Finite Element Analysis (FEA), and suggest a method for acquiring true Stress-Strain (SS) curves by predicted fracture strain. We first derived the true SS curve up to necking point from load-displacement curve. As the beginning, the posterior necking part of true SS curve is linearly extrapolated with the slope at necking point. The whole SS curve is then adopted for FE simulation of tensile test. The Bridgman factor or suitable plate correction factors are applied to pre and post FEA. In the load-true strain curve from FEA, the true fracture strain is determined as the matching point to test fracture load. The determined true strain is validated by comparing with test fracture strain. Finally, we complete the true SS curve by combining the prior necking part and linear part, the latter of which connects necking and predicted fracture points.

Acquirement of true stress-strain curve using true fracture strain obtained by tensile test and FE analysis

Energy Technology Data Exchange (ETDEWEB)

Lee, Kyoung Yoon; Kim, Tae Hyung; Lee, Hyung Yil [Sogang University, Seoul (Korea, Republic of)

2009-07-01

In this work, we predict a true fracture strain using load-displacement curves from tensile test and Finite Element Analysis (FEA), and suggest a method for acquiring true Stress-Strain (SS) curves by predicted fracture strain. We first derived the true SS curve up to necking point from load-displacement curve. As the beginning, the posterior necking part of true SS curve is linearly extrapolated with the slope at necking point. The whole SS curve is then adopted for FE simulation of tensile test. The Bridgman factor or suitable plate correction factors are applied to pre and post FEA. In the load-true strain curve from FEA, the true fracture strain is determined as the matching point to test fracture load. The determined true strain is validated by comparing with test fracture strain. Finally, we complete the true SS curve by combining the prior necking part and linear part, the latter of which connects necking and predicted fracture points.

Acquirement of True Stress-strain Curve Using True Fracture Strain Obtained by Tensile Test and FE Analysis

Energy Technology Data Exchange (ETDEWEB)

Lee, Kyoung Yoon; Lee, Hyung Yil [Sogang University, Seoul (Korea, Republic of); Kim, Tae Hyung [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2009-10-15

In this work, we predict a true fracture strain using load-displacement curves from tensile test and finite element analysis (FEA), and suggest a method for acquiring true stress-strain (SS) curves by predicted fracture strain. We first derived the true SS curve up to necking point from load-displacement curve. As the beginning, the posterior necking part of true SS curve is linearly extrapolated with the slope at necking point. The whole SS curve is then adopted for FE simulation of tensile test. The Bridgman factor or suitable plate correction factors are applied to pre and post FEA. In the load-true strain curve from FEA, the true fracture strain is determined as the matching point to test fracture load. The determined true strain is validated by comparing with test fracture strain. Finally, we complete the true SS curve by combining the prior necking part and linear part, the latter of which connects necking and predicted fracture points.

A Thermoelastic Hydraulic Fracture Design Tool for Geothermal Reservoir Development

Energy Technology Data Exchange (ETDEWEB)

Ahmad Ghassemi

2003-06-30

Geothermal energy is recovered by circulating water through heat exchange areas within a hot rock mass. Geothermal reservoir rock masses generally consist of igneous and metamorphic rocks that have low matrix permeability. Therefore, cracks and fractures play a significant role in extraction of geothermal energy by providing the major pathways for fluid flow and heat exchange. Thus, knowledge of conditions leading to formation of fractures and fracture networks is of paramount importance. Furthermore, in the absence of natural fractures or adequate connectivity, artificial fracture are created in the reservoir using hydraulic fracturing. At times, the practice aims to create a number of parallel fractures connecting a pair of wells. Multiple fractures are preferred because of the large size necessary when using only a single fracture. Although the basic idea is rather simple, hydraulic fracturing is a complex process involving interactions of high pressure fluid injections with a stressed hot rock mass, mechanical interaction of induced fractures with existing natural fractures, and the spatial and temporal variations of in-situ stress. As a result it is necessary to develop tools that can be used to study these interactions as an integral part of a comprehensive approach to geothermal reservoir development, particularly enhanced geothermal systems. In response to this need we have set out to develop advanced thermo-mechanical models for design of artificial fractures and rock fracture research in geothermal reservoirs. These models consider the significant hydraulic and thermo-mechanical processes and their interaction with the in-situ stress state. Wellbore failure and fracture initiation is studied using a model that fully couples poro-mechanical and thermo-mechanical effects. The fracture propagation model is based on a complex variable and regular displacement discontinuity formulations. In the complex variable approach the displacement discontinuities are

The use of MRI and CT in Imaging Occult Hip Fractures

Directory of Open Access Journals (Sweden)

Obadă B.

2014-11-01

Full Text Available Diagnosis of hip fractures is particularly important due to the high dependence on the integrity of this structure for people to function in their daily lives. Left unrecognized, patients face increasing morbidity and mortality as time from the original injury lengthens. A delay of just 2 days in surgical treatment for an acute hip fracture doubles mortality. In addition, an unrecognized non-displaced fracture may displace, requiring surgery of much higher risk. This may be part of the reason that the most frequent lawsuit against Emergency Physicians is for missed orthopedic injury. We reviewed the use of MRI and CT for occult hip fractures (OHF detection at a major urban trauma unit. Our study is a retrospective review. Inclusion criteria: all patients presenting to the Emergency Clinical Hospital of Constanta with a suspected, posttraumatic, occult hip fracture, over a 5 years period were included. All patients had negative initial radiographs and underwent further imaging with either CT or MRI. A total of 185 cases meeting the inclusion criteria were identified. 72 occult hip fractures were detected with both imaging modalities. Although MRI certainly enables greater image detail, in our experience both modalities are able to provide satisfactory fracture characterization. The choice of imaging should be determined by availability and indication. MRI provides superior imaging of soft tissue but is less sensitive for degenerative changes in presence of bone edema.

Greater trochanteric fracture with occult intertrochanteric extension.

Science.gov (United States)

Reiter, Michael; O'Brien, Seth D; Bui-Mansfield, Liem T; Alderete, Joseph

2013-10-01

Proximal femoral fractures are frequently encountered in the emergency department (ED). Prompt diagnosis is paramount as delay will exacerbate the already poor outcomes associated with these injuries. In cases where radiography is negative but clinical suspicion remains high, magnetic resonance imaging (MRI) is the study of choice as it has the capability to depict fractures which are occult on other imaging modalities. Awareness of a particular subset of proximal femoral fractures, namely greater trochanteric fractures, is vital for both radiologists and clinicians since it has been well documented that they invariably have an intertrochanteric component which may require surgical management. The detection of intertrochanteric or cervical extension of greater trochanteric fractures has been described utilizing MRI but is underestimated with both computed tomography (CT) and bone scan. Therefore, if MRI is unavailable or contraindicated, the diagnosis of an isolated greater trochanteric fracture should be met with caution. The importance of avoiding this potential pitfall is demonstrated in the following case of an elderly woman with hip pain and CT demonstrating an isolated greater trochanteric fracture who subsequently returned to the ED with a displaced intertrochanteric fracture.

Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults

DEFF Research Database (Denmark)

Rehn, Carl-Henrik; Kirkegaard, Martin; Viberg, Bjarke

2013-01-01

Intervention studies of clavicle fracture treatment are numerous, but only a few high quality studies prospectively compare operative and nonoperative treatment. The objective of this study was to review evidence from randomized controlled trials on operative versus nonoperative treatment of disp...

Surface displacements and energy release rates for constant stress drop slip zones in joined elastic quarter spaces

Science.gov (United States)

Rodgers, Michael J.; Wen, Shengmin; Keer, Leon M.

2000-08-01

A three-dimensional quasi-static model of faulting in an elastic half-space with a horizontal change of material properties (i.e., joined elastic quarter spaces) is considered. A boundary element method is used with a stress drop slip zone approach so that the fault surface relative displacements as well as the free surface displacements are approximated in elements over their respective domains. Stress intensity factors and free surface displacements are calculated for a variety of cases to show the phenomenological behavior of faulting in such a medium. These calculations showed that the behavior could be distinguished from a uniform half-space. Slip in a stiffer material increases, while slip in a softer material decreases the energy release rate and the free surface displacements. Also, the 1989 Kalapana earthquake was located on the basis of a series of forward searches using this method and leveling data. The located depth is 8 km, which is the closer to the seismically inferred depth than that determined from other models. Finally, the energy release rate, which can be used as a fracture criterion for fracture at this depth, is calculated to be 11.1×106 J m-2.

Application of a few orthogonal polynomials to the assessment of the fracture failure probability of a spherical tank

International Nuclear Information System (INIS)

Cao Tianjie; Zhou Zegong

1993-01-01

This paper presents some methods to assess the fracture failure probability of a spherical tank. These methods convert the assessment of the fracture failure probability into the calculation of the moment of cracks and a one-dimensional integral. In the paper, we first derive series' formulae to calculation the moments of cracks on the occasion of the crack fatigue growth and the moments of crack opening displacements according to JWES-2805 code. We then use the first n moments of crack opening displacements and a few orthogonal polynomials to compose the probability density function of the crack opening displacement. Lastly, the fracture failure probability is obtained according to the interference theory. An example proves that these methods are simpler, quicker, and more accurate. At the same time, these methods avoid the disadvantage of Edgeworth's series method. (author)

Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10 year study

Directory of Open Access Journals (Sweden)

Maini P

2006-01-01

Full Text Available Background : One of the most common treatments of displaced fracture of femoral neck in elderly is bipolar hemiarthroplasty. Method : Two hundred and seventy patients of displaced fracture of femoral neck were treated by bipolar hemiarthroplasty. The Mean age of the patients at the time of surgery was 69.80 years. Results : Follow up ranged between 12 months and 120 months. There were 8 cases each of acetabular erosion and protrusion with 10 cases of femoral stem loosening. Eight cases had post operative dislocation requiring open reduction. Eighteen patients got revision surgery to total hip replacement. The overall incidence of DVT/PE was 9.9% which declined after regular use of low molecular weight heparin. Eleven patients had post operative infection. There were 54.2 % excellent results, 21.0 % good results, 10.7 % fair and 3.7% poor results. Conclusion : Elderly patients with displaced fracture of neck femur are able to ambulate early after Cemented bipolar hemi arthroplasty. The complication rate is low, the component survival long and pre injury functional status is restored in majority of patients.

Central tarsal bone fracture in the border collie.

Science.gov (United States)

Guilliard, M

2007-07-01

Fracture of the plantar process of the central tarsal bone together with a dorsomedial displacement of the body of the bone was seen in six border collies. All injuries occurred during free exercise, with no extrinsic trauma. Three dogs had concomitant tarsal fractures. Primary treatment was by lag screwing the central tarsal bone to the fourth tarsal bone. All cases eventually made an excellent recovery. The superficial radiographic appearance was of a luxation of the bone as reported in a previous series, but appraisal of the radiographs showed evidence of fracture in all cases. A cadaver study to assess the mechanism of luxation showed that it is unlikely to occur naturally.

Arthroscopy-Assisted Reduction and Fixation of a Transversal Glenoid Fracture: About a Case

Directory of Open Access Journals (Sweden)

David Zbili

2017-01-01

Full Text Available An articular glenoid fracture is an uncommon injury. Usually significantly displaced intra-articular glenoid fractures are treated with open reduction surgery. Conventional open surgery techniques involve high morbidity. Here we describe an arthroscopy-assisted reduction and fixation method of an Ideberg type III glenoid fracture. This method provides good articular reduction without extensive exposure or soft tissue dissection and without nerve and/or vascular lesion.

Acute fractures of the pediatric foot and ankle.

Science.gov (United States)

Halai, Mansur; Jamal, Bilal; Rea, Paul; Qureshi, Mobeen; Pillai, Anand

2015-02-01

Injuries around the foot and ankle are challenging. There is a paucity of literature, outside that of specialist orthopedic journals, that focuses on this subject in the pediatric population. In this review, we outline pediatric foot and ankle fractures in an anatomically oriented manner from the current literature. Our aim is to aid the emergency department doctor to manage these challenging injuries more effectively in the acute setting. These injuries require a detailed history and examination to aid the diagnosis. Often, plain radiographs are sufficient, but more complex injuries require the use of magnetic resonance imaging. Treatment is dependent on the proximity to skeletal maturity and the degree of displacement of fracture. Children have a marked ability to remodel after fractures and therefore mainstay treatment is immobilization by a cast or splint. Operative fixation, although uncommon in this population, may be necessary with adolescents, certain unstable injuries or in cases with displaced articular surface. In the setting of severe foot trauma, skin compromise and compartment syndrome of the foot must be excluded. The integrity of the physis, articular surface and soft tissues are all equally important in treating these injuries.

Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification.

Science.gov (United States)

Melenevsky, Yulia; Mackey, Robert A; Abrahams, R Brad; Thomson, Norman B

2015-01-01

The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. Although talar fractures account for less than 1% of all fractures, they commonly result from high-energy trauma and may lead to complications and long-term morbidity if not recognized and managed appropriately. While initial evaluation is with foot and ankle radiographs, computed tomography (CT) is often performed to evaluate the extent of the fracture, displacement, comminution, intra-articular extension, and associated injuries. Talar fractures are divided by anatomic region: head, neck, and body. Talar head fractures can be treated conservatively if nondisplaced, warranting careful radiographic and CT evaluation to assess rotation, displacement, and extension into the neck. The modified Hawkins-Canale classification of talar neck fractures is most commonly used due to its simplicity, usefulness in guiding treatment, and prognostic value, as it correlates associated malalignment with risk of subsequent osteonecrosis. Isolated talar body fractures may be more common than previously thought. The Sneppen classification further divides talar body fractures into osteochondral talar dome, lateral and posterior process, and shear and crush comminuted central body fractures. Crush comminuted central body fractures carry a poor prognosis due to nonanatomic reduction, bone loss, and subsequent osteonecrosis. Lateral process fractures can be radiographically occult and require a higher index of suspicion for successful diagnosis. Subtalar dislocations are often accompanied by fractures, necessitating postreduction CT. Familiarity with the unique talar anatomy and injury patterns is essential for radiologists to facilitate

Oil recovery enhancement from fractured, low permeability reservoirs. [Carbonated Water

Energy Technology Data Exchange (ETDEWEB)

Poston, S.W.

1991-01-01

The results of the investigative efforts for this jointly funded DOE-State of Texas research project achieved during the 1990-1991 year may be summarized as follows: Geological Characterization - Detailed maps of the development and hierarchical nature the fracture system exhibited by Austin Chalk outcrops were prepared. The results of these efforts were directly applied to the development of production decline type curves applicable to a dual-fracture-matrix flow system. Analysis of production records obtained from Austin Chalk operators illustrated the utility of these type curves to determine relative fracture/matrix contributions and extent. Well-log response in Austin Chalk wells has been shown to be a reliable indicator of organic maturity. Shear-wave splitting concepts were used to estimate fracture orientations from Vertical Seismic Profile, VSP data. Several programs were written to facilitate analysis of the data. The results of these efforts indicated fractures could be detected with VSP seismic methods.Development of the EOR Imbibition Process - Laboratory displacement as well as Magnetic Resonance Imaging, MRI and Computed Tomography, CT imaging studies have shown the carbonated water-imbibition displacement process significantly accelerates and increases recovery from oil saturated, low permeability rocks.Field Tests - Two operators amenable to conducting a carbonated water flood test on an Austin Chalk well have been identified. Feasibility studies are presently underway.

Oil Recovery Enhancement from Fractured, Low Permeability Reservoirs. [Carbonated Water

Science.gov (United States)

Poston, S. W.

1991-01-01

The results of the investigative efforts for this jointly funded DOE-State of Texas research project achieved during the 1990-1991 year may be summarized as follows: Geological Characterization - Detailed maps of the development and hierarchical nature the fracture system exhibited by Austin Chalk outcrops were prepared. The results of these efforts were directly applied to the development of production decline type curves applicable to a dual-fracture-matrix flow system. Analysis of production records obtained from Austin Chalk operators illustrated the utility of these type curves to determine relative fracture/matrix contributions and extent. Well-log response in Austin Chalk wells has been shown to be a reliable indicator of organic maturity. Shear-wave splitting concepts were used to estimate fracture orientations from Vertical Seismic Profile, VSP data. Several programs were written to facilitate analysis of the data. The results of these efforts indicated fractures could be detected with VSP seismic methods. Development of the EOR Imbibition Process - Laboratory displacement as well as Magnetic Resonance Imaging, MRI and Computed Tomography, CT imaging studies have shown the carbonated water-imbibition displacement process significantly accelerates and increases recovery from oil saturated, low permeability rocks. Field Tests - Two operators amenable to conducting a carbonated water flood test on an Austin Chalk well have been identified. Feasibility studies are presently underway.

Simultaneous bilateral isolated greater trochanter fracture

Directory of Open Access Journals (Sweden)

Maruti Kambali

2013-01-01

Full Text Available A 48-year-old woman sustained simultaneous isolated bilateral greater trochanteric fracture, following a road traffic accident. The patient presented to us 1 month after the injury. She presented with complaints of pain in the left hip and inability to walk. Roentgenograms revealed displaced comminuted bilateral greater trochanter fractures. The fracture of the left greater trochanter was reduced and fixed internally using the tension band wiring technique. The greater trochanter fracture on the right side was asymptomatic and was managed conservatively. The patient regained full range of motion and use of her hips after a postoperative follow-up of 6 months. Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports of this particular type of injury are not plentiful and the average textbook coverage afforded to this entity is limited. In our study we discuss the mechanism of injury and the various treatment options available.

Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius: a rare combination and a unique mechanism of injury

Directory of Open Access Journals (Sweden)

Gupta RK

2014-07-01

Full Text Available 【Abstract】Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochleacoronoid articulation and hence to maintain the intrinsic stability of the elbow. Key words: Isolated trochlea fracture; Clavicle; Radius fractures

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.

Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

DEFF Research Database (Denmark)

Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

2007-01-01

BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...... of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants....

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

Science.gov (United States)

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

2013-07-01

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

Fracture assessment of weld material from a full-thickness clad RPV shell segment

International Nuclear Information System (INIS)

Keeney, J.A.; Bass, B.R.; McAfee, W.J.

1996-01-01

Fracture analysis was applied to full-thickness clad beam specimens containing shallow cracks in material for which metallurgical conditions are prototypic of those found in reactor pressure vessels (RPV) at beginning of life. The beam specimens were fabricated from a section of an RPV wall (removed from a canceled nuclear plant) that includes weld, plate, and clad material. Metallurgical factors potentially influencing fracture toughness for shallow cracks in the beam specimens include gradients of material properties and residual stresses due to welding and cladding applications. Fracture toughness estimates were obtained from load vs load-line displacement and load vs crack-mouth-opening displacement data using finite-element methods and estimation schemes based on the η-factor method. One of the beams experienced a significant amount of precleavage stable ductile tearing. Effects of precleavage tearing on estimates of fracture toughness were investigated using continuum damage models. Fracture toughness results from the clad beam specimens were compared with other deep- and shallow-crack single-edge notch bend (SENB) data generated previously from A533 Grade B plate material. Range of scatter for the clad beam data is consistent with that from the laboratory-scale SENB specimens tested at the same temperature

Rock fracture processes in chemically reactive environments

Science.gov (United States)

Eichhubl, P.

2015-12-01

hostrock can independently affect fracture opening displacement and thus fracture aperture profiles and aperture distribution.

A Technique of Distal Clavicle Fracture Fixation Using The Tightrope Procedure

Directory of Open Access Journals (Sweden)

CJ Soh

2011-11-01

Full Text Available We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon.

Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

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Rajasekhar Gali

2016-01-01

Full Text Available Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a the ease of access for retrieval, reimplantation and fixation of the proximal segment; b the postoperative approach related complications; c the adequacy of anatomical reduction and stability of fixation; d the occlusal changes; and the e TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby

Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures.

Science.gov (United States)

Gali, Rajasekhar; Devireddy, Sathya Kumar; Venkata, Kishore Kumar Rayadurgam; Kanubaddy, Sridhar Reddy; Nemaly, Chaithanyaa; Dasari, Mallikarjuna

2016-01-01

Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial

Displacer Diameter Effect in Displacer Pulse Tube Refrigerator

Science.gov (United States)

Zhu, Shaowei

2017-12-01

Gas driving displacer pulse tube refrigerators are one of the work recovery type of pulse tube refrigerators whose theoretical efficiency is the same as Stirling refrigerators'. Its cooling power is from the displacement of the displacer. Displace diameter, rod diameter and pressure drop of the regenerator influence the displacement, which are investigated by numerical simulation. It is shown that the displacement ratio of the displacer over the piston is almost not affected by the displacer diameter at the same rod diameter ratio, or displacer with different diameters almost has the same performance.

Influence of mesh density, cortical thickness and material properties on human rib fracture prediction.

Science.gov (United States)

Li, Zuoping; Kindig, Matthew W; Subit, Damien; Kent, Richard W

2010-11-01

The purpose of this paper was to investigate the sensitivity of the structural responses and bone fractures of the ribs to mesh density, cortical thickness, and material properties so as to provide guidelines for the development of finite element (FE) thorax models used in impact biomechanics. Subject-specific FE models of the second, fourth, sixth and tenth ribs were developed to reproduce dynamic failure experiments. Sensitivity studies were then conducted to quantify the effects of variations in mesh density, cortical thickness, and material parameters on the model-predicted reaction force-displacement relationship, cortical strains, and bone fracture locations for all four ribs. Overall, it was demonstrated that rib FE models consisting of 2000-3000 trabecular hexahedral elements (weighted element length 2-3mm) and associated quadrilateral cortical shell elements with variable thickness more closely predicted the rib structural responses and bone fracture force-failure displacement relationships observed in the experiments (except the fracture locations), compared to models with constant cortical thickness. Further increases in mesh density increased computational cost but did not markedly improve model predictions. A ±30% change in the major material parameters of cortical bone lead to a -16.7 to 33.3% change in fracture displacement and -22.5 to +19.1% change in the fracture force. The results in this study suggest that human rib structural responses can be modeled in an accurate and computationally efficient way using (a) a coarse mesh of 2000-3000 solid elements, (b) cortical shells elements with variable thickness distribution and (c) a rate-dependent elastic-plastic material model. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

Intra-articualr calcaneal fractures: Computed tomographic analysis

International Nuclear Information System (INIS)

Rosenberg, Z.S.; Feldman, F.; Singson, R.D.

1987-01-01

Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases. CT proved superior to plain films by consistently demonstrating additional fracture components within each major category suggesting subclassifications which have potential prognostic value. CT allowed more expeditious handling of acutely injured patients, and improved preoperative planning, postoperative follow-up, and detailed analysis of causes for chronic residual pain. CT further identified significant soft tissue injuries such as peroneal tendon displacement which cannot be delineated on plain films. (orig.)

A Biomechanical Study Comparing Helical Blade with Screw Design for Sliding Hip Fixations of Unstable Intertrochanteric Fractures

Directory of Open Access Journals (Sweden)

Qiang Luo

2013-01-01

Full Text Available Dynamic hip screw (DHS is a well-established conventional implant for treating intertrochanteric fracture. However, revision surgery sometimes still occurs due to the cutting out of implants. A helical blade instead of threaded screw (DHS blade was designed to improve the fixation power of the osteoporotic intertrochanteric fracture. In this study, the biomechanical properties of DHS blade compared to the conventional DHS were evaluated using an unstable AO/OTA 31-A2 intertrochanteric fracture model. Fifty synthetic proximal femoral bone models with such configuration were fixed with DHS and DHS blade in five different positions: centre-centre (CC, superior-centre (SC, inferior-center (IC, centre-anterior (CA, and centre-posterior (CP. All models had undergone mechanical compression test, and the vertical and rotational displacements were recorded. The results showed that DHS blade had less vertical or rotational displacement than the conventional DHS in CC, CA, and IC positions. The greatest vertical and rotational displacements were found at CP position in both groups. Overall speaking, DHS blade was superior in resisting vertical or rotational displacement in comparison to conventional DHS, and the centre-posterior position had the poorest performance in both groups.

Interventions for treating proximal humeral fractures in adults.

Science.gov (United States)

Handoll, Helen H G; Brorson, Stig

2015-11-11

Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference proceedings and bibliographies of trial reports. The full search ended in November 2014. We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials pertinent to the management of proximal humeral fractures in adults. Both review authors performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed. We included 31 heterogeneous RCTs (1941 participants). Most of the 18 separate treatment comparisons were tested by small single-centre trials. The main exception was the surgical versus non-surgical treatment comparison tested by eight trials. Except for a large multicentre trial, bias in these trials could not be ruled out. The quality of the evidence was either low or very low for all comparisons except the largest comparison.Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (three or four weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and

Evaluation of the conservativeness of the methodology for estimating earthquake-induced movements of fractures intersecting canisters

International Nuclear Information System (INIS)

La Pointe, Paul R.; Cladouhos, Trenton T.; Outters, Nils; Follin, Sven

2000-04-01

This study evaluates the parameter sensitivity and the conservativeness of the methodology outlined in TR 99-03. Sensitivity analysis focuses on understanding how variability in input parameter values impacts the calculated fracture displacements. These studies clarify what parameters play the greatest role in fracture movements, and help define critical values of these parameters in terms of canister failures. The thresholds or intervals of values that lead to a certain level of canister failure calculated in this study could be useful for evaluating future candidate sites. Key parameters include: 1. magnitude/frequency of earthquakes; 2. the distance of the earthquake from the canisters; 3. the size and aspect ratio of fractures intersecting canisters; and 4. the orientation of the fractures. The results of this study show that distance and earthquake magnitude are the most important factors, followed by fracture size. Fracture orientation is much less important. Regression relations were developed to predict induced fracture slip as a function of distance and either earthquake magnitude or slip on the earthquake fault. These regression relations were validated by using them to estimate the number of canister failures due to single damaging earthquakes at Aberg, and comparing these estimates with those presented in TR 99-03. The methodology described in TR 99-03 employs several conservative simplifications in order to devise a numerically feasible method to estimate fracture movements due to earthquakes outside of the repository over the next 100,000 years. These simplifications include: 1. fractures are assumed to be frictionless and cohesionless; 2. all energy transmitted to the fracture by the earthquake is assumed to produce elastic deformation of the fracture; no energy is diverted into fracture propagation; and 3. shielding effects of other fractures between the earthquake and the fracture are neglected. The numerical modeling effectively assumes that the

Evaluation of the conservativeness of the methodology for estimating earthquake-induced movements of fractures intersecting canisters

Energy Technology Data Exchange (ETDEWEB)

La Pointe, Paul R.; Cladouhos, Trenton T. [Golder Associates Inc., Las Vegas, NV (United States); Outters, Nils; Follin, Sven [Golder Grundteknik KB, Stockholm (Sweden)

2000-04-01

This study evaluates the parameter sensitivity and the conservativeness of the methodology outlined in TR 99-03. Sensitivity analysis focuses on understanding how variability in input parameter values impacts the calculated fracture displacements. These studies clarify what parameters play the greatest role in fracture movements, and help define critical values of these parameters in terms of canister failures. The thresholds or intervals of values that lead to a certain level of canister failure calculated in this study could be useful for evaluating future candidate sites. Key parameters include: 1. magnitude/frequency of earthquakes; 2. the distance of the earthquake from the canisters; 3. the size and aspect ratio of fractures intersecting canisters; and 4. the orientation of the fractures. The results of this study show that distance and earthquake magnitude are the most important factors, followed by fracture size. Fracture orientation is much less important. Regression relations were developed to predict induced fracture slip as a function of distance and either earthquake magnitude or slip on the earthquake fault. These regression relations were validated by using them to estimate the number of canister failures due to single damaging earthquakes at Aberg, and comparing these estimates with those presented in TR 99-03. The methodology described in TR 99-03 employs several conservative simplifications in order to devise a numerically feasible method to estimate fracture movements due to earthquakes outside of the repository over the next 100,000 years. These simplifications include: 1. fractures are assumed to be frictionless and cohesionless; 2. all energy transmitted to the fracture by the earthquake is assumed to produce elastic deformation of the fracture; no energy is diverted into fracture propagation; and 3. shielding effects of other fractures between the earthquake and the fracture are neglected. The numerical modeling effectively assumes that the

The incorporation of displacement-controlled loadings within the net-section stress failure criterion

International Nuclear Information System (INIS)

Smith, E.

1985-01-01

A net-section stress failure criterion can be used to evaluate the critical flaw size for a material having a high fracture resistance. A simple analysis shows that the stress arising from displacement-controlled loadings should be taken into account fully if the applied tearing modulus exceeds a critical value. (author)

Early results for treatment of two- and three-part fractures of the proximal humerus using Contours PHP (proximal humeral plate).

Science.gov (United States)

Biazzo, Alessio; Cardile, Carlo; Brunelli, Luca; Ragni, Paolo; Clementi, Daniele

2017-04-28

The management of displaced 2- and 3-part fractures of the proximal humerus is controversial, both in younger and in elderly patients. The purpose of this paper is to evaluate the functional results of the Contours Proximal Humerus Plate (OrthofixR, Bussolengo,Verona, Italy), for the treatment of displaced 2- and 3-part fractures of the proximal humerus. We retrospectively reviewed 55 patients with proximal humerus fractures, who underwent osteosynthesis with Contours Proximal Humerus Plate from December 2011 to March 2015. We had 21 patients with 2-part fractures and with an average age of 67.1 years and 34 patients with 3-part fractures, with average age of 63.6 years. The average union time was 3 months. The mean Constant score was 67 for 2-part fracture group and 64.9 for 3-part fracture group. The difference was not statistically significant (p = 0.18). The overall complication rate was 14.5 %. Six patients underwent additional surgery (10.9%). The most frequent major complication was secondary loss of reduction following varus collapse of the fracture (2 cases). In these patients, there was loss of medial hinge integrity due to impaction and osteoporosis. The placement of the main locking screw in the calcar area to provide inferomedial support is the rational of the Contours Proximal Humerus Plate. Osteosynthesis with Contours Proximal Humerus Plate is a safe system for treating displaced 2- and 3-part fractures of the proximal humerus, with good functional results and complication rates comparable to those reported in the literature.

Monitoring hydraulic fractures: state estimation using an extended Kalman filter

International Nuclear Information System (INIS)

Rochinha, Fernando Alves; Peirce, Anthony

2010-01-01

There is considerable interest in using remote elastostatic deformations to identify the evolving geometry of underground fractures that are forced to propagate by the injection of high pressure viscous fluids. These so-called hydraulic fractures are used to increase the permeability in oil and gas reservoirs as well as to pre-fracture ore-bodies for enhanced mineral extraction. The undesirable intrusion of these hydraulic fractures into environmentally sensitive areas or into regions in mines which might pose safety hazards has stimulated the search for techniques to enable the evolving hydraulic fracture geometries to be monitored. Previous approaches to this problem have involved the inversion of the elastostatic data at isolated time steps in the time series provided by tiltmeter measurements of the displacement gradient field at selected points in the elastic medium. At each time step, parameters in simple static models of the fracture (e.g. a single displacement discontinuity) are identified. The approach adopted in this paper is not to regard the sequence of sampled elastostatic data as independent, but rather to treat the data as linked by the coupled elastic-lubrication equations that govern the propagation of the evolving hydraulic fracture. We combine the Extended Kalman Filter (EKF) with features of a recently developed implicit numerical scheme to solve the coupled free boundary problem in order to form a novel algorithm to identify the evolving fracture geometry. Numerical experiments demonstrate that, despite excluding significant physical processes in the forward numerical model, the EKF-numerical algorithm is able to compensate for the un-modeled dynamics by using the information fed back from tiltmeter data. Indeed the proposed algorithm is able to provide reasonably faithful estimates of the fracture geometry, which are shown to converge to the actual hydraulic fracture geometry as the number of tiltmeters is increased. Since the location of

Osteosarcoma with a pathologic fracture in a six-month-old dog

International Nuclear Information System (INIS)

Phillips, L.; Hager, D.; Parker, R.; Yanik, D.

1986-01-01

This case history report describes the clinical, radiographic, and histopathologic features of an osteosarcoma with an associated pathologic fracture in a 6-month-old dog. A 6-month-old intact male Bloodhound was presented with a primary complaint of a right forelimb lameness of one month's duration. In radiographs, a minimally displaced transverse fracture of the proximal humeral metaphysis was seen. There was extensive cortical bone destruction at the fracture site and minimal periosteal new bone suggestive of a primary bone tumor with a pathologic fracture. Biopsy specimens demonstrated neoplastic mesenchymal cells producing osteoid compatible with a diagnosis of osteosarcoma. This case history report constitutes the youngest reported canine osteosarcoma

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

Science.gov (United States)

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

2017-02-15

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

Displacement-length scaling of brittle faults in ductile shear.

Science.gov (United States)

Grasemann, Bernhard; Exner, Ulrike; Tschegg, Cornelius

2011-11-01

Within a low-grade ductile shear zone, we investigated exceptionally well exposed brittle faults, which accumulated antithetic slip and rotated into the shearing direction. The foliation planes of the mylonitic host rock intersect the faults approximately at their centre and exhibit ductile reverse drag. Three types of brittle faults can be distinguished: (i) Faults developing on pre-existing K-feldspar/mica veins that are oblique to the shear direction. These faults have triclinic flanking structures. (ii) Wing cracks opening as mode I fractures at the tips of the triclinic flanking structures, perpendicular to the shear direction. These cracks are reactivated as faults with antithetic shear, extend from the parent K-feldspar/mica veins and form a complex linked flanking structure system. (iii) Joints forming perpendicular to the shearing direction are deformed to form monoclinic flanking structures. Triclinic and monoclinic flanking structures record elliptical displacement-distance profiles with steep displacement gradients at the fault tips by ductile flow in the host rocks, resulting in reverse drag of the foliation planes. These structures record one of the greatest maximum displacement/length ratios reported from natural fault structures. These exceptionally high ratios can be explained by localized antithetic displacement along brittle slip surfaces, which did not propagate during their rotation during surrounding ductile flow.

Investigating the Role of Gravity Wave on Equatorial Ionospheric Irregularities using SABER and C/NOFS Satellites Observations

Science.gov (United States)

Nigussie, M.; Damtie, B.; Moldwin, M.; Yizengaw, E.; Tesema, F.; Tebabal, A.

2017-12-01

Theoretical simulations have shown that gravity wave (GW) seeded perturbations amplified by Rayleigh-Taylor Instability (RTI) results in ESF (equatorial spread F); however, there have been limited observational studies using simultaneous observations of GW and ionospheric parameters. In this paper, for the fist time, simultaneous atmospheric temperature perturbation profiles that are due to GWs obtained from Sounding of the Atmosphere using Broadband Emission Radiometry (SABER) on-board the TIMED satellite and equatorial in -situ ion density and vertical plasma drift velocity observations with and without ESF activity obtained from C/NOFS satellites are used to investigate the effect of GW on the generation of ESF. The horizontal and vertical wavelengths of ionospheric oscillations and GWs respectively have been estimated applying wavelet transforms. Cross wavelet analysis has also been applied between two closely observed profiles of temperature perturbations to estimate the horizontal wavelength of the GWs. Moreover, vertically propagating GWs that dissipate energy at the upper atmosphere have been investigated using spectral analysis compared with theoretical results. The analysis show that when the ion density shows strong post sunset irregularity between 20 and 24 LT, vertically upward drift velocities increase between 17 and 19 LT, but it becomes vertically downward when the ion density shows smooth variation. The horizontal wavelengths estimated from C/NOFS and SABER observations show excellent agreement when ion density observations show strong fluctuations; otherwise, they have poor agreement. It is also found that altitude profiles of potential energy of GW increases up to 90 km and then decreases significantly. It is found that the vertical wavelength of GW, corresponding to the dominant spectral power, ranges from about 7 km to 20 km regardless of the situation of the ionosphere; however, GWs with vertical wavelengths between 100 m to 1 km are found to

Is Closed Manipulative Reduction and Percutaneous Kirschner Wiring of Supracondylar Humeral Fracture in Children as Day-Care Surgery a Safe Procedure ?

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Ashok R Nayak

2013-07-01

Full Text Available INTRODUCTION: Supracondylar fracture of the humerus is a common injury in children. It accounts for 60% of fractures around the elbow children. If the fracture is not treated properly it may give rise to many complications like malunion, Volkmann’s ischemic contracture, nerve injury, arterial injury, skin slough, heterotopic bone formation , and stiffness of elbow. The management of displaced supracondylar fracture of the elbow is one of the most difficult of the many fractures seen in children. The purpose of the study was to evaluate the anatomical and functional results of treatment of supracondylar fractures of humerus with closed reduction and percutaneous ‘K’ wire fixation as a day care procedure and record associated complications, thus decreasing the cost of treating these fractures and hospitalization. METHODS: Fifty displaced closed extension type supracondylar fractures (Gartland’s type III of the humerus in children were treated by closed reduction and percutaneous fixation with Kirschner wires. All the patients selected for this study had been treated in a day care unit and were discharged in the same evening and followed up at 3 and 6 weeks and 3 months. Open fractures, fractures with neurovascular complications and children older than 15 yrs were excluded. The final results were evaluated by Flynn’s criteria. RESULTS: The majority (72%, of the patients had fracture displaced posteomedially, Fourty one of the fifty patients had satisfactory results. The majority of the patients were male, and the average age was 8-9 years. CONCLUSION: Percutaneous fixation of supracondylar humerus done as a day care procedure is an acceptable modality of treatment and reduces the duration of hospital stay for the patient.

Is the lateral radiograph necessary for the management of intra-capsular proximal femoral fractures?

International Nuclear Information System (INIS)

Korim, Muhammad Tawfiq; Mohan Reddy, Venthurla Ram; Gibbs, David; Wildin, Clare

2012-01-01

Aims: To investigate if a lateral hip radiograph is always needed in the management of intra-capsular proximal femoral fractures. Furthermore, we sought to evaluate if a radiographer could accurately identify cases in which the lateral radiograph is not required. Methods: All patients who underwent surgical management of an intra-capsular proximal femoral fracture over a 3 month period at our unit were identified. Radiographs were reviewed by 6 observers: 2 consultant orthopaedic surgeons, 2 registrars, and 2 radiographers. Initially the observers viewed the AP radiographs alone and classified the fractures into displaced, undisplaced, or unclear categories. They were then shown the lateral view and asked for a diagnosis and management plan. Comparison of diagnosis and management based on AP views alone, and AP in-combination with a lateral view was made. Results: 90 patients were included; the mean age was 80.8 years with a range of 42–100 years. 73 underwent arthroplasty and 17 had internal fixation. All observers, including the radiographer were able to make a surgical decision in 90% of the cases based on AP views alone. Lateral radiographs improved the diagnostic accuracy by 6%. The availability of the lateral view did not alter the management in patients where the AP clearly demonstrated a displaced fracture. Conclusion: Elderly patients with a displaced intra-capsular fracture identifiable on the AP do not require a lateral radiograph. Such patients can be accurately identified by the radiographer. Patient discomfort experienced during positioning for the lateral view would be avoided, and a financial saving made.

Bilateral femoral neck fractures following pelvic irradiation

International Nuclear Information System (INIS)

Mitsuda, Kenji; Nishi, Hosei; Oba, Hiroshi

1977-01-01

Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

Reducing the environmental impact of hydraulic fracturing through design optimisation of positive displacement pumps

International Nuclear Information System (INIS)

Josifovic, Aleksandar; Roberts, Jennifer J.; Corney, Jonathan; Davies, Bruce; Shipton, Zoe K.

2016-01-01

The current approach to hydraulic fracturing requires large amounts of industrial hardware to be transported, installed and operated in temporary locations. A significant proportion of this equipment is comprised of the fleet of pumps required to provide the high pressures and flows necessary for well stimulation. Studies have shown that over 90% of the emissions of CO_2 and other pollutants that occur during a hydraulic fracturing operation are associated with these pumps. Pollution and transport concerns are of paramount importance for the emerging hydraulic fracturing industry in Europe, and so it is timely to consider these factors when assessing the design of high pressure pumps for the European resources. This paper gives an overview of the industrial plant required to carry out a hydraulic fracturing operation. This is followed by an analysis of the pump's design space that could result in improved pump efficiency. We find that reducing the plunger diameter and running the pump at higher speeds can increase the overall pump efficiency by up to 4.6%. Such changes to the pump's parameters would results in several environmental benefits beyond the obvious economic gains of lower fuel consumption. The paper concludes with a case study that quantifies these benefits. - Highlights: • We develop a parameterized model of hydraulic fracturing pumps. • We explore performance variation to optimise pump efficiency and performance. • New design could increase pump energy efficiency up to 4.6% and improve reliability. • The new design could also reduce environmental and social impacts of pumping. • This illustrates how optimised mechanical design can lower impacts and cost.

The Place of Ultrasonography in the Evaluation of Rib Fractures

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Fulya Bakılan

2015-12-01

Full Text Available Objective: The aim of this study was to investigate whether ultrasonography is superior to chest x-ray in detecting rib fractures in patients with minor blunt chest trauma and chest pain. Materials and Methods: Ultrasonography findings of 32 patients with minor blunt chest trauma showing no evidence of a rib fracture on anteroposterior chest x-rays, were documented. Presence of cortical discontinuities, acoustic shadows, reverberation artifacts, and hematoma by ultrasonography was proposed as the diagnostic criteria for detecting the rib fracture. Results: Rib fracture was detected in 20 patients (62.5% according to ultrasonography results. A mildly displaced fracture was detected in 7 patients (35%, hematoma was detected in 3 patients (15% and multiple fractures (in 5th, 6th, 7th, and 8th ribs were detected in 1 patient (5%. Conclusion: The results of our study showed that ultrasonography is superior to chest x-ray, in detecting rib fractures.

Recovery of mouth-opening after closed treatment of a fracture of the mandibular condyle: a longitudinal study.

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Niezen, E T; Stuive, I; Post, W J; Bos, R R M; Dijkstra, P U

2015-02-01

The aim of this retrospective study was to assess recovery of mouth opening after closed treatment of fractures of the mandibular condyle, and analyse which characteristics might influence recovery. We measured mouth opening in 142 patients (mean (SD) age 30 (14) years, 96 of whom were male) during follow-up at 3, 6, 13, 26, and 52 weeks after the injury. Fractures were assessed on radiographs. Data were analysed using a multilevel analysis. Half the fractures were of the low condylar neck (n=71). Thirty-seven patients had bilateral condylar fractures, 29 had dislocated fractures, and in 80 the fracture was displaced. One or more additional mandibular fractures were present in 68. During follow-up mean (SD) mouth opening increased to: 33.6 (9.6) at 3 weeks, 40.1 (10.0) at 6 weeks, 45.1 (9.6) at 13 weeks, 49.8 (9.5) at 26 weeks, and 52.6 (7.5) at 52 weeks. Older age, female sex, displaced fracture, bilateral fractures, additional mandibular fractures, and the interaction between follow-up time and additional mandibular fractures, were predictors of a less favourable recovery of mouth opening. Clinicians can use the results of this study to predict recovery of mouth opening after closed treatment of fractures of the mandibular condyle at first consultation. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Crack edge collocation for the direct computation of stress intensity factors using the displacement discontinuity method

CSIR Research Space (South Africa)

Napier, JAL

2002-09-01

Full Text Available The numerical solution of problems relating to crack fracture and failure can be accomplished using the displacement discontinuity boundary element method. This paper presents an extension to the normal formulation of this method to enable stress...

Surgical Stabilization of Rib Fractures in a 6-Year-Old Child After Blunt Trauma.

Science.gov (United States)

Abdelsattar, Zaid M; Ishitani, Michael B; Kim, Brian D

2017-12-01

When identified, rib fractures in children are associated with high-energy trauma, nonaccidental trauma, or both. Traditionally, the optimal management of rib fractures in children is supportive care. In this case report, we present a 6-year-old boy who underwent surgical rib fixation for multiple displaced and comminuted rib fractures after being stepped on by a horse. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Experimental Study On Fracture Property Of Tapered Double Cantilever Beam Specimen With Aluminum Foam

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Kim Y.C.

2015-06-01

Full Text Available It is indispensable to evaluate fracture energy as the bonding strength of adhesive at composite material with aluminum foam. This specimen is designed with tapered double cantilever beam by British standards (BS 7991 and ISO 11343. 4 kinds of specimens due to m values of 2, 2.5, 3 and 3.5 are manufactured and compared each other with the experimental results. Adhesive fracture energy is calculated from the formulae of British standards. The value of m is the gradient which is denoted as the length and the height of specimen. As m becomes greater at static experimental result, the maximum load becomes higher and the displacement becomes lower. And the critical fracture energy becomes higher. As m becomes less at fatigue experimental result, the displacement becomes higher and the critical fracture energy becomes higher. Fracture behavior of adhesive can be analyzed by this study and these experimental results can be applied into real field effectively. The stability on TDCB structure bonded with aluminum foam composite can be predicted by use of this experimental result. Adhesive fracture energy is calculated from the formulae of British standards. Based on correlations obtained in this study, the fracture behavior of bonded material would possibly be analyzed and aluminum foam material bonded with adhesive would be applied to a composite structure in various fields, thereby analyzing the mechanical and fracture characteristic of the material.

[Posterior partial trochanteric osteotomy for the treatment of the roof involved acetabular fractures].

Science.gov (United States)

Wang, Pan-Feng; Xu, Shuo-Gui; Zhang, Chun-Cai; Fu, Qing-Ge; Zhang, Yun-Tong; Liu, Xin-Wei; Niu, Yun-Fei; Tang, Yang

2013-11-01

To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof. Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction. All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5. Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.

Etude hydromecanique d'une fracture en cisaillement sous contrainte normale constante

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Lamontagne, Eric

This research study deals with the effects of shear direction and injection flow rate on the flow directional anisotropy for a given normal stress. It presents experimental works on hydromechanical shear behaviour of a fracture under constant normal stress conditions that permits the characterisation of the intrinsic hydraulic transmissivity in relation with the directional anisotropy of the roughness morphology on the fracture surfaces. Tests were performed on mortar replicas of a natural fracture so that the fracture roughness and void space geometry were kept the same for each test. The experimental work program was performed through direct shear tests on the fracture replicas in four shear directions under four constant normal stress levels. The application of the normal stress was followed by several injections of fluid under constant flow rate. Then, for each defined shear displacement, several injections of fluid were done at different flow rate but under constant flow rate. The test results show that: (1) for the whole shear tests, the global intrinsic transmissivity is included within an enveloping zone of about one order of size. The transmissivity curves within the enveloping zone has a particularity to increase about two orders of size in the first millimetre of shear displacement and subsequently stabilised rapidly; (2) the highest dilatancy do not correspond necessarily with the highest intrinsic transmissivity so that, the behaviour of the global intrinsic transmissivity is not directly proportional to the fracture dilatancy during shear; (3) after the peak shear stress, the divergence is more marked between the global intrinsic transmissivity curves at various flow rate; (4) after peak shear strength and the beginning of asperity degradation, the gradual passage to residual friction shear behaviour causes a directional flow anisotropy and a reorientation of the flow chenalisation direction sub perpendicularly to the shear direction; (5) the

ARTHROSCOPIC TREATEMENT OF PATELLA FRACTURES IN CHILDREN

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Igor V. Timofeev

2017-03-01

Full Text Available Introduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2–3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment. Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14–17. These were 3 males and 1 female. All patients had sport-related injuries. Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing. Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective method of surgical treatment for patellar fractures.

Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

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Tânia Maria da Silva Mendonça

2008-01-01

Full Text Available OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years, 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36 at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

Update on mandibular condylar fracture management.

Science.gov (United States)

Weiss, Joshua P; Sawhney, Raja

2016-08-01

Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm. Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach. There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.

A coupled inversion of pressure and surface displacement

International Nuclear Information System (INIS)

Vasco, D.W.; Karasaki, Kenzi; Kishida, Kiyoshi

2001-01-01

A coupled inversion of transient pressure observations and surface displacement measurements provides an efficient technique for estimating subsurface permeability variations. The methodology has the advantage of utilizing surface observations, which are typically much less expensive than measurements requiring boreholes. Furthermore, unlike many other geophysical observables, the relationship between surface deformation and reservoir pore fluid volume changes is relatively well understood. Our treatment enables us to partition the estimation problem into a sequence of three linear sub-problems. An application of the approach to a set of tilt and borehole pressure data from the Raymond field site in California illustrates it's efficiency and utility. The observations are associated with a well test in which fluid is withdrawn from a shallow fracture zone. During the test thirteen tiltmeters recorded the movement of the ground surface. Simultaneously, nine transducers measured pressure changes in boreholes intersecting the fracture system. We are able to image a high permeability, north trending channel located within the fracture zone. The existence and orientation of this high permeability feature is substantiated by a semi-quantitative analysis of some 4,000 transient pressure curves. (author)

Standard test method for crack-tip opening displacement (CTOD) fracture toughness measurement

CERN Document Server

American Society for Testing and Materials. Philadelphia

2008-01-01

1.1 This test method covers the determination of critical crack-tip opening displacement (CTOD) values at one or more of several crack extension events, and may be used to measure cleavage crack initiation toughness for materials that exhibit a change from ductile to brittle behavior with decreasing temperature, such as ferritic steels. This test method applies specifically to notched specimens sharpened by fatigue cracking. The recommended specimens are three-point bend [SE(B)], compact [C(T)], or arc-shaped bend [A(B)] specimens. The loading rate is slow and influences of environment (other than temperature) are not covered. The specimens are tested under crosshead or clip gage displacement controlled loading. 1.1.1 The recommended specimen thickness, B, for the SE(B) and C(T) specimens is that of the material in thicknesses intended for an application. For the A(B) specimen, the recommended depth, W, is the wall thickness of the tube or pipe from which the specimen is obtained. Superficial surface machini...

Radial nerve palsy in mid/distal humeral fractures: is early exploration effective?

Science.gov (United States)

Keighley, Geffrey; Hermans, Deborah; Lawton, Vidya; Duckworth, David

2018-03-01

Radial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery. A total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post-operative period every 2 months or until full recovery of the radial nerve function had occurred. All patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12-month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2-26 weeks) and then finger extension started to recover 2-6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post-operatively. Our study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve. © 2017 Royal Australasian College of Surgeons.

Simulating Earthquake Rupture and Off-Fault Fracture Response: Application to the Safety Assessment of the Swedish Nuclear Waste Repository

KAUST Repository

Falth, B.

2014-12-09

To assess the long-term safety of a deep repository of spent nuclear fuel, upper bound estimates of seismically induced secondary fracture shear displacements are needed. For this purpose, we analyze a model including an earthquake fault, which is surrounded by a number of smaller discontinuities representing fractures on which secondary displacements may be induced. Initial stresses are applied and a rupture is initiated at a predefined hypocenter and propagated at a specified rupture speed. During rupture we monitor shear displacements taking place on the nearby fracture planes in response to static as well as dynamic effects. As a numerical tool, we use the 3Dimensional Distinct Element Code (3DEC) because it has the capability to handle numerous discontinuities with different orientations and at different locations simultaneously. In tests performed to benchmark the capability of our method to generate and propagate seismic waves, 3DEC generates results in good agreement with results from both Stokes solution and the Compsyn code package. In a preliminary application of our method to the nuclear waste repository site at Forsmark, southern Sweden, we assume end-glacial stress conditions and rupture on a shallow, gently dipping, highly prestressed fault with low residual strength. The rupture generates nearly complete stress drop and an M-w 5.6 event on the 12 km(2) rupture area. Of the 1584 secondary fractures (150 m radius), with a wide range of orientations and locations relative to the fault, a majority move less than 5 mm. The maximum shear displacement is some tens of millimeters at 200 m fault-fracture distance.

Weak layer fracture: facets and depth hoar

Directory of Open Access Journals (Sweden)

I. Reiweger

2013-09-01

Full Text Available Understanding failure initiation within weak snow layers is essential for modeling and predicting dry-snow slab avalanches. We therefore performed laboratory experiments with snow samples containing a weak layer consisting of either faceted crystals or depth hoar. During these experiments the samples were loaded with different loading rates and at various tilt angles until fracture. The strength of the samples decreased with increasing loading rate and increasing tilt angle. Additionally, we took pictures of the side of four samples with a high-speed video camera and calculated the displacement using a particle image velocimetry (PIV algorithm. The fracture process within the weak layer could thus be observed in detail. Catastrophic failure started due to a shear fracture just above the interface between the depth hoar layer and the underlying crust.

Diagnosis of scaphoid fracture: optimal imaging techniques

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Geijer M

2013-07-01

Full Text Available Mats Geijer Center for Medical Imaging and Physiology, Skåne University Hospital and Lund University, Lund, Sweden Abstract: This review aims to provide an overview of modern imaging techniques for evaluation of scaphoid fracture, with emphasis on occult fractures and an outlook on the possible evolution of imaging; it also gives an overview of the pathologic and anatomic basis for selection of techniques. Displaced scaphoid fractures detected by wrist radiography, with or without special scaphoid views, pose no diagnostic problems. After wrist trauma with clinically suspected scaphoid fracture and normal scaphoid radiography, most patients will have no clinically important fracture. Between 5% and 19% of patients (on average 16% in meta-analyses will, however, have an occult scaphoid fracture which, untreated, may lead to later, potentially devastating, complications. Follow-up imaging may be done with repeat radiography, tomosynthesis, computed tomography, magnetic resonance imaging (MRI, or bone scintigraphy. However, no method is perfect, and choice of imaging may be based on availability, cost, perceived accuracy, or personal preference. Generally, MRI and bone scintigraphy are regarded as the most sensitive modalities, but both are flawed by false positive results at various rates. Keywords: occult fracture, wrist, radiography, computed tomography, magnetic resonance imaging, radionuclide imaging

Contact characteristics of the subtalar joint after a simulated calcaneus fracture.

Science.gov (United States)

Sangeorzan, B J; Ananthakrishnan, D; Tencer, A F

1995-06-01

A simple calcaneus fracture consisting of two parts was modeled in nine fresh cadaver hindfoot specimens to assess changes in subtalar joint contact characteristics with increasing plantar depression of the posterolateral fracture component. To perform the experiment, rods were placed in the tibial and fibular shafts of each specimen, which was mounted in a frame in neutral stance. A pneumatic cylinder was used to deliver a vertical compressive load through the rods into the foot while permitting free motion of the foot in the horizontal plane. Sealed packets of pressure-sensitive film were inserted into the anterior-middle and posterior facets of the talocalcaneal articulation, and a 700-N load was applied. After testing of the intact foot, a primary fracture line was created using a microoscillating saw. The osteotomized posterolateral component was anatomically reduced and fixed, the film inserted, and the load reapplied. The test was repeated after the posterolateral fragment was displaced 2, 5, and 10 mm in a plantar direction. The resulting pressure prints were scanned along with pressure/color density calibration strips using a flat-bed scanner, and an image analysis system was used to determine contact areas within specified pressure intervals. The contact area (> 0.5 MPa) of the posterior facet was significantly decreased with 2, 5, and 10 mm displacements of the posterolateral calcaneus fracture component. The ratio of high-pressure area (< 5.0 MPa) to contact area in the posterior facet was significantly increased only with displacements of 5 and 10 mm. There were no significant changes in any contact parameters in the anterior-middle facet.(ABSTRACT TRUNCATED AT 250 WORDS)

Fracture permeability under effect of normal and shear stress: A preliminary experimental investigation

International Nuclear Information System (INIS)

Mohanty, S.; Manteufel, R.D.; Chowdhury, A.H.

1995-01-01

The change in fracture permeability under mechanical loads have been investigated. An apparatus has been developed to measure change in fracture permeability, when a single fracture is subjected to normal and shear stress. Both radial and linear flow experiments have been conducted by modifying a direct shear test apparatus. Preliminary results suggest a 35-percent change in fracture permeability under normal stress to 8 MPa and nearly 350 percent under shear displacement of 9.9254 m (1 in.) at 5 MPa normal stress. Effort is underway to separate the permeability change due to gouge material production from that of due to dilation

Treatment of neglected femoral neck fracture

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Anil K Jain

2015-01-01

Full Text Available Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the "Pubmed" search with the keywords "NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture." A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a treated by muscle-pedicle bone grafting (MPBG, (b closed/open reduction internal fixation and fibular grafting (c open reduction and internal fixation with valgus osteotomy, (d miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective, classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu′s staging neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90

ARTHROSCOPIC METHOD OF THE RADIAL HEAD FRACTURE OSTEOSYNTHESIS (СASE REPORT

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I. A. Kuznetsov

2016-01-01

Full Text Available Radial head fractures constitute about 3% of all fractures and 30% within the group of elbow joint injuries. Conventional open surgical treatment is accompanied by an extensive soft tissue incision and sometimes by capsule release for adequate visualization. Arthroscopic methods feature relatively insignificant soft tissue trauma, allow to reduce pain syndrome in postoperative period and to accelerate rehabilitation. Besides, arthroscopy improves surgical view in cases of intraarticular fractures and facilitates a better anatomical reduction of articular surface. The authors demonstrate a clinical case of a patient with closed fractures of radial head and ulna coronoid process with displacement of left elbow joint fragments where arthroscopic surgery provided for good anatomical and functional results.

Acoustic emission characterization of fracture toughness for fiber reinforced ceramic matrix composites

International Nuclear Information System (INIS)

Mei, Hui; Sun, Yuyao; Zhang, Lidong; Wang, Hongqin; Cheng, Laifei

2013-01-01

The fracture toughness of a carbon fiber reinforced silicon carbide composite was investigated relating to classical critical stress intensity factor K IC , work of fracture, and acoustic emission energy. The K IC was obtained by the single edge notch beam method and the work of fracture was calculated using the featured area under the load–displacement curves. The K IC , work of fracture, and acoustic emission energy were compared for the composites before and after heat treatment and then analyzed associated with toughening microstructures of fiber pullout. It indicates that the work of fracture and acoustic emission energy can be more suitable to reflect the toughness rather than the traditional K IC , which has certain limitation for the fracture toughness characterization of the crack tolerant fiber ceramic composites.

Atypical femur fractures associated with bisphosphonates: from prodrome to resolution

Directory of Open Access Journals (Sweden)

Braulio Sastre-Jala

2015-10-01

Full Text Available Atypical fractures related to the prolonged use of bisphosphonates are caused by low energy mechanisms and are characterized by oblique and transverse lines and frequent bilateralism. We present a clinical case of a patient who we believe illustrates, both in clinical and radiological aspects, the new definition of atypical femur fracture related to treatment using bisphosphonates treated conservatively and successfully with discharge and teriparatide 20 mcg/80 mcl s.c./24h. The appearance of painful symptoms in the upper thigh, especially if bilateral, in patients treated with bisphosphonates for long periods of time, makes it necessary to dismiss bone lesions that might otherwise suggest atypical fracture. In those cases where the fracture is incomplete, restoring bone metabolism through the administration of teriparatide 20 mcg/80 mcl s.c./24h could prevent displaced fractures.

STUDY ON SPANNING EXTERNAL FIXATORS FOR PERIARTICULAR OPEN FRACTURES

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Prasanth Maddila

2017-04-01

Full Text Available BACKGROUND Open fractures which occur close to any fracture need immobilisation for the soft tissues to heal. Some open fractures are even fixed with provisional fixations to maintain the alignment of the fractures. The provisional fixation needs to be augmented with external support, which can be given by spanning external fixators across a joint. MATERIALS AND METHODS Our study consists of 38 open fractures of the lower limbs, which are of Gustilo-Anderson’s type IIIB, an MT4 of AO-ASIF soft tissue injury classification essentially requiring open wound management as well as fracture fixation. Wound lavage and debridements are carried out till the soft tissues show granulations. The position in which joint is immobilised is functional and with access to open wound for dressings and inspection without any displacement of the fracture as well as creeping granulation tissue. RESULTS All the cases in our study are maintained with functional position till soft tissue cover is achieved and provisional fixation is done with definitive fixation after soft tissue cover with skin grafting. CONCLUSION Spanning external fixators are useful in maintaining functional positions as well as augmenting the provisional fixation of the compound fractures.

The enhanced local pressure model for the accurate analysis of fluid pressure driven fracture in porous materials

NARCIS (Netherlands)

Remij, E.W.; Remmers, J.J.C.; Huyghe, J.M.R.J.; Smeulders, D.M.J.

2015-01-01

In this paper, we present an enhanced local pressure model for modelling fluid pressure driven fractures in porous saturated materials. Using the partition-of-unity property of finite element shape functions, we describe the displacement and pressure fields across the fracture as a strong

Simulation of water seepage through a vadose zone in fractured rock

International Nuclear Information System (INIS)

Fuentes, Nestor O.

2003-01-01

In order to improve our understanding of the vadose zone in fractured rock, obtaining useful tools to simulate, predict and prevent subsurface contamination, a three-dimensional model has been developed from the base of recent two-dimensional codes. Fracture systems are simulated by means of a dynamical evolution of a random-fuse network model, and the multiphase expression of Richards equation is used to describe fluid displacements. Physical situations presented here emphasized the importance of fracture connectivity and spatial variability on the seepage evolution through the vadose zone, and confirm the existence of dendritic patterns along localized preferential paths. (author)

Correlation between classification and secondary screw penetration in proximal humeral fractures.

Directory of Open Access Journals (Sweden)

Qiuke Wang

Full Text Available In this study, we investigated the correlation between fracture classification and secondary screw penetration.We retrospectively identified 189 patients with displaced proximal humeral fractures treated by ORIF at our hospital between June 2006 and June 2013. All fractures were classified radiographically before surgery and follow-up for least 2 years after surgery was recommended. At each follow-up, radiographs were taken in three orthogonal views to evaluate secondary screw penetration.The study population consisted of 189 patients. Of these, 70 were male and 119 female, with a mean age of 59.1 years; the mean follow-up time was 28.5 months. Secondary screw penetration occurred in 26 patients. The risk of developing secondary screw penetration was 11.3-fold higher in four-part fractures than two-part fractures (P 0.05.Patients with four-part fractures, type C fractures and medial hinges disruption are vulnerable to secondary screw penetration. This allows additional precautions to be instituted and measures to be taken as needed.

Plastic fracture mechanics prediction of fracture instability in a circumferentially cracked pipe in bending - 1. J-integral analysis

Energy Technology Data Exchange (ETDEWEB)

Zahoor, A.; Kanninen, M.F.

1981-11-01

A method of evaluating the J-integral for a circumferentially cracked pipe in bending is proposed. The method allows a J-resistance curve to be evaluated directly from the load-displacement record obtained in a pipe fracture experiment. It permits an analysis for fracture instability in a circumferential crack growth using a J-resistance curve and the tearing modulus parameter. The influence of the system compliance on fracture instability is discussed in conjunction with the latter application. The importance of using a J-resistance curve that is consistent with the type of constraint for a given application is emphasized. The possibility of a pipe fracture emanating from a stress corrosion crack in the heat-affected zones of girth-welds in Type 304 stainless steel pipes was investigated. The J-resistance curve was employed. A pipe fracture experiment was performed using a spring-loaded four-point bending system that simulated an 8.8-m long section of unsupported 102-mm-dia pipe. An initial through-wall crack of length equal to 104 mm was used. Fracture instability was predicted to occur between 15.2 and 22.1 mm of stable crack growth at each tip. In the actual experiment, the onset of fracture instability occurred beyond maximum load at an average stable crack growth of 11.7 to 19 mm at each tip. 24 refs.

Plastic fracture mechanics prediction of fracture instability in a circumferentially cracked pipe in bending - 1. J-integral analysis

International Nuclear Information System (INIS)

Zahoor, A.; Kanninen, M.F.

1981-01-01

A method of evaluating the J-integral for a circumferentially cracked pipe in bending is proposed. The method allows a J-resistance curve to be evaluated directly from the load-displacement record obtained in a pipe fracture experiment. It permits an analysis for fracture instability in a circumferential crack growth using a J-resistance curve and the tearing modulus parameter. The influence of the system compliance on fracture instability is discussed in conjunction with the latter application. The importance of using a J-resistance curve that is consistent with the type of constraint for a given application is emphasized. The possibility of a pipe fracture emanating from a stress corrosion crack in the heat-affected zones of girth-welds in Type 304 stainless steel pipes was investigated. The J-resistance curve was employed. A pipe fracture experiment was performed using a spring-loaded four-point bending system that simulated an 8.8-m long section of unsupported 102-mm-dia pipe. An initial through-wall crack of length equal to 104 mm was used. Fracture instability was predicted to occur between 15.2 and 22.1 mm of stable crack growth at each tip. In the actual experiment, the onset of fracture instability occurred beyond maximum load at an average stable crack growth of 11.7 to 19 mm at each tip. 24 refs

Early Experience with Biodegradable Fixation of Pediatric Mandibular Fractures.

Science.gov (United States)

Mazeed, Ahmed Salah; Shoeib, Mohammed Abdel-Raheem; Saied, Samia Mohammed Ahmed; Elsherbiny, Ahmed

2015-09-01

This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-l/dl-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3-12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact.

Estimation scheme for unstable ductile fracture of pressure vessel

International Nuclear Information System (INIS)

Takahashi, Jun; Okamura, Hiroyuki; Sakai, Shinsuke

1990-01-01

This paper presents a new scheme for the estimation of unstable ductile fracture using the J-integral. The proposed method uses a load-versus-displacement diagram which is generated using fully plastic solutions. By this method, the phenomena of the ductile fracture can be grasped visually. Thus, the parametrical survey can be executed far more easily than before. Then, using the proposed method, unstable ductile fracture is analyzed for single-edge cracked plates under both uniform tension and pure bending. In addition, several parametrical surveys are performed concerning (1) J-controlled crack growth, (2) compliance of the structure, (3) ductility of the material (i.e., J-resistance curve), and (4) scale of the structure (i.e., screening criterion). As a result, it is shown that the proposed method is especially effective for the paramtrical study of unstable ductile fracture. (author)

Avascular necrosis associated with nailing of femoral neck fracture

International Nuclear Information System (INIS)

Stroemqvist, B.; Hansson, L.I.

1983-01-01

Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. SR 85 -scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures. (author)

Avascular necrosis associated with nailing of femoral neck fracture

Energy Technology Data Exchange (ETDEWEB)

Stroemqvist, B; Hansson, L I [Department of Orthopaedic Surgery, University Hospital in Lund, Sweden

1983-01-01

Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. Sr/sup 85/-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures.

Internal fixation and muscle pedicle bone grafting in femoral neck fractures

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Gupta A

2008-01-01

Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

Calcaneal Fractures and Böhler’s Angle

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Lindsey Spiegelman

2017-01-01

Full Text Available History of present illness: 40-year-old male presents to the emergency department after falling off a ladder. He was repairing a window when he fell, landing on the ground 12 feet below. The patient landed onto his feet bilaterally and then fell backwards onto his buttocks. On arrival, the patient had bilateral foot pain. He denied any back pain, headache, or loss of consciousness. Significant findings: The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow in addition to fracture fragments along the heel pad margin (blue arrow. The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow. There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle. Discussion: Calcaneal fractures occur typically in adults who have undergone significant axial load on their feet secondary to a fall from high height.2,3 There are two broad types of calcaneal fractures: intraarticular and extraarticular.2 The intraarticular fractures are colloquially referred to as a “Lover’s Fracture” as they have been known to occur in those jumping out of a tall window to escape the wrath of a lover’s spouse.1 Calcaneal fractures are best diagnosed with a CT scan or with lateral x-ray by measuring Böhler’s angle.2,3 This is the angle formed by the intersection of two lines demonstrated on a normal lateral ankle radiograph. The first line is drawn between the superior aspect of the anterior process of the calcaneus (point A and the superior edge of the posterior articular facet (point B. The second line is drawn between the superior aspect of the posterior calcaneal tuberosity (point C and point B.2

Complications of ankle fracture in patients with diabetes.

Science.gov (United States)

Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

2008-03-01

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

Fracture studies on stainless steel straight pipes under earthquake-type cyclic loading

International Nuclear Information System (INIS)

Raghava, G.; Vishnuvardhan, S.; Gandhi, P.; Vaze, K.K.

2014-01-01

In order to study the crack growth and cyclic fracture behaviour, which are required for realistic assessment of Leak Before Break (LBB) applicability, experimental investigations were carried out on straight pipes under quasi-crystal loading. Totally 13 pipes were tested; three were stainless steel welded (SSW) using conventional shielded metal arc welding (SMAW) technique and the remaining specimens were Narrow Gap Welded (NGW). The fracture tests were carried out under load control, displacement control and combination of the two; the pipes were subjected to different amplitudes of load or load-line displacement (LLD), which were decided based on the response of the pipes under monotonic loading. Cyclic tearing and crack growth studies on eight straight pipes of the same material reported earlier in published literature are also considered for studying the results and understanding the behaviour. Under load control, with almost equal load amplitude, the NGW pipe exhibited improved life in comparison with SMAW pipe when both are subjected to cyclic loading. The crack growth and tearing instability behaviour of the pipes were studied. The same were found to be different for load control, displacement control and combined control tests. Based in the load-controlled experimental results, material specific plot between cyclic load amplitude (as a percentage of maximum load carrying capacity of a specimen under monotonic fracture) and number of cycles to failure was obtained. The results indicate that the piping components subjected to quasi-cyclic loading may fail in very less number of cycles even when the load amplitude is sufficiently below the monotonic fracture/collapse load. These studies will be helpful in designing nuclear power plant (NPP) piping components subjected to earthquake-type cyclic loading. (author)

Finite element analysis of the three different posterior malleolus fixation strategies in relation to different fracture sizes.

Science.gov (United States)

Anwar, Adeel; Lv, Decheng; Zhao, Zhi; Zhang, Zhen; Lu, Ming; Nazir, Muhammad Umar; Qasim, Wasim

2017-04-01

Appropriate fixation method for the posterior malleolar fractures (PMF) according to the fracture size is still not clear. Aim of this study was to evaluate the outcomes of the different fixation methods used for fixation of PMF by finite element analysis (FEA) and to compare the effect of fixation constructs on the size of the fracture computationally. Three dimensional model of the tibia was reconstructed from computed tomography (CT) images. PMF of 30%, 40% and 50% fragment sizes were simulated through computational processing. Two antero-posterior (AP) lag screws, two postero-anterior (PA) lag screws and posterior buttress plate were analysed for three different fracture volumes. The simulated loads of 350N and 700N were applied to the proximal tibial end. Models were fixed distally in all degrees of freedom. In single limb standing condition, the posterior plate group produced the lowest relative displacement (RD) among all the groups (0.01, 0.03 and 0.06mm). Further nodal analysis of the highest RD fracture group showed a higher mean displacement of 4.77mm and 4.23mm in AP and PA lag screws model (p=0.000). The amounts of stress subjected to these implants, 134.36MPa and 140.75MPa were also significantly lower (p=0.000). There was a negative correlation (p=0.021) between implant stress and the displacement which signifies a less stable fixation using AP and PA lag screws. Progressively increasing fracture size demands more stable fixation construct because RD increases significantly. Posterior buttress plate produces superior stability and lowest RD in PMF models irrespective of the fragment size. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of orthodontic brackets for intermaxillary fixation for management of mandibular fracture in a pediatric patient

OpenAIRE

Rajeev Pandey; Anit Khatri; Rajat Gupta; Nitin Bhagat

2017-01-01

Fracture of mandible is relatively less common in pediatric population when compared to adults. Management of pediatric mandibular fracture is a very complex issue and requires accurate and early treatment. Although the general principles of treatment remain the same as adult but various factors which influence the choice of management: age, dentition status, site involved, amount of displacement, number of fractures, and socioeconomic status. This case report describes a conservative way of ...

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)

Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M.

2006-01-01

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

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.

A numerical approach for assessing effects of shear on equivalent permeability and nonlinear flow characteristics of 2-D fracture networks

Science.gov (United States)

Liu, Richeng; Li, Bo; Jiang, Yujing; Yu, Liyuan

2018-01-01

Hydro-mechanical properties of rock fractures are core issues for many geoscience and geo-engineering practices. Previous experimental and numerical studies have revealed that shear processes could greatly enhance the permeability of single rock fractures, yet the shear effects on hydraulic properties of fractured rock masses have received little attention. In most previous fracture network models, single fractures are typically presumed to be formed by parallel plates and flow is presumed to obey the cubic law. However, related studies have suggested that the parallel plate model cannot realistically represent the surface characters of natural rock fractures, and the relationship between flow rate and pressure drop will no longer be linear at sufficiently large Reynolds numbers. In the present study, a numerical approach was established to assess the effects of shear on the hydraulic properties of 2-D discrete fracture networks (DFNs) in both linear and nonlinear regimes. DFNs considering fracture surface roughness and variation of aperture in space were generated using an originally developed code DFNGEN. Numerical simulations by solving Navier-Stokes equations were performed to simulate the fluid flow through these DFNs. A fracture that cuts through each model was sheared and by varying the shear and normal displacements, effects of shear on equivalent permeability and nonlinear flow characteristics of DFNs were estimated. The results show that the critical condition of quantifying the transition from a linear flow regime to a nonlinear flow regime is: 10-4 〈 J hydraulic gradient. When the fluid flow is in a linear regime (i.e., J reduce the equivalent permeability significantly in the orientation perpendicular to the sheared fracture as much as 53.86% when J = 1, shear displacement Ds = 7 mm, and normal displacement Dn = 1 mm. By fitting the calculated results, the mathematical expression for δ2 is established to help choose proper governing equations when

Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus

NARCIS (Netherlands)

Wijgman, A. J.; Roolker, W.; Patt, T. W.; Raaymakers, E. L. F. B.; Marti, R. K.

2002-01-01

BACKGROUND: Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and

The Vector Electric Field Investigation on the C/NOFS Satellite

Science.gov (United States)

Pfaff, R.; Acuna, M.; Kujawski, J.; Fourre, R.; Uribe, P.; Hunsaker, F.; Rowland, D.; Le, G.; Farrell, W.; Maynard, N.;

Primary Total Hip Replacement for a Femoral Neck Fracture in a Below-Knee Amputee

OpenAIRE

Masmoudi, Karim; Rbai, H?di; Fradj, Ayman Ben; Sa?dena, Jecem; Boughattas, Anouar

2016-01-01

Introduction: Femoral neck fracture on amputated limb is an uncommon lesion and challenging to manage. Case Report: We report a case of a displaced neck fracture of the left femur in a 57-year-old female. She underwent at the age of the three a below-knee amputation of the ipsilateral limb for post traumatic ischemia. The fracture was managed by a total hip arthroplasty (THA), as a primary procedure. In this article we describe our experience of this unusual entity. Conclusion: Total hip arth...

Simulation of petroleum recovery in naturally fractured reservoirs: physical process representation

Energy Technology Data Exchange (ETDEWEB)

Paiva, Hernani P.; Miranda Filho, Daniel N. de [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil); Schiozer, Denis J. [Universidade Estadual de Campinas (UNICAMP), SP (Brazil)

2012-07-01

The naturally fractured reservoir recovery normally involves risk especially in intermediate to oil wet systems because of the simulations poor efficiency results under waterflood displacement. Double-porosity models are generally used in fractured reservoir simulation and have been implemented in the major commercial reservoir simulators. The physical processes acting in petroleum recovery are represented in double-porosity models by matrix-fracture transfer functions, therefore commercial simulators have their own implementations, and as a result different kinetics and final recoveries are attained. In this work, a double porosity simulator was built with Kazemi et al. (1976), Sabathier et al. (1998) and Lu et al. (2008) transfer function implementations and their recovery results have been compared using waterflood displacement in oil-wet or intermediate-wet systems. The results of transfer function comparisons have showed recovery improvements in oil-wet or intermediate-wet systems under different physical processes combination, particularly in fully discontinuous porous medium when concurrent imbibition takes place, coherent with Firoozabadi (2000) experimental results. Furthermore, the implemented transfer functions, related to a double-porosity model, have been compared to double-porosity commercial simulator model, as well a discrete fracture model with refined grid, showing differences between them. Waterflood can be an effective recovery method even in fully discontinuous media for oil-wet or intermediate-wet systems where concurrent imbibition takes place with high enough pressure gradients across the matrix blocks. (author)

An efficient hydro-mechanical model for coupled multi-porosity and discrete fracture porous media

Science.gov (United States)

Yan, Xia; Huang, Zhaoqin; Yao, Jun; Li, Yang; Fan, Dongyan; Zhang, Kai

2018-02-01

In this paper, a numerical model is developed for coupled analysis of deforming fractured porous media with multiscale fractures. In this model, the macro-fractures are modeled explicitly by the embedded discrete fracture model, and the supporting effects of fluid and fillings in these fractures are represented explicitly in the geomechanics model. On the other hand, matrix and micro-fractures are modeled by a multi-porosity model, which aims to accurately describe the transient matrix-fracture fluid exchange process. A stabilized extended finite element method scheme is developed based on the polynomial pressure projection technique to address the displacement oscillation along macro-fracture boundaries. After that, the mixed space discretization and modified fixed stress sequential implicit methods based on non-matching grids are applied to solve the coupling model. Finally, we demonstrate the accuracy and application of the proposed method to capture the coupled hydro-mechanical impacts of multiscale fractures on fractured porous media.

Multiple intramedullary nailing of proximal phalangeal fractures of hand

Directory of Open Access Journals (Sweden)

Patankar Hemant

2008-01-01

Full Text Available Background: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique. Materials and Methods: Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength. Results: All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient. Conclusion: Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.

Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture.

Science.gov (United States)

Min, Byung-Woo; Kim, Sung-Jin

2011-05-18

The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. We evaluated the incidence of avascular necrosis of the femoral head with the use of contemporary techniques for femoral neck fracture fixation. We then sought to determine what potential risk factors influenced the development of avascular necrosis.Between 1990 and 2005, one hundred sixty-three intracapsular femoral neck fractures in 163 patients were treated with internal fixation at our level-I trauma center. All patients were monitored until conversion to total hip arthroplasty or for a minimum of 2 years postoperatively. Ten patients (10 hips) died and 7 patients (7 hips) were lost to follow-up. The remaining 146 patients (146 hips) had a mean 5.2 years of follow-up (range, 3 months to 17 years). The incidence of avascular necrosis was 25.3% (37 hips). The average time to diagnosis of avascular necrosis was 18.8 months (range, 3-47 months). Patient sex, age, interval from injury to surgery, and mechanism of injury were statistically not associated with the development of avascular necrosis. The quality of fracture reduction, adequacy of fixation, degree of displacement, and comminution of the posterior cortex were significantly associated. After we controlled for patient and radiographic characteristics, multivariate analyses indicated that the important predictors for avascular necrosis are poor reduction (odds ratio=13.889) and initial displacement of the fracture (odds ratio=4.693). Copyright 2011, SLACK Incorporated.

Oil recovery enhancement from fractured, low permeability reservoirs. Part 2, Annual report, October 1, 1990--September 31, 1991

Energy Technology Data Exchange (ETDEWEB)

Poston, S.W.

1991-12-31

The results of the investigative efforts for this jointly funded DOE-State of Texas research project achieved during the 1990--1991 year may be summarized as follows: Geological Characterization -- Detailed maps of the development and hierarchical nature the fracture system exhibited by Austin Chalk outcrops were prepared. These results of these efforts were directly applied to the development of production decline type curves applicable to a dual fracture-matrix flow system. Analysis of production records obtained from Austin Chalk operators illustrated the utility of these type curves to determine relative fracture/matrix contributions and extent. Well-log response in Austin Chalk wells has been shown to be a reliable indicator of organic maturity. (VSP) Vertical-Seismic Profile data was used to use shear-wave splitting concepts to estimate fracture orientations. Several programs were to be written to facilitate analysis of the data. The results of these efforts indicated fractures could be detected with VSP seismic methods. Development of the (EOR) Enhanced Oil Recovery Imbibition Process -- Laboratory displacement as well as MRI and CT imaging studies have shown the carbonated water-imbibition displacement process significantly accelerates and increases recovery of an oil saturated, low permeability core material, when compared to that of a normal brine imbibition displacement process. A study of oil recovery by the application of a cyclic carbonated water imbibition process, followed by reducing the pressure below the bubble point of the CO{sub 2}-water solution, indicated the possibility of alternate and new enhanced recovery method. The installation of an artificial solution gas drive significantly increased oil recovery. The extent and arrangement of micro-fractures in Austin Chalk horizontal cores was mapped with CT scanning techniques. The degree of interconnection of the micro-fractures was easily visualized.

Determination of fracture parameters for interface cracks in transverse isotropic magnetoelectroelastic composites

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Lei Jun

2015-01-01

Full Text Available To determine fracture parameters of interfacial cracks in transverse isotropic magnetoelectroelastic composites, a displacement extrapolation formula was derived. The matrix-form formula can be applicable for both material components with arbitrary poling directions. The corresponding explicit expression of this formula was obtained for each poling direction normal to the crack plane. This displacement extrapolation formula is only related to the boundary quantities of the extended crack opening displacements across crack faces, which is convenient for numerical applications, especially for BEM. Meantime, an alternative extrapolation formula based on the path-independent J-integral and displacement ratios was presented which may be more adaptable for any domain-based numerical techniques like FEM. A numerical example was presented to show the correctness of these formulae.

Numerical simulation of single-phase and multiphase non-Darcy flowin porous and fractured reservoirs

Energy Technology Data Exchange (ETDEWEB)

Wu, Yu-Shu

2000-06-02

A numerical method as well as a theoretical study of non-Darcy fluid flow of through porous and fractured reservoirs is described. The non-Darcy flow is handled in a three-dimensional, multiphase flow reservoir simulator, while the model formulation incorporates the Forchheimer equation for describing single-phase or multiphase non-Darcy flow and displacement. The numerical scheme has been verified by comparing its results against those of analytical methods. Numerical solutions are used to obtain some insight into the physics of non-Darcy flow and displacement in reservoirs. In addition, several type curves are provided for well-test analyses of non-Darcy flow to demonstrate a methodology for modeling this type of flow in porous and fractured rocks, including flow in geothermal reservoirs.

Technology development on analysis program for measuring fracture toughness of irradiated specimens

International Nuclear Information System (INIS)

Shibata, Akira; Takada, Fumiki

2007-03-01

The fracture toughness which represents resistance for brittle or ductile fracture is one of the most important material property concerning linear and non-linear fracture mechanics analyses. In order to respond to needs of collecting data relating to fracture toughness of pressure vessel and austenitic stainless steels, fracture toughness test for irradiated materials has been performed in JMTR hot laboratory. On the other hand, there has been no computer program for analysis of fracture toughness using the test data obtained from the test apparatus installed in the hot cell. Therefore, only load-displacement data have been provided to users to calculate fracture toughness of irradiated materials. Recently, request of analysis of fracture toughness have been increased. Thus a computer program, which calculates the amount of the crack extension, the compliance and the fracture toughness from the data acquired from the test apparatus installed in the hot cell, has been developed. In the program unloading elastic compliance method is applied based on ASTM E1820-01. Through the above development, the request for the fracture toughness analysis can be satisfied and the fracture toughness of irradiated test specimens can be provided to users. (author)

Fractures of the third trochanter in horses: 8 cases (2000-2012).

Science.gov (United States)

Bertoni, Lélia; Seignour, Maeva; de Mira, Monica C; Coudry, Virginie; Audigie, Fabrice; Denoix, Jean-Marie

2013-07-15

To determine history; clinical, radiographic, ultrasonographic, and scintigraphic features; management; and outcome associated with third trochanter fractures in horses. Retrospective case series. 8 horses. Records from 2000 to 2012 were reviewed, and signalment, case history, severity and duration of lameness, results of physical and lameness examinations, imaging findings, management, and outcome were evaluated. All horses had a history of acute onset of severe lameness. Four of the 8 horses had localizing physical signs of fracture. No specific gait characteristics were identified. Ultrasonographically, there was a single bony fragment displaced cranially in 7 of 8 horses and multiple bony fragments in 1. Concurrent gluteus superficialis muscle enthesopathy was identified in 7 horses. A standing craniolateral-caudomedial 25° oblique radiographic view was obtained in 3 horses to document the lesion and revealed in all 3 horses a simple complete longitudinal fracture between the midlevel and the base of the third trochanter. Nuclear scintigraphy was used to identify the affected area of the limb for further examination in 2 horses. Follow-up revealed that fractures healed with a fibrous union, with persistence of cranial displacement of the fragment. Lameness resolved after nonsurgical management for all horses. Fracture of the third trochanter should be considered as a cause of hind limb lameness in horses when the proximal portion of the limb is affected. Diagnosis can easily be made with ultrasonography, but nuclear scintigraphy may help in identifying the lesion. Prognosis for return to athletic activity is good after an appropriate period of rest and restricted exercise.

Evaluation of static and dynamic fracture toughness in ductile cast iron

International Nuclear Information System (INIS)

Kobayashi, Toshiro; Yamada, Shinya

1994-01-01

Ductile cast irons have been explored as a cask (container for spent nuclear fuel) material because of their low cost and good formability. The cask, which is a huge casting with 400-mm thickness and 100-Mg weight, envelops the nuclear material. Therefore, the fracture toughness of cask must be evaluated not only under the static loading condition but also under the dynamic loading condition to ensure its safety against an accident during the transport. In this article, crack extension behavior and fracture toughness of ductile cast iron were examined by three-point bend tests, where various detection methods of crack initiation under static and dynamic loading conditions were adopted. Loading on the specimens was interrupted at various displacement points, and the final fracture surfaces of the specimen were observed via scanning electron microscopy (SEM). Crack-tip opening displacement (CTOD) obtained under the dynamic loading conditions was smaller than that under the static loading condition in ferritic ductile cast iron, and CTOD additionally decreased with increasing pearlite content in the matrix. The relationship between J(ΔC) obtained by the compliance changing rate method and J(R) established by the intersection of the crack extension resistance curve and the theoretical blunting line varied with pearlite content. The average value of J(ΔC) and J(R), that is J(mid), was proposed to define the fracture toughness of ductile cast iron; J(mid) was considered to be a reasonable measure for the fracture toughness of ductile cast iron, irrespective of loading condition and the pearlite content in the matrix

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

Science.gov (United States)

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

2016-08-01

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

Effect of interfragmentary gap on the mechanical behavior of mandibular angle fracture with three fixation designs: A finite element analysis.

Science.gov (United States)

Wang, Russell; Liu, Yunfeng; Wang, Joanne Helen; Baur, Dale Allen

2017-03-01

The aim of this study was to simulate stress and strain distribution numerically on a normal mandible under physiological occlusal loadings. The results were compared with those of mandibles that had an angle fracture stabilized with different fixation designs under the same loadings. The amount of displacement at two interfragmentary gaps was also studied. A three-dimensional (3D) virtual mandible was reconstructed with an angle fracture that had a fracture gap of either 0.1 or 1 mm. Three types of plate fixation designs were used: Type I, a miniplate was placed across the fracture line following the Champy technique; Type II, two miniplates were used; and Type III, a reconstruction plate was used on the inferior border of the mandible. Loads of 100 and 500 N were applied to the models. The maximum von Mises stress, strain, and displacement were computed using finite element analysis. The results from the control and experimental groups were analyzed and compared. The results demonstrated that high stresses and strains were distributed to the condylar and angular areas regardless of the loading position. The ratio of the plate/bone average stress ranged from 215% (Type II design) to 848% (Type I design) irrespective of the interfragmentary gap size. With a 1-mm fracture gap, the ratio of the plate/bone stress ranged from 204% (Type II design) to 1130% (Type I design). All strains were well below critical bone strain thresholds. Displacement on the cross-sectional mapping at fracture interface indicated that uneven movement occurred in x, y, and z directions. Interfragmentary gaps between 0.1 and 1 mm did not have a substantial effect on the average stress distribution to the fractured bony segments; however, they had a greater effect on the stress distribution to the plates and screws. Type II fixation was the best mechanical design under bite loads. Type I design was the least stable system and had the highest stress distribution and the largest displacement