Bilateral Complex Regional Pain Syndrome after Fracture of Bilateral Tibia and Fibula

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Senem Şaş

2017-04-01

Full Text Available Complex regional syndrome type 1 (CRPS-1 is a painful clinical condition. It occurs after a painful event and characterized by allodynia, hyperalgesia, edema, abnormalities in skin blood flow and abnormal sudomotor activity. When CRPS-1 is associated with nerve injury, it is defined as CRPS-2. Central and peripheral theory are responsible in etiopathogenesis of CRPS-1. Generally it occurs in the injured limb. But, it may ocur in the opposite extremities. In this article, we present a case developing bilateral CRPS-1 after bilateral tibia and fibula fracture by reviewing current literatüre.

Lower limb stress fractures in sport: Optimising their management and outcome

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Robertson, Greg A J; Wood, Alexander M

2017-01-01

Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting. PMID:28361017

Lower limb stress fractures in sport: Optimising their management and outcome.

Science.gov (United States)

Robertson, Greg A J; Wood, Alexander M

2017-03-18

Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by "high" and "low" risk. "Low risk" stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. "High risk" stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting.

Evaluation of Fibular Fracture Type vs Location of Tibial Fixation of Pilon Fractures.

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Busel, Gennadiy A; Watson, J Tracy; Israel, Heidi

2017-06-01

Comminuted fibular fractures can occur with pilon fractures as a result of valgus stress. Transverse fibular fractures can occur with varus deformation. No definitive guide for determining the proper location of tibial fixation exists. The purpose of this study was to identify optimal plate location for fixation of pilon fractures based on the orientation of the fibular fracture. One hundred two patients with 103 pilon fractures were identified who were definitively treated at our institution from 2004 to 2013. Pilon fractures were classified using the AO/OTA classification and included 43-A through 43-C fractures. Inclusion criteria were age of at least 18 years, associated fibular fracture, and definitive tibial plating. Patients were grouped based on the fibular component fracture type (comminuted vs transverse), and the location of plate fixation (medial vs lateral) was noted. Radiographic outcomes were assessed for mechanical failures. Forty fractures were a result of varus force as evidenced by transverse fracture of the fibula and 63 were due to valgus force with a comminuted fibula. For the transverse fibula group, 14.3% mechanical complications were noted for medially placed plate vs 80% for lateral plating ( P = .006). For the comminuted fibular group, 36.4% of medially placed plates demonstrated mechanical complications vs 16.7% for laterally based plates ( P = .156). Time to weight bearing as tolerated was also noted to be significant between groups plated medially and laterally for the comminuted group ( P = .013). Correctly assessing the fibular component for pilon fractures provides valuable information regarding deforming forces. To limit mechanical complications, tibial plates should be applied in such a way as to resist the original deforming forces. Level of Evidence Level III, comparative study.

[Z-osteotomy of distal fibula to correct widened ankle mortice after fracture].

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Tao, Xu; Tang, Kanglai; Zhou, Jianbo

2012-07-01

To analyse the clinical outcomes of the Z-osteotomy of the distal fibula to correct widened mortice of the ankle after fracture. Between September 2009 and February 2011, 5 patients (5 feet) with widened ankle mortice after fracture underwent Z-osteotomy. There were 4 males and 1 female, aged from 23 to 58 years (mean, 38 years). At 3 months after operation of internal fixation when function exercises were done, patients got pains. The interval between trauma and operation ranged from 5 to 36 months (mean, 13.2 months). Lateral pressure test showed positive in 2 cases and negative in 3 cases. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 50.2 +/- 17.3. Primary healing of incision was achieved in all cases. Five patients were followed up 9 to 24 months (mean, 15.6 months). Mild to moderate swelling of the affected limb and anterolateral skin numbness of the ipsilateral dorsal foot occurred, and gradually improved. The clinical exam and radiology showed bone union at 12-15 weeks (mean, 13.5 weeks). Postoperative range of motion of ankle had no significant improvement. AOFAS ankle-hindfoot scores were 76.8 +/- 11.2 at 6 months after operation, and 85.4 +/- 3.2 at last follow-up, showing significant differences when compared with preoperative score (P ankle mortice after fracture; Z-osteotomy can effectively reduce the width of the ankle mortice, increase the stability of ankle joint, and decrease the complication rate.

Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

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Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

2017-09-01

Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

Double segmental tibial fractures - an unusual fracture pattern

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Bali Kamal

2012-02-01

Full Text Available 【Abstract】A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech- nique with a pleasing outcome. Key words: Fracture, bone; Tibia; Fibula; Nails

Valgusdeformitet i anklen som følge af distal fibula-epifysefraktur

DEFF Research Database (Denmark)

Al-Aubaidi, Zaid

2011-01-01

Ankle fracture with involvement of the growth plate is the second most common paediatric fracture after the distal radius. The most common fracture type according to Salter Harris (SH) is type II of the distal tibia combined with green stick of the fibula. Isolated fracture of the distal fibular...... growth plate is not common and as a rule it does not give any growth arrest. We describe a case of isolated fibular fracture SH type II in a ten year-old girl which ended with symptomatic valgus deformity of the ankle. The patient was operated with good results....

Stress Fractures

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

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

NARCIS (Netherlands)

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

2008-01-01

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

Controlling rotational deformity in ankle fractures : the Bridgend ...

African Journals Online (AJOL)

Management. Recognition of the forces is usually possible by observing the pattern of the fracture lines, especially in the fibula. Abduction and adduction forces cause transverse or short oblique fracture lines near the level of the ankle joint (Fig 1) whereas rotation forces produce spiral fractures of the fibula above the level ...

Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures.

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Parrett, Brian M; Matros, Evan; Pribaz, Julian J; Orgill, Dennis P

2006-04-01

Open lower leg fractures with exposed bone or tendon continue to be challenging for plastic surgeons. Microvascular free-tissue transfer increases the ability to close wounds, transfer vascularized bone, and prevent amputation, yet remains a complex, invasive procedure with significant complication rates, donor-site morbidity, and failure rates. This review documents the changing treatment protocol in the authors' institution for these injuries. Two hundred ninety consecutive open tibia-fibula fractures over a 12-year period (1992 to 2003) were retrospectively reviewed and methods and outcomes were compared by grouping the fractures into 4-year intervals. The number of open lower extremity fractures increased, whereas the distribution of Gustilo grade I to III fractures remained unchanged. Overall, free-tissue transfer was performed less frequently and constituted 20 percent of reconstructions in period 1 (1992 to 1995), 11 percent in period 2 (1996 to 1999), and 5 percent in period 3 (2000 to 2003). For the most severe fractures, Gustilo grade III, free-flap reconstruction has decreased significantly, constituting 42 percent, 26 percent, and 11 percent of procedures in periods 1, 2, and 3, respectively. Local flaps for grade III fractures have remained relatively constant throughout the study. In contrast, local wound care for grade III fractures, including skin grafts, delayed primary closures, and secondary intention closures has significantly increased from 22 percent to 49 percent of reconstructions from periods 1 through 3. In 1997, the authors began to use the vacuum-assisted closure device and now use it in nearly half of all open fractures. Despite this trend, there has been no change in infection, amputation, or malunion/nonunion rates and a decrease in reoperation rate with at least 1-year follow-up. These results demonstrate a change in practice, with a trend down the reconstructive ladder, currently using fewer free flaps and more delayed closures and

Implantes de biomateriais em falha óssea produzida na fíbula de ratos Biomaterial implants in bone fractures produced in rat fibulas

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Henrique Yassuhiro Shirane

2010-01-01

Full Text Available OBJETIVO: Avaliar a importância do colágeno e hidroxiapatita na regeneração de fraturas provocadas experimentalmente na fíbula de ratos. MÉTODOS: Utilizou-se 15 ratos nos quais foram submetidos à cirurgia para retirada de um fragmento da fíbula sendo o local enxertado com tubos de silicone preenchidos com hidroxiapatita e colágeno. RESULTADOS: Ocorreu pouca neoformação óssea no interior dos tubos preenchidos com os biomateriais sendo em maior quantidade naqueles com colágeno. CONCLUSÃO: Os biomateriais usados apresentaram biocompatibilidade e capacidade osteocondutora capaz de estimular a osteogênese mesmo nos ossos com funções mecânicas e morfológicas secundárias como a fíbula de ratos.OBJECTIVE: To evaluate the importance of collagen and hydroxyapatite in the regeneration of fractures experimentally induced in the fibulas of mice. METHOD: 15 rats were submitted to a surgery for the removal of a fragment of the fibula. The fragment was replaced by a silicone tube filled with hydroxyapatite and collagen. RESULTS: Little bone neoformation occurred inside the tubes filled with biomaterials, the largest amount occurring in those with collagen. CONCLUSION: The biomaterials used demonstrated biocompatibility and osteoconductive capacity capable of stimulating osteogenesis, even in bones with secondary mechanical and morphological functions such as the fibula of the rat.

Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion.

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El Ashry, Saad R; El Gamal, Tarek A; Platt, Simon R

Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

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CK Chan

2013-07-01

Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

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

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

2014-01-01

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

Effect of hyperbaric oxygen therapy combined with autologous platelet concentrate applied in rabbit fibula fraction healing

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Paulo Cesar Fagundes Neves

2013-09-01

Full Text Available OBJECTIVES: The purpose is to study the effects of hyperbaric oxygen therapy and autologous platelet concentrates in healing the fibula bone of rabbits after induced fractures. METHODS: A total of 128 male New Zealand albino rabbits, between 6-8 months old, were subjected to a total osteotomy of the proximal portion of the right fibula. After surgery, the animals were divided into four groups (n = 32 each: control group, in which animals were subjected to osteotomy; autologous platelet concentrate group, in which animals were subjected to osteotomy and autologous platelet concentrate applied at the fracture site; hyperbaric oxygen group, in which animals were subjected to osteotomy and 9 consecutive daily hyperbaric oxygen therapy sessions; and autologous platelet concentrate and hyperbaric oxygen group, in which animals were subjected to osteotomy, autologous platelet concentrate applied at the fracture site, and 9 consecutive daily hyperbaric oxygen therapy sessions. Each group was divided into 4 subgroups according to a pre-determined euthanasia time points: 2, 4, 6, and 8 weeks postoperative. After euthanasia at a specific time point, the fibula containing the osseous callus was prepared histologically and stained with hematoxylin and eosin or picrosirius red. RESULTS: Autologous platelet concentrates and hyperbaric oxygen therapy, applied together or separately, increased the rate of bone healing compared with the control group. CONCLUSION: Hyperbaric oxygen therapy and autologous platelet concentrate combined increased the rate of bone healing in this experimental model.

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

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

2011-01-01

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

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

OpenAIRE

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

2014-01-01

INTRODUCTION Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. PRESENTATION OF CASE This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for las...

Stress fracture of the femoral neck in a child (stress fracture)

International Nuclear Information System (INIS)

Coldwell, D.; Gross, G.W.; Boal, D.K.

1984-01-01

Femoral neck stress fracture is extremely rare in childhood. We report a case of femoral neck stress fracture in an 11-year-old girl. Differentials diagnosis and a brief review of the literature follow. (orig.)

Tibiofibula Transposition in High-Energy Fractures

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Peter R. Loughenbury

2016-01-01

Full Text Available We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia. Open reduction and exposure of the fracture sites revealed that the distal fibula fragment was “transposed” and entrapped in the medulla of the proximal tibial fragment. Reduction required simulation of the mechanism of injury in order to disengage the fragments and allow reduction. Tibiofibula transposition is a rare complication of high-energy lower limb fractures which has not previously been reported and may prevent adequate closed reduction. Impaction of the distal fibula within the tibial medulla occurs as the limb is realigned by paramedic staff before transfer to hospital. We recommend that when this complication is identified the patient is transferred to the operating room for open reduction and stabilization of the fracture.

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

Use of vascularised free fibula in limb reconstruction (for non-malignant defects).

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Hameed, Shahid; Ehtesham-ul-haq, Rana Hassan Javaid; Ahmed, Rao Saood; Majid, Abdul; Waqas, Muhammad; Aslam, Ayesha; Yusuf, Omamah; Butt, Ahsin Masood; Ali, Ghazanfar

2013-12-01

The case series was conducted at the Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to May 2011, and comprised 19 patients in whom free fibula flap was performed for upper and lower limb reconstruction, using SPSS 16. Results showed that flap survival was 100%. One (5.2%) flap was re-explored for venous congestion and was salvaged. One (5.2%) patient of congenital pseudoarthrosis of tibia had a fracture of the fibula and was treated with external fixation. Average follow up was 8 months. Mean union time and full weight-bearing was 6.5 +/- 1.34 months (range 3-8 months) and 9 months, respectively. No recurrence of pseudoathrosis was observed until the last follow up, with only a 1.5 cm length discrepancy in one patient. The results proved that a microvascular free fibular flap heals rapidly, causes early functional recovery and it can be raised as an osteocutaneous flap.

Nontraumatic femur fracture in an oligomenorrheic athlete.

Science.gov (United States)

Dugowson, C E; Drinkwater, B L; Clark, J M

1991-12-01

Exercise-associated amenorrhea is the cessation of menses in a woman following onset of training or an increase in training intensity. Its physiologic basis is characterized by consistently low levels of gonadotropin and ovarian hormones, but the underlying cause of this phenomenon is unknown. Although osteopenia has been described in amenorrheic women athletes, it has been primarily a laboratory diagnosis. Several recent studies have described a significantly lower bone mineral density (BMD) in the lumbar spine of amenorrheic athletes. Marcus et al. also reported an increased number of metatarsal and tibial stress fractures in a group of amenorrheic women. We report here the first case of a nontraumatic femur fracture in an amenorrheic athlete. A 32-yr-old white female, with four prior fibular stress fractures, suffered a left femoral shaft fracture during the 13th mile of a half-marathon. The fracture was successfully internally fixed. Biochemical studies showed no metabolic abnormality. Bone mineral density of the lumbar spine, femoral neck, tibia, and fibula were below the mean for both eumenorrheic and amenorrheic female athletes. Exercise-associated amenorrhea is a medical problem that may have serious implications for both competitive and high-intensity recreational female athletes.

fracture of the dome of the talus associated with a fracture of the os ...

African Journals Online (AJOL)

1971-03-13

Mar 13, 1971 ... region of the ankle joint is reported. Falls from a height are commonly associated with fractures of the os calcis, the distal tibia and fibula, the acetabulum, the thoracic and lumbar spine and the base of the skull. An association between a fracture of the dome of the talus on one side and a fracture of the os ...

Stress fractures in athletes

International Nuclear Information System (INIS)

Kirschberger, R.; Henning, A.; Graff, K.H.

1984-01-01

The early exclusion of the presence of a stress fracture may be decisive for the success of an athlete. Scintigraphy with a bone-seeking radiopharmaceutical is suitable for the early detection of stress lesions. Of 30 athletes, fractures were demonstrated in 17 whereas in 6 they were excluded. We found most fractures in the tarsal bones such as os naviculare pedis, ossa cuneiformia and talus. The type of sport engaged in appears to be an important factor in determining the location of the fracture. Scintiphotos were taken in several views using region of interest techniques and two phase-scintigraphy. This method is considered to be useful for localization and follow-up of skeletal stress lesions as well as for differential diagnosis. (orig.) [de

Stress fractures in athletes

Energy Technology Data Exchange (ETDEWEB)

Kirschberger, R; Henning, A; Graff, K H

1984-12-01

The early exclusion of the presence of a stress fracture may be decisive for the success of an athlete. Scintigraphy with a bone-seeking radiopharmaceutical is suitable for the early detection of stress lesions. Of 30 athletes, fractures were demonstrated in 17 whereas in 6 they were excluded. We found most fractures in the tarsal bones such as os naviculare pedis, ossa cuneiformia and talus. The type of sport engaged in appears to be an important factor in determining the location of the fracture. Scintiphotos were taken in several views using region of interest techniques and two phase-scintigraphy. This method is considered to be useful for localization and follow-up of skeletal stress lesions as well as for differential diagnosis.

Bone stress in runners with tibial stress fracture.

Science.gov (United States)

Meardon, Stacey A; Willson, John D; Gries, Samantha R; Kernozek, Thomas W; Derrick, Timothy R

2015-11-01

Combinations of smaller bone geometry and greater applied loads may contribute to tibial stress fracture. We examined tibial bone stress, accounting for geometry and applied loads, in runners with stress fracture. 23 runners with a history of tibial stress fracture & 23 matched controls ran over a force platform while 3-D kinematic and kinetic data were collected. An elliptical model of the distal 1/3 tibia cross section was used to estimate stress at 4 locations (anterior, posterior, medial and lateral). Inner and outer radii for the model were obtained from 2 planar x-ray images. Bone stress differences were assessed using two-factor ANOVA (α=0.05). Key contributors to observed stress differences between groups were examined using stepwise regression. Runners with tibial stress fracture experienced greater anterior tension and posterior compression at the distal tibia. Location, but not group, differences in shear stress were observed. Stepwise regression revealed that anterior-posterior outer diameter of the tibia and the sagittal plane bending moment explained >80% of the variance in anterior and posterior bone stress. Runners with tibial stress fracture displayed greater stress anteriorly and posteriorly at the distal tibia. Elevated tibial stress was associated with smaller bone geometry and greater bending moments about the medial-lateral axis of the tibia. Future research needs to identify key running mechanics associated with the sagittal plane bending moment at the distal tibia as well as to identify ways to improve bone geometry in runners in order to better guide preventative and rehabilitative efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Stress fractures and bone pain

International Nuclear Information System (INIS)

Groshar, D.; Even-Sapir, E.; Lam, M.; Israel, O.; Front, D.

1984-01-01

Stress fractures result from an unusual repetitive physical activity causing absorption of bone in excess of repair and bone formation. This leads to the weakening of the bone and subsequently to a fracture. It is a benign condition that if recognized in time does not need any treatment besides rest. However, if diagnosis is not made and physical activity continues it may result in severe injury to the bone and a frank fracture may result. Pain is the typical clinical feature and bone scintigraphy, being more sensitive than radiography, is done to establish early diagnosis. The presence of asymptomatic sites of abnormal bone uptake typical of stress fracture in which pain appeared only about 2 weeks after scintigraphy, drew the authors' attention to the question of how close is the relationship between stress fractures and bone pain. Sixty-four military recruits diagnosed as suffering from stress fracture were investigated in order to correlate sites with abnormal uptake of Tc-99m MDP on bone scintigraphy with sites of local pain. In 37 (58%) subjects multiple sites of abnormal uptake were recognised. Of 123 sites of abnormal uptake, 31 (25%) were asymptomatic. In three patients bone pain appeared at the site of the abnormal uptake two weeks after scintigraphy. Bone scintigraphy appears to be more sensitive than bone pain in the diagnosis of stress fractures. The osteoblastic activity which manifests itself by abnormal uptake appears in some cases earlier than the pain caused by the fracture. Present findings may suggest that under certain circumstances, in a population prone to stress fracture, bone scan should be considered as a screening method

Distinguishing stress fractures from pathologic fractures: a multimodality approach

International Nuclear Information System (INIS)

Fayad, Laura M.; Kamel, Ihab R.; Kawamoto, Satomi; Bluemke, David A.; Fishman, Elliot K.; Frassica, Frank J.

2005-01-01

Whereas stress fractures occur in normal or metabolically weakened bones, pathologic fractures occur at the site of a bone tumor. Unfortunately, stress fractures may share imaging features with pathologic fractures on plain radiography, and therefore other modalities are commonly utilized to distinguish these entities. Additional cross-sectional imaging with CT or MRI as well as scintigraphy and PET scanning is often performed for further evaluation. For the detailed assessment of a fracture site, CT offers a high-resolution view of the bone cortex and periosteum which aids the diagnosis of a pathologic fracture. The character of underlying bone marrow patterns of destruction can also be ascertained along with evidence of a soft tissue mass. MRI, however, is a more sensitive technique for the detection of underlying bone marrow lesions at a fracture site. In addition, the surrounding soft tissues, including possible involvement of adjacent muscle, can be well evaluated with MRI. While bone scintigraphy and FDG-PET are not specific, they offer a whole-body screen for metastases in the case of a suspected malignant pathologic fracture. In this review, we present select examples of fractures that underscore imaging features that help distinguish stress fractures from pathologic fractures, since accurate differentiation of these entities is paramount. (orig.)

Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children.

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Maeda, Manabu; Maeda, Nana; Takaoka, Takanori; Tanaka, Yasuhito

2017-02-01

In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula. © 2017 by the American Institute of Ultrasound in Medicine.

Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial.

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Sanders, David W; Tieszer, Christina; Corbett, Bradley

2012-03-01

To compare clinical and functional outcomes after operative and nonoperative treatment of undisplaced, unstable, isolated fibula fractures. Randomized multicenter clinical trial. Six level 1 trauma centers. Eighty-one patients with undisplaced, unstable, isolated fibula fractures as confirmed by an external rotation stress examination demonstrating an increase in medial clear space to 5 mm or greater were followed for 12 months after treatment. Forty-one patients were treated operatively by open reduction and internal fixation of the fibula. Forty patients underwent nonoperative treatment, which included the use of a short leg cast or brace and protected weight bearing for 6 weeks. Functional outcomes determined using the Olerud-Molander Ankle Score and the Short Form 36. Radiographic outcomes included measurement of union and displacement at each visit. There were no statistically significant differences in functional outcome scores or pace of recovery between the operative and nonoperative groups at any time interval (β = -0.28, 3.49; P = 0.936). Complications in the nonoperative group included 8 patients with a medial clear space ≥5 mm and 8 patients with delayed union or nonunion. In the operative group, 5 patients had a surgical site infection and 5 patients required hardware removal. Patients managed operatively had equivalent functional outcomes compared with nonoperative treatment; however, the risk of displacement and problems with union was substantially lower in patients managed with surgery.

Fracture criteria of reactor graphite under multiaxial stresses

International Nuclear Information System (INIS)

Sato, S.; Kawamata, K.; Kurumada, A.; Oku, T.

1987-01-01

New fracture criteria for graphite under multiaxial stresses are presented for designing core and support materials of a high temperature gas cooled reactor. Different kinds of fracture strength tests are carried out for a near isotropic graphite IG-11. Results show that, under the stress state in which tensile stresses are predominant, the maximum principal stress theory is seen as applicable for brittle fracture. Under the stress state in which compressive stresses are predominant there may be two fracture modes for brittle fracture, namely, slipping fracture and mode II fracture. For the former fracture mode the maximum shear stress criterion is suitable, but for the latter fracture mode a new mode II fracture criterion including a restraint effect for cracks is verified to be applicable. Also a statistical correction for brittle fracture criteria under multiaxial stresses is discussed. By considering the allowable stress values for safe design, the specified minimum ultimate strengths corresponding to a survival probability of 99% at the 95% confidence level are presented. (orig./HP)

Risk factors for stress fractures.

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Bennell, K; Matheson, G; Meeuwisse, W; Brukner, P

1999-08-01

Preventing stress fractures requires knowledge of the risk factors that predispose to this injury. The aetiology of stress fractures is multifactorial, but methodological limitations and expediency often lead to research study designs that evaluate individual risk factors. Intrinsic risk factors include mechanical factors such as bone density, skeletal alignment and body size and composition, physiological factors such as bone turnover rate, flexibility, and muscular strength and endurance, as well as hormonal and nutritional factors. Extrinsic risk factors include mechanical factors such as surface, footwear and external loading as well as physical training parameters. Psychological traits may also play a role in increasing stress fracture risk. Equally important to these types of analyses of individual risk factors is the integration of information to produce a composite picture of risk. The purpose of this paper is to critically appraise the existing literature by evaluating study design and quality, in order to provide a current synopsis of the known scientific information related to stress fracture risk factors. The literature is not fully complete with well conducted studies on this topic, but a great deal of information has accumulated over the past 20 years. Although stress fractures result from repeated loading, the exact contribution of training factors (volume, intensity, surface) has not been clearly established. From what we do know, menstrual disturbances, caloric restriction, lower bone density, muscle weakness and leg length differences are risk factors for stress fracture. Other time-honoured risk factors such as lower extremity alignment have not been shown to be causative even though anecdotal evidence indicates they are likely to play an important role in stress fracture pathogenesis.

Metatarsal stress fractures - aftercare

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... Metatarsal stress fracture. In: Safran MR, Zachazewski J, Stone DA, eds. Instructions for Sports Medicine Patients . 2nd ed. Elsevier Saunders; 2012:648-652. Smith MS. Metatarsal fractures. In: Eiff PM, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. ...

Stress fractures in elite cross-country athletes.

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Laker, Scott R; Saint-Phard, Deborah; Tyburski, Mark; Van Dorsten, Brent

2007-04-01

This retrospective and comparative survey investigates an unusual number of stress fractures seen within a Division I college cross-country team. An anonymous questionnaire-designed to observe factors known to increase stress fracture incidence-was distributed to members of the current and previous seasons' teams. Running surface, sleep hours, intake of calcium, and shoe type were among the factors investigated. Eleven lower extremity stress fractures were found in nine athletes. Athletes with stress fractures reported significantly fewer workouts per week on the new track. All other study parameters had no statistically significant effect on stress fractures in these athletes.

Stress fractures in the lower extremity

International Nuclear Information System (INIS)

Berger, Ferco H.; Jonge, Milko C. de; Maas, Mario

2007-01-01

Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely

Prefabricated fibula free flap with dental implants for mandibular reconstruction.

Science.gov (United States)

Pauchet, D; Pigot, J-L; Chabolle, F; Bach, C-A

2018-03-02

Free fibula transplant is routinely used for mandibular reconstruction in head and neck cancer. Dental rehabilitation, the objective of mandibular reconstruction, requires the use of dental implants as supports for fixed or removable dentures. Positioning of fibular bone grafts and implants determines implant osseointegration and the possibilities of dental rehabilitation. Prefabrication of a fibula free flap with dental implants prior to harvesting as a free flap can promote implant osseointegration. The position of the implants must then be precisely planned. Virtual surgery and computer-assisted design and prefabrication techniques are used to plan the reconstruction and then reproduce this planning by means of tailored fibula and mandible cutting guides, thereby ensuring correct positioning of fibular bone fragments and implants. The prefabricated fibula free flap technique requires two surgical procedures (prefabrication and flap transfer) and precise preoperative planning. Prefabricated fibula free flap with dental implants, by improving the quality of osseointegration of the implants before flap transfer, extends the possibilities of prosthetic rehabilitation in complex secondary mandibular reconstructions. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula

Energy Technology Data Exchange (ETDEWEB)

Kendell, Scott D. [Department of Radiology, Duke University, Box 3808, 27710, Durham, North Carolina (United States); Department of Radiology E-2, Mayo Clinic, 200 First Street, 55905, SW Rochester, Minnesota (United States); Collins, Mark S.; Adkins, Mark C.; Sundaram, Murali; Unni, Krishnan K. [Department of Radiology E-2, Mayo Clinic, 200 First Street, 55905, SW Rochester, Minnesota (United States)

2004-08-01

To evaluate demographic and radiographic features that may differentiate between enchondroma and low-grade chondrosarcoma of the fibula. The radiographs of ninety-three histologically-confirmed cartilaginous tumors of the fibula were retrospectively reviewed along with demographic information as to patient age and gender. Fifty-four enchondromas and thirty-nine low-grade chondrosarcomas were included in the study. Multiple previously-established radiographic features distinguishing enchondroma from chondrosarcoma were evaluated in each fibular tumor in a consensus manner by two experienced, board-certified and fellowship-trained musculoskeletal radiologists. Five radiographic features were shown to statistically favor chondrosarcoma over enchondroma in the fibula. These were soft-tissue mass (p<0.0001), periosteal reaction (p=0.008), cortical disruption in the juxta-articular fibula (p=0.0133), cortical thickening (p=0.032), and tumor size greater than 4 cm (p=0.0046). No statistically-significant demographic differences were found between patients with enchondroma and chondrosarcoma of the fibula. When two or more of the identified features of malignancy are identified in the same patient, chondrosarcoma is 2.4 times more likely than in those patients exhibiting none of the features of malignancy. Soft-tissue mass, periosteal reaction, cortical disruption in the juxta-articular fibula, cortical thickening, and tumor size greater than 4 cm indicate chondrosarcoma over enchondroma of the fibula. Radiographs demonstrating more than one of the identified malignant features are more likely to be due to chondrosarcoma than radiographs demonstrating none or only one of the identified features. No unique malignant features of chondrosarcoma in the fibula were observed when compared to previous descriptions of these tumors in the long and short tubular bones of the appendicular skeleton. (orig.)

Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula

International Nuclear Information System (INIS)

Kendell, Scott D.; Collins, Mark S.; Adkins, Mark C.; Sundaram, Murali; Unni, Krishnan K.

2004-01-01

To evaluate demographic and radiographic features that may differentiate between enchondroma and low-grade chondrosarcoma of the fibula. The radiographs of ninety-three histologically-confirmed cartilaginous tumors of the fibula were retrospectively reviewed along with demographic information as to patient age and gender. Fifty-four enchondromas and thirty-nine low-grade chondrosarcomas were included in the study. Multiple previously-established radiographic features distinguishing enchondroma from chondrosarcoma were evaluated in each fibular tumor in a consensus manner by two experienced, board-certified and fellowship-trained musculoskeletal radiologists. Five radiographic features were shown to statistically favor chondrosarcoma over enchondroma in the fibula. These were soft-tissue mass (p<0.0001), periosteal reaction (p=0.008), cortical disruption in the juxta-articular fibula (p=0.0133), cortical thickening (p=0.032), and tumor size greater than 4 cm (p=0.0046). No statistically-significant demographic differences were found between patients with enchondroma and chondrosarcoma of the fibula. When two or more of the identified features of malignancy are identified in the same patient, chondrosarcoma is 2.4 times more likely than in those patients exhibiting none of the features of malignancy. Soft-tissue mass, periosteal reaction, cortical disruption in the juxta-articular fibula, cortical thickening, and tumor size greater than 4 cm indicate chondrosarcoma over enchondroma of the fibula. Radiographs demonstrating more than one of the identified malignant features are more likely to be due to chondrosarcoma than radiographs demonstrating none or only one of the identified features. No unique malignant features of chondrosarcoma in the fibula were observed when compared to previous descriptions of these tumors in the long and short tubular bones of the appendicular skeleton. (orig.)

Pedicular stress fracture in the lumbar spine

International Nuclear Information System (INIS)

Chong, V.F.H.; Htoo, M.M.

1997-01-01

Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle ('pediculolysis') is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal. (authors)

Fracture patterns and stresses in granite

International Nuclear Information System (INIS)

Price, N.J.

1979-01-01

If granite bodies are to be used as receptacles for toxic waste materials, the presence or absence of barren fractures and the virgin stresses in the granite are of fundamental importance. Unfortunately, very little is known regarding the incidence of fractures, or stresses, which exist at depths (of about 1 km) in granite bodies. A simple analysis is presented of a hypothetical intrusion which indicates the magnitudes of stresses and the possible fracture development which may be expected in such bodies. (auth)

Pedicular stress fracture in the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Chong, V.F.H.; Htoo, M.M. [Singapore General Hospital, Singapore, (Singapore). Department of Diagnostic Radiology

1997-08-01

Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle (`pediculolysis`) is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal. (authors). 10 refs., 2 figs.

Jogger's fracture and other stress fractures of the lumbo-sacral spine

International Nuclear Information System (INIS)

Abel, M.S.

1985-01-01

The posterior rings of the lower lumbo-sacral vertebrae are subject to stress fractures at any part - pedicle, pars, or lamina. The site of fracture is apparently determined by the axis of weight bearing. The three illustrative clinical examples cited include a jogger with a laminar fracture, a ballet dancer with pedicle fractures, and a nine-year-old boy with fractures of pars and lamina. Chronic low back pain is the typical complaint with stress fractures of the lower lumbo-sacral spine. Special imaging techniques are usually needed to demonstrate these lesions, including vertebral arch views, multi-directional tomography, and computed tomography (CT). (orig.)

High-Risk Stress Fractures: Diagnosis and Management.

Science.gov (United States)

McInnis, Kelly C; Ramey, Lindsay N

2016-03-01

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

Stress fractures in military training

International Nuclear Information System (INIS)

Jofre, M.J.; Sierralta, M.P.

2002-01-01

During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population

Stress fractures in military training

Energy Technology Data Exchange (ETDEWEB)

Jofre, M J; Sierralta, M P [Military Hospital Nuclear Medicine Department, Santiago (Chile)

2002-09-01

During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population.

Rare stress fracture: longitudinal fracture of the femur.

Science.gov (United States)

Pérez González, M; Velázquez Fragua, P; López Miralles, E; Abad Moretón, M M

42-year-old man with pain in the posterolateral region of the right knee that began while he was running. Initially, it was diagnosed by magnetic resonance (MR) as a possible aggressive process (osteosarcoma or Ewing's sarcoma) but with computed tomography it was noted a cortical hypodense linear longitudinal image with a continuous, homogeneous and solid periosteal reaction without clear soft tissue mass that in this patient suggest a longitudinal distal femoral fatigue stress fracture. This type of fracture at this location is very rare. Stress fractures are entities that can be confused with an agressive process. MR iscurrently the most sensitive and specific imaging method for its diagnosis. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Congenital transverse deficiency of the tibia and fibula: a report of two cases

International Nuclear Information System (INIS)

Yasui, N.; Nakase, T.; Sahara, W.; Ochi, T.; Okumura, E.; Sato, M.

2000-01-01

We report two similar, but unrelated, patients with congenital bilateral partial deficiencies of the tibia and fibula associated with intact feet. In both patients, the tibia and fibula were absent on initial radiographs, while the femur and the tarsal bones were well developed and there was bilateral teratologic dislocation of the hips. Ultrasound and magnetic resonance imaging (MRI) studies suggested the presence of cartilaginous remnants of the tibia and fibula. There were multidirectional instabilities in the knees and ankles. The clinical and radiological features of these cases are distinct from those of congenital longitudinal deficiency of the tibia, in which the fibula is always preserved, and from longitudinal deficiency of the fibula, in which the tibia is present and the foot is usually involved. We suggest that the bilateral partial deficiencies of the tibia and fibula associated with the intact foot and teratologic dislocation of the hips is a single-entity disorder, possibly categorized as an intercalary transverse deficiency of the lower limb. (orig.)

Analysis of fracture patterns and local stress field variations in fractured reservoirs

Science.gov (United States)

Deckert, Hagen; Drews, Michael; Fremgen, Dominik; Wellmann, J. Florian

2010-05-01

A meaningful qualitative evaluation of permeabilities in fractured reservoirs in geothermal or hydrocarbon industry requires the spatial description of the existing discontinuity pattern within the area of interest and an analysis how these fractures might behave under given stress fields. This combined information can then be used for better estimating preferred fluid pathway directions within the reservoir, which is of particular interest for defining potential drilling sites. A description of the spatial fracture pattern mainly includes the orientation of rock discontinuities, spacing relationships between single fractures and their lateral extent. We have examined and quantified fracture patterns in several outcrops of granite at the Costa Brava, Spain, and in the Black Forest, Germany, for describing reservoir characteristics. For our analysis of fracture patterns we have used photogrammetric methods to create high-resolution georeferenced digital 3D images of outcrop walls. The advantage of this approach, compared to conventional methods for fracture analysis, is that it provides a better 3D description of the fracture geometry as the entity of position, extent and orientation of single fractures with respect to their surrounding neighbors is conserved. Hence for instance, the method allows generating fracture density maps, which can be used for a better description of the spatial distribution of discontinuities in a given outcrop. Using photogrammetric techniques also has the advantage to acquire very large data sets providing statistically sound results. To assess whether the recorded discontinuities might act as fluid pathways information on the stress field is needed. A 3D model of the regional tectonic structure was created and the geometry of the faults was put into a mechanical 3D Boundary Element (BE) Model. The model takes into account the elastic material properties of the geological units and the orientation of single fault segments. The

Computed tomography of stress fracture

International Nuclear Information System (INIS)

Murcia, M.; Brennan, R.E.; Edeiken, J.

1982-01-01

An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic. (orig.)

Computed tomography of stress fracture

International Nuclear Information System (INIS)

Murcia, M.; Brennan, R.E.; Edeiken, J.

1982-01-01

An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic

CANDIDATE GENE ANALYSIS IN ISRAELI SOLDIERS WITH STRESS FRACTURES

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Ran Yanovich

2012-03-01

Full Text Available To investigate the association of polymorphisms within candidate genes which we hypothesized may contribute to stress fracture predisposition, a case-control, cross- sectional study design was employed. Genotyping 268 Single Nucleotide Polymorphisms- SNPs within 17 genes in 385 Israeli young male and female recruits (182 with and 203 without stress fractures. Twenty-five polymorphisms within 9 genes (NR3C1, ANKH, VDR, ROR2, CALCR, IL6, COL1A2, CBG, and LRP4 showed statistically significant differences (p < 0.05 in the distribution between stress fracture cases and non stress fracture controls. Seventeen genetic variants were associated with an increased stress fracture risk, and eight variants with a decreased stress fracture risk. None of the SNP associations remained significant after correcting for multiple comparisons (false discovery rate- FDR. Our findings suggest that genes may be involved in stress fracture pathogenesis. Specifically, the CALCR and the VDR genes are intriguing candidates. The putative involvement of these genes in stress fracture predisposition requires analysis of more cases and controls and sequencing the relevant genomic regions, in order to define the specific gene mutations

Development of stress-modified fracture strain criterion for ductile fracture of API X65 steel

International Nuclear Information System (INIS)

Oh, Chang Kyun; Kim, Yun Jae; Park, Jin Moo; Kim, Woo Sik; Baek, Jong Hyun

2005-01-01

This paper presents a stress-modified fracture strain for API X65 steel used for gas pipeline, as a function of stress triaxiality. To determine the stress-modified fracture strain, tension test of bars with four different notch radii, made of API X65 steel, is firstly performed, from which true fracture strains are determined as a function of notch radius. Then detailed elastic-plastic, large strain Finite Element (FE) analyses are performed to estimate variations of stress triaxiality in the notched bars with load. Combining experimental with FE results provides the true fracture strain as a function of stress triaxiality, which is regarded as a criterion of ductile fracture. Application of the developed stress-modified fracture strain to failure prediction of gas pipes made of API X65 steel with various types of defects is discussed

STRESS FRACTURE PREVALENCE IN ELITE FIGURE SKATERS

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Sanda Dubravcic-Simunjak

2008-09-01

Full Text Available Figure skating is a physically demanding sport that requires a unique combination of artistic ability, speed, agility, flexibility and power. During the last decades not only the competitive schedule has become tougher, but after introduction of the new judging system in 2003, also more emphasis is put on difficult technical elements, jumps, steps and spins (ISU Rules, 2006. More studies about possible increasing prevalence of stress fractures in figure skaters and contributing factors are lacking (Dubravcic-Simunjak et al., 2003; Moran, 2000; Pecina et al., 1990. Therefore the aim of this study was to obtain data about the current stress fracture cumulative risk among elite junior and senior figure skaters, as well as possible factors that may contribute to stress fracture incidence. An anonymous questionnaire, divided into 5 sections, inquired about the prevalence of stress fracture were mailed and distributed to all 62 International Skating Union (ISU members by the ISU headquarters in Lausanne, Switzerland. The guidelines of the Helsinki declaration 2004 were followed. From the 644 skaters who received the questionnaire, 412 completed ones were returned from 110 female juniors (78 single skaters, 12 pair skaters and 20 ice dancers and 135 female seniors (97 single skaters, 16 pair skaters and 22 ice dancers and from 79 male juniors (47 single skaters, 12 pair skaters and 20 ice dancers and 88 male seniors (50 single skaters, 16 pair skaters and 22 ice dancers, coming from different ISU members. The response rate was 62% in females and 67% in males. The median age for female skaters was 16 years and for males 18 years (range 12-25 years. All participants started to skate between 3 and 6 years of age and started to compete in national and international competitions when they were between 5 and 7 years old. At the time of this analysis, they had been skating between 9 and 20 years.In females 41 (16.7%, and in males 25 (13.8% figure skaters

Congenital osteofibrous dysplasia associated with pseudoarthrosis of the tibia and fibula

International Nuclear Information System (INIS)

Teo, Harvey E.L.; Peh, Wilfred C.G.; Akhilesh, M.; Tan, S.B.; Ishida, T.

2007-01-01

The association between congenital pseudoarthrosis and osteofibrous dysplasia of the tibia and fibula is a rare entity that has been recently recognized. We report a male newborn who was found to have swelling and deformity of the left lower leg. Radiographs and magnetic resonance imaging showed an extensive destructive lesion of the tibial shaft, with dysplastic congenital pseudoarthrosis of the lower fibula. Histopathologial examination confirmed the diagnosis of congenital pseudoarthrosis of the tibia and fibula with underlying osteofibrous dysplasia involving both bones. Immunohistochemical stains showed cytokeratin positivity. (orig.)

Anomalous Transport in Natural Fracture Networks Induced by Tectonic Stress

Science.gov (United States)

Kang, P. K.; Lei, Q.; Lee, S.; Dentz, M.; Juanes, R.

2017-12-01

Fluid flow and transport in fractured rock controls many natural and engineered processes in the subsurface. However, characterizing flow and transport through fractured media is challenging due to the high uncertainty and large heterogeneity associated with fractured rock properties. In addition to these "static" challenges, geologic fractures are always under significant overburden stress, and changes in the stress state can lead to changes in the fracture's ability to conduct fluids. While confining stress has been shown to impact fluid flow through fractures in a fundamental way, the impact of confining stress on transportthrough fractured rock remains poorly understood. The link between anomalous (non-Fickian) transport and confining stress has been shown, only recently, at the level of a single rough fracture [1]. Here, we investigate the impact of geologic (tectonic) stress on flow and tracer transport through natural fracture networks. We model geomechanical effects in 2D fractured rock by means of a finite-discrete element method (FEMDEM) [2], which can capture the deformation of matrix blocks, reactivation of pre-existing fractures, and propagation of new cracks, upon changes in the stress field. We apply the model to a fracture network extracted from the geological map of an actual rock outcrop to obtain the aperture field at different stress conditions. We then simulate fluid flow and particle transport through the stressed fracture networks. We observe that anomalous transport emerges in response to confining stress on the fracture network, and show that the stress state is a powerful determinant of transport behavior: (1) An anisotropic stress state induces preferential flow paths through shear dilation; (2) An increase in geologic stress increases aperture heterogeneity that induces late-time tailing of particle breakthrough curves. Finally, we develop an effective transport model that captures the anomalous transport through the stressed fracture

The Level of Fibula Osteotomy and Incidence of Peroneal Nerve ...

African Journals Online (AJOL)

2010-06-29

Jun 29, 2010 ... Journal of Surgical Technique and Case Report | Jan-Jun 2010 | Vol-2 | Issue-1. 17. The Level of Fibula Osteotomy and Incidence of Peroneal. Nerve Palsy in Proximal Tibial Osteotomy. A. O. Ogbemudia, P. F. A. Umebese, A. Bafor, E. Igbinovia, P. E. Ogbemudia. INTRODUCTION. Osteotomy of the fibula is ...

Concurrent periosteal chondroma and enchondroma of the fibula mimicking chondrosarcoma

International Nuclear Information System (INIS)

Yamamoto, Yasuhiro; Washimi, Osuke; Yamada, Harumoto; Washimi, Yuki; Itoh, Masato; Kuroda, Makoto

2006-01-01

We present a rare concurrence of enchondroma and periosteal chondroma in the right distal fibula that mimicked chondrosarcoma in a 13-year-old boy. Radiographs and CT scans showed a periosteal lesion producing saucerization without periosteal reaction and calcification in the distal metaphysis of the right fibula. MRI showed an intramedullary lesion adjacent to the periosteal lesion, although it was invisible at CT. There was no cortical breach on imaging and gross examination. Because both lesions represented benign cartilaginous tumors on histology, concurrent periosteal chondroma and enchondroma of the fibula was diagnosed. This combination in the same bone in a patient without enchondromatosis is exceedingly rare. Such imaging features may be confused with those of chondrosarcoma. (orig.)

Concurrent periosteal chondroma and enchondroma of the fibula mimicking chondrosarcoma

Energy Technology Data Exchange (ETDEWEB)

Yamamoto, Yasuhiro; Washimi, Osuke; Yamada, Harumoto; Washimi, Yuki; Itoh, Masato [Fujita Health University, Department of Orthopedic Surgery, Toyoake City, Aichi (Japan); Kuroda, Makoto [Fujita Health University, Department of Pathology, Toyoake City, Aichi (Japan)

2006-05-15

We present a rare concurrence of enchondroma and periosteal chondroma in the right distal fibula that mimicked chondrosarcoma in a 13-year-old boy. Radiographs and CT scans showed a periosteal lesion producing saucerization without periosteal reaction and calcification in the distal metaphysis of the right fibula. MRI showed an intramedullary lesion adjacent to the periosteal lesion, although it was invisible at CT. There was no cortical breach on imaging and gross examination. Because both lesions represented benign cartilaginous tumors on histology, concurrent periosteal chondroma and enchondroma of the fibula was diagnosed. This combination in the same bone in a patient without enchondromatosis is exceedingly rare. Such imaging features may be confused with those of chondrosarcoma. (orig.)

Spartan Release Engagement Mechanism (REM) stress and fracture analysis

Science.gov (United States)

Marlowe, D. S.; West, E. J.

1984-01-01

The revised stress and fracture analysis of the Spartan REM hardware for current load conditions and mass properties is presented. The stress analysis was performed using a NASTRAN math model of the Spartan REM adapter, base, and payload. Appendix A contains the material properties, loads, and stress analysis of the hardware. The computer output and model description are in Appendix B. Factors of safety used in the stress analysis were 1.4 on tested items and 2.0 on all other items. Fracture analysis of the items considered fracture critical was accomplished using the MSFC Crack Growth Analysis code. Loads and stresses were obtaind from the stress analysis. The fracture analysis notes are located in Appendix A and the computer output in Appendix B. All items analyzed met design and fracture criteria.

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.

Lower thoracic rib stress fractures in baseball pitchers.

Science.gov (United States)

Gerrie, Brayden J; Harris, Joshua D; Lintner, David M; McCulloch, Patrick C

2016-01-01

Stress fractures of the first rib on the dominant throwing side are well-described in baseball pitchers; however, lower thoracic rib fractures are not commonly recognized. While common in other sports such as rowing, there is scant literature on these injuries in baseball. Intercostal muscle strains are commonly diagnosed in baseball pitchers and have a nearly identical presentation but also a highly variable healing time. The diagnosis of a rib stress fracture can predict a more protracted recovery. This case series presents two collegiate baseball pitchers on one team during the same season who were originally diagnosed with intercostal muscle strains, which following magnetic resonance imaging (MRI) were found to have actually sustained lower thoracic rib stress fractures. The first sustained a stress fracture of the posterior aspect of the right 8th rib on the dominant arm side, while the second presented with a left-sided 10th rib stress fracture on the nondominant arm side. In both cases, MRI was used to visualize the fractures as plain radiographs are insensitive and commonly negative early in patient presentation. Patients were treated with activity modification, and symptomatic management for 4-6 weeks with a graduated return to throwing and competition by 8-10 weeks. The repetitive high stresses incurred by pitching may cause either dominant or nondominant rib stress fractures and this should be included in the differential diagnosis of thoracic injuries in throwers. It is especially important that athletic trainers and team physicians consider this diagnosis, as rib fractures may have a protracted course and delayed return to play. Additionally, using the appropriate imaging techniques to establish an accurate diagnosis can help inform return-to-play decisions, which have important practical applications in baseball, such as roster management and eligibility.

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.

Diagnostic Ultrasonography of an Ankle Fracture Undetectable by Conventional Radiography: A Case Report

Science.gov (United States)

Daniels, Clinton J.; Welk, Aaron B.; Enix, Dennis E.

2016-01-01

Objective The purpose of this study is to present diagnostic ultrasonography assessment of an occult fracture in a case of persistent lateral ankle pain. Clinical Features A 35-year-old woman presented to a chiropractic clinic with bruising, swelling, and pain along the distal fibula 3 days following an inversion ankle trauma. Prior radiographic examination at an urgent care facility was negative for fracture. Conservative care over the next week noted improvement in objective findings, but the pain persisted. Intervention and Outcome Diagnostic ultrasonography was ordered to assess her persistent ankle pain and showed a minimally displaced fracture of the fibula 4 cm proximal to the lateral malleolus. The patient was referred to her primary care physician and successfully managed with conservative care. Conclusion In this case, diagnostic ultrasonography was able to identify a Danis-Weber subtype B1 fracture that was missed by plain film radiography. PMID:27069430

MR imaging findings of fatigue fractures of lower extremity in young soldiers

International Nuclear Information System (INIS)

Mo, Jong Hyun; Moon, Sung Hee; Kim, Young Bok; Park, Yang Hee; Park, Jin Kyoon

1999-01-01

To evaluate the MR imaging findings of fatigue fractures of the lower extremity in young soldiers. In 22 cases of fatigue fractures of the lower extremity in young soldiers proven by clinical findings and radiological follow up, the MRI findings were retrospectively evalvated. All patients were male and aged between 19 and 21 years. As seen on MRI, the bone marrow edema, intramedullary low signal intensity band, cortical fracture line, periosteal reaction, surrounding soft tissue edema, and enhancement pattern were analyzed and the site of involvement was determined in the axial plane. The locations of fatigue fractures of the lower extremity were the tibia (n=12), fibula (n=8), femur (n=1) and second metatarsus (n=1). All occurred in diaphyses: the junction of the proximal and middle (n=10), middle (n=9), proximal (n=2), and distal shaft (n=1). The sites of involvement were the posteromedial (n=6) and medial side (n=6) of the tibia, and the entire portion of the fibula(n=5) in the axial plane. MRI findings were bone marrow edema in 20 cases, intramedullary low signal intensity band in 14 (which were continuous with the cortex or cortical fracture line), cortical fracture line in 13, and periosteal reaction and surrounding soft tissue edema in all. On gadolinium-enhanced images, enhancement was seen in the bone marrow in 19 cases, in the subperiosteal region in 18, and in the surrounding soft tissue in 22. In fatigue fractures of the lower extremity in young soldiers, the main locations were the tibia and fibula, and characteristic MR imaging findings were intramedullary low signal intensity bands, which were continuous with the cortex or cortical fracture line and often accompanied by bone marrow edema, periosteal reaction, and surrounding soft tissue edema

Lower limb fracture presentations at a regional hospital.

Science.gov (United States)

Holloway, K L; Yousif, D; Bucki-Smith, G; Hosking, S; Betson, A G; Williams, L J; Brennan-Olsen, S L; Kotowicz, M A; Sepetavc, A; Pasco, J A

2017-08-28

We found that lower limb fractures, which were largely the result of minimal trauma, had high levels of hospitalisation, length of stay and surgery. It is therefore important to prevent fractures at all sites to avoid the associated morbidity and mortality. Hip fractures are a major cause of morbidity and mortality, particularly in older women. In comparison, less is known about the epidemiology and burden of other lower limb fractures. The study aimed to investigate the epidemiology and burden of these fractures. Incident fractures of the hip, femur, tibia/fibula, ankle and foot in women (≥ 20 years) managed through the University Hospital Geelong, Australia, were ascertained from 1 Jan. 2014 to 31 Dec. 2014 from radiology reports. Age, cause of fracture, post-fracture hospitalisation, surgery, length of stay and discharge location were ascertained from medical records. We identified 585 fractures of the lower limb (209 hip, 42 femur, 41 tibia/fibula, 162 ankle, 131 foot). Most fractures were sustained by women aged ≥ 50 years. Fractures were largely a result of minimal trauma. Most women with hip or femur fractures were hospitalised; fewer were hospitalised for fractures at other sites. Surgery for fracture followed the same pattern as hospitalisations. Length of stay was the highest for hip and femur fractures and the lowest for foot fractures. Women with hip or femur fractures were discharged to rehabilitation more often than home. Fractures at other sites were most commonly discharged home. Fractures of the lower limb occurred frequently in older women. Hospitalisation and subsequent surgery were common in cases of hip and femur fractures. It is important for prevention strategies to target fractures at a range of skeletal sites to reduce costs, hospitalisations, loss of independence and reduced quality of life.

Influence of fracture extension on in-situ stress in tight reservoir

Science.gov (United States)

Zhang, Yongping; Wei, Xu; Zhang, Ye; Xing, Libo; Xu, Jianjun

2018-01-01

Currently, hydraulic fracturing is an important way to develop low permeability reservoirs. The fractures produced during the fracturing process are the main influencing factors of changing in-situ stress. In this paper, the influence of fracture extension on in-situ stress is studied by establishing a mathematical model to describe the relationship between fracture length and in-situ stress. The results show that the growth rate gradually decreases after the fracture reaches a certain length with the increase of fracturing time; the continuous extension of the fracture is the main factor to change the in-situ stress. In order to reduce the impact on the subsequent fracture extension due to the changing of in-situ stress, controlling fracturing time and fracture length without affecting the stimulated reservoir effect is an important way. The results presented in this study can effectively reduce the impact of changing of in-situ stress on subsequent fracturing construction.

[Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures].

Science.gov (United States)

Lobenhoffer, P; Gerich, T; Bertram, T; Lattermann, C; Pohlemann, T; Tscheme, H

1997-12-01

Tibial plateau fractures with depression of posterior aspects of the proximal tibia cause significant therapeutic problems. Posterior fractures on the medial side are mainly highly instable fracture-dislocations (Moore type I). Posterolateral fractures usually cause massive depression and destruction of the chondral surface. Surgical exposure of these fractures from anterior requires major soft tissue dissection and has a significant complication rate. However, incomplete restoration of the joint surface results in chronic postero-inferior joint subluxation, osteoarthritis and pain. We present new specific approaches for posterior fracture types avoiding large skin incisions, but allowing for atraumatic exposure, reduction and fixation. Posteromedial fracture-dislocations are exposed by a direct posteromedial skin incision and a deep incision between medial collateral ligament and posterior oblique ligament. The posteromedial pillar and the posterior flare of the proximal tibia are visualized. The inferior extent of the joint fragment can be reduced by indirect techniques or direct manipulation of the fragment. Fixation is achieved with subchondral lag screws and an anti-glide plate at the tip of the fragment. Posterolateral fractures are exposed by a transfibular approach: the skin is incised laterally, the peroneal nerve is dissected free. The fibula neck is osteotomized, the tibiofibular syndesmosis is divided and the fibula neck is reflected upwards in one layer with the meniscotibial ligament and the iliotibial tract attachment. Reflexion of the fibula head relaxes the lateral collateral ligament, allows for lateral joint opening and internal rotation of the tibia and thus exposes the posterolateral and posterior aspect of the tibial plateau. Fixation and buttressing on the posterolateral side can be achieved easily with this approach. In closure, the fibula head is fixed back with a lag screw or a tension-band system. These two exposures can be combined in

Correlation Between Fracture Network Properties and Stress Variability in Geological Media

Science.gov (United States)

Lei, Qinghua; Gao, Ke

2018-05-01

We quantitatively investigate the stress variability in fractured geological media under tectonic stresses. The fracture systems studied include synthetic fracture networks following power law length scaling and natural fracture patterns based on outcrop mapping. The stress field is derived from a finite-discrete element model, and its variability is analyzed using a set of mathematical formulations that honor the tensorial nature of stress data. We show that local stress perturbation, quantified by the Euclidean distance of a local stress tensor to the mean stress tensor, has a positive, linear correlation with local fracture intensity, defined as the total fracture length per unit area within a local sampling window. We also evaluate the stress dispersion of the entire stress field using the effective variance, that is, a scalar-valued measure of the overall stress variability. The results show that a well-connected fracture system under a critically stressed state exhibits strong local and global stress variabilities.

Specific variants of gold and silver early zwiebelknopf fibulae from eastern Serbia

Directory of Open Access Journals (Sweden)

Popović Ivana M.

2003-01-01

Full Text Available The discovery of fragmented silver fibula with twice bent bow in the necropolis by the castellum Ravna (Timacum Minus as well as inspection of some specimens of gold zwiebelknopf fibulae from the collections of the National Museum in Belgrade and Museum of Krajina in Negotin have drawn our attention to some finds of gold and silver fibulae from eastern Serbia and Romania that, according to their shape and decoration, represent specific variants in the initial phase of development of the zwiebelknopf fibulae. They are classified into three groups on the basis of their typological traits and their production is connected to Aurelian’s withdrawal from Dacia (group I, Diocletian’s victories over barbarians in the Danube basin (group II and Constantine’s decennalia, i.e. his preparations for encounter with Licinius (group III.

The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury

DEFF Research Database (Denmark)

Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid

2016-01-01

Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All...

Connection between tectonic stresses and well fracturing data

Energy Technology Data Exchange (ETDEWEB)

Scheidegger, A E [Imperial Oil Res. Lab., Calgary, CA

1961-01-01

Theoretical considerations of hydraulic well fracturing normally utilize a model in which the borehole is assumed to be a cylinder of infinite length. This leads to treatment of the induced stress state in two dimensions. The two-dimensional model is obviously an oversimplification. Therefore, a three-dimensional model is proposed in which the well pressure is assumed to be equivalent to a spherical pressure center. The bottom hole pressure during fracturing is determined by 4 variables; i.e., the 3 principal geological stresses and the rock strength. The response to fracturing is determined primarily by the prevailing stress state and to a lesser degree by the rock strength. The fracture condition is formulated and the model is used in the calculation of geological stresses from well data.

Trochanteric Stress Fracture in a Female Window Cleaner

OpenAIRE

Lee, Bong-Jin; Song, Jyewon

2016-01-01

Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and...

Non union of an epiphyseal fibular fracture in a pediatric patient.

Science.gov (United States)

Mirmiran, Roya; Schuberth, John M

2006-01-01

There are few reports on delayed or nonunion in the pediatric ankle fracture. The authors present a case of a nonunion of a mid-epiphyseal fracture of the distal fibula, described as a type 7 pediatric fracture. Both the occurrence of this injury pattern and a nonunion has not been reported in the same patient. Operative reduction of the nonunion resulted in a satisfactory outcome.

3-D description of fracture surfaces and stress-sensitivity analysis for naturally fractured reservoirs

Energy Technology Data Exchange (ETDEWEB)

Zhang, S.Q.; Jioa, D.; Meng, Y.F.; Fan, Y.

1997-08-01

Three kinds of reservoir cores (limestone, sandstone, and shale with natural fractures) were used to study the effect of morphology of fracture surfaces on stress sensitivity. The cores, obtained from the reservoirs with depths of 2170 to 2300 m, have fractures which are mated on a large scale, but unmated on a fine scale. A specially designed photoelectric scanner with a computer was used to describe the topography of the fracture surfaces. Then, theoretical analysis of the fracture closure was carried out based on the fracture topography generated. The scanning results show that the asperity has almost normal distributions for all three types of samples. For the tested samples, the fracture closure predicted by the elastic-contact theory is different from the laboratory measurements because plastic deformation of the aspirates plays an important role under the testing range of normal stresses. In this work, the traditionally used elastic-contact theory has been modified to better predict the stress sensitivity of reservoir fractures. Analysis shows that the standard deviation of the probability density function of asperity distribution has a great effect on the fracture closure rate.

Radioisotopic and Radiological Evaluation in Patient with Stress Fracture

International Nuclear Information System (INIS)

Ko, Kwang Seop; Kim, Jai Young; Kang, Sung Koo; Kim, So Yon; Lee, Gwon Jun

1987-01-01

The stress fracture is a disease caused by and abnormal stress to the normal bone with constant, repeated pull. Early detection of stress fracture plays an important role in treatment and prevention of its complication. Bone scintigraphy was performed to evaluate 18 patients with stress fracture of the lower extremities from May, 1985 to April, 1987, in the Department of Internal Medicine of National Police Hospital. The results were as follows: 1) Seventeen of the 18 cases showed positive bone scans at the initial study performed from 1 week to 5 months after the onset of symptom. 2) Ten of the 18 patients had findings of stress fracture at the initial X-ray film. Two out of 8 negative case revealed positive findings in the follow-up studies. 3) The bone scans in the 2 cases taken 5 months after the onset of symptom; the one showed only slightly increased radio uptake, the other showed no abnormal findings. In conclusion, bone scanning is a more sensitive indicator of early stress fracture than radiologic study, The healing phase is characterized by a gradual decline in radioactivity at the fracture site in concordance with subsidence of symptom.

Intraosseous neurilemmoma of the fibula

Energy Technology Data Exchange (ETDEWEB)

Aoki, J. [Department of Radiology, Shinshu University School of Medicine, Asahi, Matsumoto (Japan); Tanikawa, H. [Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto (Japan); Fujioka, F. [Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto (Japan); Ishii, K. [Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto (Japan); Seo, G.S. [Department of Radiology, Shinshu University School of Medicine, Matsumoto (Japan); Karakida, O. [Department of Radiology, Shinshu University School of Medicine, Matsumoto (Japan); Sone, S. [Department of Radiology, Shinshu University School of Medicine, Matsumoto (Japan)

1997-01-01

We present a case of intraosseous neurilemmoma of the fibula in a 56-year-old woman. This case showed the typical radiographic appearance except for the presence of spotted calcifications that mimicked a cartilaginous tumor. Enhanced MR images revealed the heterogeneity of the tumor, which consisted of Antoni type A and B tissue. (orig.). With 4 figs.

Intraosseous neurilemmoma of the fibula

International Nuclear Information System (INIS)

Aoki, J.; Tanikawa, H.; Fujioka, F.; Ishii, K.; Seo, G.S.; Karakida, O.; Sone, S.

1997-01-01

We present a case of intraosseous neurilemmoma of the fibula in a 56-year-old woman. This case showed the typical radiographic appearance except for the presence of spotted calcifications that mimicked a cartilaginous tumor. Enhanced MR images revealed the heterogeneity of the tumor, which consisted of Antoni type A and B tissue. (orig.). With 4 figs

Case report: bilateral ischial stress fractures in an elite tennis player

International Nuclear Information System (INIS)

Clarke, A.W.; Connell, D.A.

2009-01-01

A case report of bilateral ischial stress fractures in an elite tennis player initially mimicking hamstring pathology is described. This is an unusual site of stress fracture. Typical sites of stress fracture are well documented; however, awareness of less common sites of stress-related bone injury can aid early diagnosis and treatment before overt fracture occurs. (orig.)

Case report: bilateral ischial stress fractures in an elite tennis player

Energy Technology Data Exchange (ETDEWEB)

Clarke, A.W.; Connell, D.A. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London, Middlesex (United Kingdom)

2009-07-15

A case report of bilateral ischial stress fractures in an elite tennis player initially mimicking hamstring pathology is described. This is an unusual site of stress fracture. Typical sites of stress fracture are well documented; however, awareness of less common sites of stress-related bone injury can aid early diagnosis and treatment before overt fracture occurs. (orig.)

Postpartum Sacral Stress Fracture: An Atypical Case Report

Directory of Open Access Journals (Sweden)

Andrea Speziali

2015-01-01

Full Text Available Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

Tibial stress fractures in racing Standardbreds: 13 cases (1989-1993)

International Nuclear Information System (INIS)

Ruggles, A.J.; Moore, R.M.; Bertone, A.L.; Schneider, R.K.; Bailey, M.Q.

1996-01-01

To determine clinical signs, radiographic and scintigraphic findings, and performance outcome of racing Standardbreds with tibial stress fractures. Retrospective case series. 13 racing Standardbreds with tibial stress fractures. Information concerning clinical signs, diagnostic evaluation, and recommendations was obtained by review of the medical records. Performance information before and after diagnosis of the fracture was collected from racing records, and follow-up information was obtained from the owners or trainers by use of a telephone questionnaire. Horses with tibial stress fractures were moderately lame, and diagnosis was made by nuclear scintigraphy and radiography. Fractures were more likely to occur in 2-year-old horses than in older horses. The fracture location was unique for Standardbreds; 11 of 13 developed stress fractures in the mid-diaphysis of the tibia, whereas fractures in Thoroughbreds are usually in the proximal caudal or caudolateral cortex. Fractures occurred in young horses that had raced or were in advanced race training. All horses were treated with rest alone, and 10 of 13 horses raced after injury. The horses that raced after injury were able to return to a level of performance that was equal to or better than the level raced before injury. 8 of 10 horses established a lifetime-best winning time after injury. Tibial stress fractures are a cause of lameness in young racing Standardbreds. Diagnosis is aided by nuclear scintigraphy. The prognosis for return to previous level of performance after a tibial stress fracture is good

Fatigue stress fractures of the sacrum: diagnosis with MR imaging

International Nuclear Information System (INIS)

Ahovuo, J.A.; Vusuri, T.

2004-01-01

The aim of this study was to describe the MRI findings and clinical observations in a fatigue stress fracture of the sacrum. In this retrospective study, 380 conscripts (53 women, 327 men; age range 18-29 years, mean age 20.7 years) who suffered from stress-related hip pain were studied with MRI of the pelvis. The findings of MRI were evaluated with regard to stress fracture of the sacrum. Thirty-one (8%) patients had MRI changes in signal intensity of the cranial part of the sacrum, extending to the first and second sacral foramina. The MRI changes in signal intensity were intermediate on T1-weighted images, and high on short tau inversion recovery or T2-weighted fat-suppressed images. A linear signal void fracture line was also seen. Multiple stress injuries to the pelvic bones were also seen in 7 of 31 (23%) patients. Five patients (16%) had bilateral sacral stress fracture. Fatigue sacral stress fractures appeared more commonly in women than in men (p<0.001). During recovery time 20 of the 31 patients underwent control MRI, and fatty marrow conversion was seen in 8 (40%) cases as high signal intensity on T1-weighted images, which disappeared 5-6 months after the onset of symptoms. Fatigue sacral stress fractures are associated with stress-related hip pain. These fractures were more common in women than in men. Other stress injuries of the pelvis may be seen simultaneously with sacral stress fractures. Signal intensity of the sacrum was normal after 5-6 months

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

Upper extremity and rib stress fractures in a child

International Nuclear Information System (INIS)

Moon, B.S.; Price, C.T.; Campbell, J.B.

1998-01-01

Stress fractures in children are rare compared with the incidence in [ults. This report describes an 11-year-old girl with stress fractures of the acromion, clavicle, and first rib on the left and contralateral fractures of the first and second ribs. It was eventually discovered that these fractures were caused by a nervous tic consisting of repetitive, vigorous shrugging and translation of the shoulders. (orig.)

Polyaxial stress-dependent permeability of a three-dimensional fractured rock layer

Science.gov (United States)

Lei, Qinghua; Wang, Xiaoguang; Xiang, Jiansheng; Latham, John-Paul

2017-12-01

A study about the influence of polyaxial (true-triaxial) stresses on the permeability of a three-dimensional (3D) fractured rock layer is presented. The 3D fracture system is constructed by extruding a two-dimensional (2D) outcrop pattern of a limestone bed that exhibits a ladder structure consisting of a "through-going" joint set abutted by later-stage short fractures. Geomechanical behaviour of the 3D fractured rock in response to in-situ stresses is modelled by the finite-discrete element method, which can capture the deformation of matrix blocks, variation of stress fields, reactivation of pre-existing rough fractures and propagation of new cracks. A series of numerical simulations is designed to load the fractured rock using various polyaxial in-situ stresses and the stress-dependent flow properties are further calculated. The fractured layer tends to exhibit stronger flow localisation and higher equivalent permeability as the far-field stress ratio is increased and the stress field is rotated such that fractures are preferentially oriented for shearing. The shear dilation of pre-existing fractures has dominant effects on flow localisation in the system, while the propagation of new fractures has minor impacts. The role of the overburden stress suggests that the conventional 2D analysis that neglects the effect of the out-of-plane stress (perpendicular to the bedding interface) may provide indicative approximations but not fully capture the polyaxial stress-dependent fracture network behaviour. The results of this study have important implications for understanding the heterogeneous flow of geological fluids (e.g. groundwater, petroleum) in subsurface and upscaling permeability for large-scale assessments.

Sacral Stress Fracture in an Amateur Badminton Player

Directory of Open Access Journals (Sweden)

Yusuke Yuasa

2017-01-01

Full Text Available Sacral stress fractures are rare among athletes but have been reported most frequently in long distance runners. We report herein the first case of a sacral stress fracture in an amateur badminton player. A 16-year-old, left-handed adolescent girl, who had just started to play badminton 3 months previously, complained of acute left buttock pain when she received a shuttlecock. Magnetic resonance imaging revealed a linear lesion of the left sacrum with low signal intensity on T1- and high signal intensity on T2-weighted images, which was consistent with a stress fracture. Conservative treatment with rest relieved her symptoms. Her fracture was considered to have occurred due to repetition of an exercise that caused excessive vertical power.

Stress fractures of ankle and wrist in childhood: nature and frequency

International Nuclear Information System (INIS)

Oestreich, Alan E.; Bhojwani, Nicholas

2010-01-01

Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

Stress fractures of ankle and wrist in childhood: nature and frequency

Energy Technology Data Exchange (ETDEWEB)

Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Bhojwani, Nicholas [University of Cincinnati College of Medicine, Cincinnati, OH (United States)

2010-08-15

Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

Stress fractures: definition, diagnosis and treatment ?

OpenAIRE

Astur, Diego Costa; Zanatta, Fernando; Arliani, Gustavo Gon?alves; Moraes, Eduardo Ramalho; Pochini, Alberto de Castro; Ejnisman, Benno

2015-01-01

ABSTRACT Stress fractures were first described in Prussian soldiers by Breithaupt in 1855. They occur as the result of repeatedly making the same movement in a specific region, which can lead to fatigue and imbalance between osteoblast and osteoclast activity, thus favoring bone breakage. In addition, when a particular region of the body is used in the wrong way, a stress fracture can occur even without the occurrence of an excessive number of functional cycles. The objective of this study wa...

Influence of microporosity on fracture stress of pyrocarbon coatings

International Nuclear Information System (INIS)

Krautwasser, P.; Nickel, H.; Taueber, K.

1975-01-01

In this paper recent investigations on fracture behaviour of integral PyC-coatings are presented. The fracture stresses of propene, acetylene, and methane-derived pyrocarbons are measured as a function of deposition temperature and deposition rate. The measured fracture stresses are interpreted in terms of microporosity values determined by X-ray small angle scattering (SAXS). It can be shown that the fracture stress is correlated unambigously with the concentration of micropores in the range of about 50 to 500A diameter. TEM inspection of the investigated materials revealed a component of disordered, tangled fibres with a high microporosity in agreement with SAXS results. This component increases with temperature in the range of 1250 to 1400 at the expense of of a high-density component. As a result, the coatings deposited in this temperature range show decreasing fracture stress with increasing amount of the porous glass wool like component. PyC coatings with a good irradiation behaviour had an initial pore size distribution typical for a relatively high content of tangled material. The assumption, that a relatively high amount of the disordered material is fafourable for a good behaviour i.e. integrity of coating up to high neutron doses, was confirmed besides other investigations by the relative low preirradiation fracture stresses of the well behaving coatings. This means, the integrity of pyrocarbon coatings after irradiation is favoured not so much by a high preirradiation fracture stress, but by the enhanced dimensional stability of the disordered porous material. In addition to this, the increase of the relatively low fractures stress due to the measured irradiation induced reduction of pores in the size range of 200 to 1000A diameter is in favour of coating integrity

Bilateral femoral supracondylar stress fractures in a cross country runner.

Science.gov (United States)

Ross, Kate; Fahey, Mark

2008-08-01

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

kISMET: Stress and fracture characterization in a deep mine

Science.gov (United States)

Oldenburg, C. M.; Dobson, P. F.; Daley, T. M.; Birkholzer, J. T.; Cook, P. J.; Ajo Franklin, J. B.; Rutqvist, J.; Siler, D.; Kneafsey, T. J.; Nakagawa, S.; Wu, Y.; Guglielmi, Y.; Ulrich, C.; Marchesini, P.; Wang, H. F.; Haimson, B. C.; Sone, H.; Vigilante, P.; Roggenthen, W.; Doe, T.; Lee, M.; Mattson, E.; Huang, H.; Johnson, T. C.; Morris, J.; White, J. A.; Johnson, P. A.; Coblentz, D. D.; Heise, J.

2016-12-01

We are developing a community facility called kISMET (permeability (k) and Induced Seismicity Management for Energy Technologies) at the Sanford Underground Research Facility (SURF) in Lead, SD. The purpose of kISMET is to investigate stress and the effects of rock fabric on hydraulic fracturing. Although findings from kISMET may have broad applications that inform stress and fracturing in anisotropic rock, results will be most applicable to improving control of hydraulic fracturing for enhanced geothermal systems (EGS) in crystalline rock. At the kISMET site on the 4850 ft (1480 m depth) level of SURF, we have drilled and cored an array of nearly vertical boreholes in Precambrian phyllite. The array consists of four 50-m deep monitoring boreholes surrounding one 100-m deep borehole forming a 6 m-wide five-spot pattern at a depth of 1530 m. Previous investigations of the stress field at SURF suggest that the principal stress s1 is nearly vertical. By aligning the kISMET boreholes approximately with σ1, fractures created in the center borehole should in theory be perpendicular to σ3, the least principal horizontal stress. But the phyllite at kISMET has a strong fabric (foliation) that could influence fracturing. Stress measurements and stimulation using hydraulic fracturing will be carried out in the center borehole using a straddle packer and high-pressure pump. We will use an impression packer and image logs after stress testing and stimulation to determine fracture orientation and extent at the center borehole. In order to study the control of stress, rock fabric, and stimulation approach on size, aperture, and orientation of hydraulic fractures, we will carefully monitor the stress measurements and stimulation. For example, we will use continuous active source seismic (CASSM) in two of the monitoring boreholes to measure changes in seismic-wave velocity as water fills the fracture. Second, near real-time electrical resistance tomography (ERT) will be used in

Study of mandible reconstruction using a fibula flap with application of additive manufacturing technology.

Science.gov (United States)

Tsai, Ming-June; Wu, Ching-Tsai

2014-05-06

This study aimed to establish surgical guiding techniques for completing mandible lesion resection and reconstruction of the mandible defect area with fibula sections in one surgery by applying additive manufacturing technology, which can reduce the surgical duration and enhance the surgical accuracy and success rate. A computer assisted mandible reconstruction planning (CAMRP) program was used to calculate the optimal cutting length and number of fibula pieces and design the fixtures for mandible cutting, registration, and arrangement of the fibula segments. The mandible cutting and registering fixtures were then generated using an additive manufacturing system. The CAMRP calculated the optimal fibula cutting length and number of segments based on the location and length of the defective portion of the mandible. The mandible cutting jig was generated according to the boundary surface of the lesion resection on the mandible STL model. The fibular cutting fixture was based on the length of each segment, and the registered fixture was used to quickly arrange the fibula pieces into the shape of the defect area. In this study, the mandibular lesion was reconstructed using registered fibular sections in one step, and the method is very easy to perform. The application of additive manufacturing technology provided customized models and the cutting fixtures and registered fixtures, which can improve the efficiency of clinical application. This study showed that the cutting fixture helped to rapidly complete lesion resection and fibula cutting, and the registered fixture enabled arrangement of the fibula pieces and allowed completion of the mandible reconstruction in a timely manner. Our method can overcome the disadvantages of traditional surgery, which requires a long and different course of treatment and is liable to cause error. With the help of optimal cutting planning by the CAMRP and the 3D printed mandible resection jig and fibula cutting fixture, this all

Stress generation and hierarchical fracturing in reactive systems

Science.gov (United States)

Jamtveit, B.; Iyer, K.; Royne, A.; Malthe-Sorenssen, A.; Mathiesen, J.; Feder, J.

2007-12-01

Hierarchical fracture patterns are the result of a slowly driven fracturing process that successively divides the rocks into smaller domains. In quasi-2D systems, such fracture patterns are characterized by four sided domains, and T-junctions where new fractures stop at right angles to pre-existing fractures. We describe fracturing of mm to dm thick enstatite layers in a dunite matrix from the Leka ophiolite complex in Norway. The fracturing process is driven by expansion of the dunite matrix during serpentinization. The cumulative distributions of fracture lengths show a scaling behavior that lies between a log - normal and power law (fractal) distribution. This is consistent with a simple fragmentation model in which domains are divided according to a 'top hat' distribution of new fracture positions within unfractured domains. Reaction-assisted hierarchical fracturing is also likely to be responsible for other (3-D) structures commonly observed in serpentinized ultramafic rocks, including the mesh-textures observed in individual olivine grains, and the high abundance of rectangular domains at a wide range of scales. Spectacular examples of 3-D hierarchical fracture patterns also form during the weathering of basaltic intrusions (dolerites). Incipient chemical weathering of dolerites in the Karoo Basin in South Africa occurs around water- filled fractures, originally produced by thermal contraction or by externally imposed stresses. This chemical weathering causes local expansion of the rock matrix and generates elastic stresses. On a mm to cm scale, these stresses lead to mechanical layer-by-layer spalling, producing the characteristic spheroidal weathering patterns. However, our field observations and computer simulations demonstrate that in confined environments, the spalling process alone is unable to relieve the elastic stresses. In such cases, chemical weathering drives a much larger scale hierarchical fracturing process in which fresh dolerite undergoes a

Estimation of the controlling stress in creep fracture

International Nuclear Information System (INIS)

Henderson, J.; Ferguson, F.R.

1975-01-01

The implementation of correct criterion in creep design, has been shown to be of fundamental significance in the assessment of component life. The present report considers the problem of the means whereby the criterion may be derived for a particular metal without the availability of sophisticated complex-stress testing equipment and procedures such as the combined tension and torsion tests on thin walled tubular specimens employed in the earlier fundamental researches on the subject. By investigating a wide spectrum of engineering metals it was established that for homogeneous stress conditions two criteria appeared to be sufficient to cover all the metals studied for complex-stress creep fracture, either the maximum principal stress or the octahedral shear stress criterion. Further, it was found that those metals which developed random and continuous cracking during creep were controlled with respect to fracture time by the maximum principal stress, while metals which showed virtually no cracking were governed by the octahedral shear stress or second order invariant. The physical nature of the final fracture (transcrystalline or inter-crystalline), contrary to considerable current concepts, was found to be unrelated to which criterion was operative. Having reduced the possible fracture criteria to two, it only remained to develop a simple test method exploiting this finding to achieve the precise identification for a particular metal. Seven metals including aluminium, copper, titanium, cast iron and three steels have been investigated in the present report at temperatures where creep conditions are operative. The results have shown that the method leads to sufficiently accurate prediction of the complex stress creep fracture criterion for the metals studied

Atypical stress-avulsion fracture of the Lisfranc joint complex.

LENUS (Irish Health Repository)

O'Neill, Barry J

2014-04-01

Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury.

Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report.

Science.gov (United States)

Amoako, Adae; Abid, Ayesha; Shadiack, Anthony; Monaco, Robert

2017-01-01

Stress fractures are a frequent cause of lower extremity pain in athletes, and especially in runners. Plain imaging has a low sensitivity. Magnetic resonance imaging (MRI) or bone scan scintigraphy is the criterion standard, but expensive. We present the case of a young female distance runner with left shin pain. Plain radiography was unremarkable. Ultrasound showed focal hyperechoic elevation of the periosteum with irregularity over the distal tibia and increased flow on Doppler. These findings were consistent with a distal tibia stress fracture and confirmed by MRI. Examination of our case will highlight the utility of considering an ultrasound for diagnosis of tibial stress fracture.

Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report

Directory of Open Access Journals (Sweden)

Adae Amoako

2017-04-01

Full Text Available Stress fractures are a frequent cause of lower extremity pain in athletes, and especially in runners. Plain imaging has a low sensitivity. Magnetic resonance imaging (MRI or bone scan scintigraphy is the criterion standard, but expensive. We present the case of a young female distance runner with left shin pain. Plain radiography was unremarkable. Ultrasound showed focal hyperechoic elevation of the periosteum with irregularity over the distal tibia and increased flow on Doppler. These findings were consistent with a distal tibia stress fracture and confirmed by MRI. Examination of our case will highlight the utility of considering an ultrasound for diagnosis of tibial stress fracture.

Exercise-induced rib stress fractures: influence of reduced bone mineral density

DEFF Research Database (Denmark)

Vinther, Anders; Kanstrup, Inge-Lis; Christiansen, Erik

2005-01-01

study investigated BMD in seven Danish national team rowers with previous rib stress fracture (RSF) and 7 controls (C) matched for gender, age, height, weight and training experience. Total body scan and specific scans of the lumbar spine (L2-L4), femoral neck and distal radius were performed using......Exercise-induced rib stress fractures have been reported frequently in elite rowers during the past decade. The etiology of rib stress fractures is unclear, but low bone mineral density (BMD) has been suggested to be a potential risk factor for stress fractures in weight-bearing bones. The present...... density may be a potential risk factor for the development of exercise-induced rib stress fractures in elite rowers....

Stress Fracture and Nonunion of Coronoid Process in a Gymnast

Directory of Open Access Journals (Sweden)

T. Hetling

2016-01-01

Full Text Available Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported. Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.

Proximal tibial stress fracture associated with mild osteoarthritis of the knee: case report.

Science.gov (United States)

Curković, Marko; Kovac, Kristina; Curković, Bozidar; Babić-Naglić, Durda; Potocki, Kristina

2011-03-01

Stress fractures are considered as multifactorial overuse injuries occurring in 0.3%-0.8% of patients suffering from rheumatic diseases, with rheumatoid arthritis being the most common underlying condition. Stress fractures can be classified according to the condition of the bone affected as: 1) fatigue stress fractures occurring when normal bone is exposed to repeated abnormal stresses; and 2) insufficiency stress fractures that occur when normal stress is applied to bone weakened by an underlying condition. Stress fractures are rarely associated with severe forms of knee osteoarthritis, accompanied with malalignment and obesity. We present a patient with a proximal tibial stress fracture associated with mild knee osteoarthritis without associated malalignment or obesity. Stress fracture should be considered when a patient with osteoarthritis presents with sudden deterioration, severe localized tenderness to palpation and localized swelling or periosteal thickening at the pain site and elevated local temperature. The diagnosis of stress fractures in patients with rheumatic diseases may often be delayed because plain film radiographs may not reveal a stress fracture soon after the symptom onset; moreover, evidence of a fracture may never appear on plain radiographs. Triple phase nuclear bone scans and magnetic resonance imaging are more sensitive in the early clinical course than plain films for initial diagnosis.

Hajdu-Cheney syndrome associated with serpentine fibulae and polycystic kidney disease

International Nuclear Information System (INIS)

Currarino, Guido

2009-01-01

Six patients who presented with craniofacial anomalies, musculoskeletal anomalies including elongated and bowed (serpentine) fibulae, and polycystic kidneys are reported. This association of anomalies is referred to as serpentine fibula polycystic kidney syndrome (SFPKS) and is currently interpreted as a manifestation of Hajdu-Cheney syndrome (HCS). We report a new instance of this association of anomalies and review the clinical and radiographic features of HCS and of the reported cases of SFPKS. (orig.)

Longitudinal stress fracture of the tibia

International Nuclear Information System (INIS)

Lopez, J.M.; Onatibia, A.; Galardi, A.; Laso, C.

1997-01-01

We present two cases of lengthwise stress fracture in tibia. This is an atypical and uncommon presentation. We describe the major clinical and radiological findings, stressing the enormous importance of CT in the correct diagnosis. (Author) 6 refs

Stress fractures about the tibia, foot, and ankle.

Science.gov (United States)

Shindle, Michael K; Endo, Yoshimi; Warren, Russell F; Lane, Joseph M; Helfet, David L; Schwartz, Elliott N; Ellis, Scott J

2012-03-01

In competitive athletes, stress fractures of the tibia, foot, and ankle are common and lead to considerable delay in return to play. Factors such as bone vascularity, training regimen, and equipment can increase the risk of stress fracture. Management is based on the fracture site. In some athletes, metabolic workup and medication are warranted. High-risk fractures, including those of the anterior tibial diaphysis, navicular, proximal fifth metatarsal, and medial malleolus, present management challenges and may require surgery, especially in high-level athletes who need to return to play quickly. Noninvasive treatment modalities such as pulsed ultrasound and extracorporeal shock wave therapy may have some benefit but require additional research.

The treatment of residual stress in fracture assessment of pressure vessels

International Nuclear Information System (INIS)

Green, D.; Knowles, J.

1992-01-01

The treatment of weld residual stress in the fracture assessment of cylindrical pressure vessels is considered through partitioning the stress into membrane, bending and self-balancing through wall components. The influence of each on fracture behavior is discussed. Stress intensity factor solutions appropriate to each type of stress are presented. Short range, medium range and long range stress categories are identified according to simple rules relating the effect of increasing crack length to stress intensity factor and ligament net stress. Proposals are made on how the stress intensity factor from these stress types may be incorporated into a Kr, Lr based fracture assessment

The role of local stress perturbation on the simultaneous opening of orthogonal fractures

Science.gov (United States)

Boersma, Quinten; Hardebol, Nico; Barnhoorn, Auke; Bertotti, Giovanni; Drury, Martyn

2016-04-01

Orthogonal fracture networks (ladder-like networks) are arrangements that are commonly observed in outcrop studies. They form a particularly dense and well connected network which can play an important role in the effective permeability of tight hydrocarbon or geothermal reservoirs. One issue is the extent to which both the long systematic and smaller cross fractures can be simultaneously critically stressed under a given stress condition. Fractures in an orthogonal network form by opening mode-I displacements in which the main component is separation of the two fracture walls. This opening is driven by effective tensile stresses as the smallest principle stress acting perpendicular to the fracture wall, which accords with linear elastic fracture mechanics. What has been well recognized in previous field and modelling studies is how both the systematic fractures and perpendicular cross fractures require the minimum principle stress to act perpendicular to the fracture wall. Thus, these networks either require a rotation of the regional stress field or local perturbations in stress field. Using a mechanical finite element modelling software, a geological case of layer perpendicular systematic mode I opening fractures is generated. New in our study is that we not only address tensile stresses at the boundary, but also address models using pore fluid pressure. The local stress in between systematic fractures is then assessed in order to derive the probability and orientation of micro crack propagation using the theory of sub critical crack growth and Griffith's theory. Under effective tensile conditions, the results indicate that in between critically spaced systematic fractures, local effective tensile stresses flip. Therefore the orientation of the least principle stress will rotate 90°, hence an orthogonal fracture is more likely to form. Our new findings for models with pore fluid pressures instead of boundary tension show that the magnitude of effective tension

Length scale of secondary stresses in fracture and fatigue

International Nuclear Information System (INIS)

Dong, P.

2008-01-01

In an attempt to provide a consistent framework for the analysis and treatment of secondary stresses associated with welding and thermal loading in the context of fracture mechanics, this paper starts with an effective stress characterization procedure by introducing a length-scale concept. With it, a traction-based stress separation procedure is then presented to provide a consistent characterization of stresses from various sources based on their length scale. Their relative contributions to fracture driving force are then quantified in terms of their characteristic length scales. Special attention is given to the implications of the length-scale argument on both analysis and treatment of welding residual stresses in fracture assessment. A series of examples is provided to demonstrate how the present developments can be applied for treating not only secondary stresses but also externally applied stresses, as well as their combined effects on the structural integrity of engineering components

Dynamic Response in Transient Stress-Field Behavior Induced by Hydraulic Fracturing

Science.gov (United States)

Jenkins, Andrew

Hydraulic fracturing is a technique which is used to exploit geologic features and subsurface properties in an effort to increase production in low-permeability formations. The process of hydraulic fracturing provides a greater surface contact area between the producing formation and the wellbore and thus increases the amount of recoverable hydrocarbons from within the reservoir. The use of this stimulation technique has brought on massive applause from the industry due to its widespread success and effectiveness, however the dynamic processes that take part in the development of hydraulic fractures is a relatively new area of research with respect to the massive scale operations that are seen today. The process of hydraulic fracturing relies upon understanding and exploiting the in-situ stress distribution throughout the area of study. These in-situ stress conditions are responsible for directing fracture orientation and propagation paths throughout the period of injection. The relative magnitude of these principle stresses is key in developing a successful stimulation plan. In horizontal well plan development the interpretation of stress within the reservoir is required for determining the azimuth of the horizontal well path. These horizontal laterals are typically oriented in a manner such that the well path lies parallel to the minimum horizontal stress. This allows for vertical fractures to develop transversely to the wellbore, or normal to the least principle stress without the theoretical possibility of fractures overlapping, creating the most efficient use of the fluid energy during injection. The orientation and magnitude of these in-situ stress fields however can be dynamic, controlled by the subsequent fracture propagation and redistribution of the surrounding stresses. That is, that as the fracture propagates throughout the reservoir, the relative stress fields surrounding the fractures may see a shift and deviate from their original direction or

'Cable-maker's clavicle': stress fracture of the medial clavicle

International Nuclear Information System (INIS)

Peebles, C.R.; Sulkin, T.; Sampson, M.A.

2000-01-01

A 50-year-old man presented with a non-traumatic painful swelling over the medial clavicle. Radiographs showed a poorly defined fracture and the possibility of an underlying pathology was raised. Computed tomography suggested a stress fracture. This prompted a further, more detailed occupational history to be obtained from the patient, which revealed a hitherto undescribed cause of clavicular stress fracture and obviated the need for further imaging or biopsy. (orig.)

Stress Fractures of the Foot.

Science.gov (United States)

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

2015-10-01

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

Taking a holistic approach to managing difficult stress fractures.

Science.gov (United States)

Miller, Timothy L; Best, Thomas M

2016-09-09

Stress fractures and other bony stress injuries occur along a spectrum of severity which can impact treatment and prognosis. When treating these injuries, it should be borne in mind that no two stress fractures behave exactly alike. Given that they are not a consistent injury, standardized treatment protocols can be challenging to develop. Treatment should be individualized to the patient or athlete, the causative activity, the anatomical site, and the severity of the injury. A holistic approach to the treatment of the most difficult stress fractures should be taken by orthopedists and sports medicine specialists. This approach is necessary to obtain optimal outcomes, minimize loss of fitness and time away from sports participation, and decrease the risk of recurrence.

Preliminary experience with biodegradable implants for fracture fixation

Directory of Open Access Journals (Sweden)

Dhillon Mandeep

2008-01-01

Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

Stress analysis of implant-bone fixation at different fracture angle

Science.gov (United States)

Izzawati, B.; Daud, R.; Afendi, M.; Majid, MS Abdul; Zain, N. A. M.; Bajuri, Y.

2017-10-01

Internal fixation is a mechanism purposed to maintain and protect the reduction of a fracture. Understanding of the fixation stability is necessary to determine parameters influence the mechanical stability and the risk of implant failure. A static structural analysis on a bone fracture fixation was developed to simulate and analyse the biomechanics of a diaphysis shaft fracture with a compression plate and conventional screws. This study aims to determine a critical area of the implant to be fractured based on different implant material and angle of fracture (i.e. 0°, 30° and 45°). Several factors were shown to influence stability to implant after surgical. The stainless steel, (S. S) and Titanium, (Ti) screws experienced the highest stress at 30° fracture angle. The fracture angle had a most significant effect on the conventional screw as compared to the compression plate. The stress was significantly higher in S.S material as compared to Ti material, with concentrated on the 4th screw for all range of fracture angle. It was also noted that the screws closest to the intense concentration stress areas on the compression plate experienced increasing amounts of stress. The highest was observed at the screw thread-head junction.

The ``gray cortex``: an early sign of stress fracture

Energy Technology Data Exchange (ETDEWEB)

Mulligan, M.E. [Dept. of Radiology, Univ. of Maryland Medical Center, Baltimore, MD (United States)

1995-04-01

The purpose of this report is to describe an early radiographic sign of stress fracture, the ``gray cortex.`` The imaging findings in three patients with tibial stress fractures were reviewed. The ``gray cortex`` sign was evident on the initial conventional radiographs in all three cases. It was prospectively reported as a sign of stress fracture in two patients and was evident on the initial radiographs (taken elsewhere) of the third patient, who was referred for additional workup of a possible neoplasm. Special imaging studies (technetium-99m bone scan, computed tomography, and magnetic resonance imaging) confirmed the diagnosis in all three cases. (orig.)

The ''gray cortex'': an early sign of stress fracture

International Nuclear Information System (INIS)

Mulligan, M.E.

1995-01-01

The purpose of this report is to describe an early radiographic sign of stress fracture, the ''gray cortex.'' The imaging findings in three patients with tibial stress fractures were reviewed. The ''gray cortex'' sign was evident on the initial conventional radiographs in all three cases. It was prospectively reported as a sign of stress fracture in two patients and was evident on the initial radiographs (taken elsewhere) of the third patient, who was referred for additional workup of a possible neoplasm. Special imaging studies (technetium-99m bone scan, computed tomography, and magnetic resonance imaging) confirmed the diagnosis in all three cases. (orig.)

An Unusual Stress Fracture in an Archer with Hypophosphatasia

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Umut Yavuz

2013-01-01

Full Text Available We report a 45-year-old male archer with stress fracture in his left ulna on the background of adult type of hypophosphatasia. The patient presented to several medical centers for pain around the left elbow and received medical treatment upon diagnosis of tenosynovitis. History of the patient revealed that he had had diagnosis of hypophosphatasia ten years ago and underwent percutaneous screwing for stress fracture on both of his femoral necks. Upon finding nondisplaced stress fracture on proximal metaphysis of the ulna on X-ray, the patient underwent magnetic resonance imaging (MRI in order to exclude pathological causes. No additional pathology was observed in MRI scanning. The patient’s sportive activities were restricted for 6 weeks and he received conservative management with arm slings. Adult type of hypophosphatasia is a disease manifesting with widespread osteoporosis and presenting with low serum level of alkali phosphatase (ALP. Stress fracture should definitely be considered in the patients with history of hypophosphatasia and refractory extremity pain.

A rare type of ankle fracture: Syndesmotic rupture combined with a high fibular fracture without medial injury.

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van Wessem, K J P; Leenen, L P H

2016-03-01

High fibular spiral fractures are usually caused by pronation-external rotation mechanism. The foot is in pronation and the talus externally rotates, causing a rupture of the medial ligaments or a fracture of the medial malleolus. With continued rotation the anterior and posterior tibiofibular ligament will rupture, and finally, the energy leaves the fibula by creating a spiral fracture from anterior superior to posterior inferior. In this article we demonstrate a type of ankle fracture with syndesmotic injury and high fibular spiral fractures without a medial component. This type of ankle fractures cannot be explained by the Lauge-Hansen classification, since it lacks injury on the medial side of the ankle, but it does have the fibular fracture pattern matching the pronation external rotation injury (anterior superior to posterior inferior fracture). We investigated the mechanism of this injury illustrated by 3 cases and postulate a theory explaining the biomechanics behind this type of injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

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Kahanov L

2015-03-01

Full Text Available Leamor Kahanov,1 Lindsey E Eberman,2 Kenneth E Games,2 Mitch Wasik2 1College of Health Science, Misericordia University, Dallas, PA, USA; 2Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA Abstract: Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence. Keywords: medial tibial stress syndrome, stress injury, nonunion stress fracture

Vascularized Fibula Flaps for Mandibular Reconstruction: An ...

African Journals Online (AJOL)

For decades, osseous vascularised flaps have been used for reconstruction of the mandible with the vascularised fibula flap (VFF) remaining the commonly used osseous free flap, reasons ranging from its adequate bone and pedicle length to its receptive dental implant placement quality. This report considers a modest use ...

Reconstruction of lower end of radius using vascularized upper end of fibula

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Koul Ashok

2007-01-01

Full Text Available Background: Giant cell tumor is a fairly common locally invasive tumor in young adults. The lower end of the radius is the second commonest site for this tumor. The most common treatment for this tumor is curettage with or without bone grafting but it carries a significant rate of recurrence. Excision is the treatment of choice, especially for cases in which the cortex has been breached. After excision of the distal end of the radius, different procedures have been described to reconstruct the defect of distal radius. These include partial arthrodesis and hemiarthroplasty using the upper end of the fibula. The upper end of the fibula has a morphological resemblance to the lower end of the radius and has been used to replace the latter. Traditionally it was used as a ′free′ (non-vascularized graft. More recently the upper end of the fibula has been transferred as a vascularized transfer for the same purpose. Though vascularized transfer should be expected to be more physiological, its superiority over the technically simpler non-vascularized transfer has not been conclusively proven. Materials and Methods: Two patients are presented who had giant cell tumor of distal radius. They underwent wide local excision and reconstruction with free vascularized upper end of the fibula. Result: Follow-up period was two and a half years and 12 months respectively. Both patients have returned to routine work. One patient has excellent functional result and the other has a good result. Conclusion: Vascularized upper end of fibula transfer is a reliable method of reconstruction for loss of the distal end of the radius that restores local anatomy and physiology.

Stress Fractures of Tibia Treated with Ilizarov External Fixator.

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Górski, Radosław; Żarek, Sławomir; Modzelewski, Piotr; Górski, Ryszard; Małdyk, Paweł

2016-08-30

Stress fractures are the result of cyclic loading of the bone, which gradually becomes damaged. Most often they are treated by rest or plaster cast and, in rare cases, by internal fixation. There is little published data on initial reposition followed by stabilization with the Ilizarov apparatus in such fractures. Six patients were treated with an external fixator according to the Ilizarov method for a stress fracture of the tibia between 2007 and 2015. Three patients were initially treated conservatively. Due to increasing tibial deformation, they were qualified for surgical treatment with external stabilization. In the other patients, surgery was the first-line treatment. All patients demonstrated risk factors for a stress fracture. After the surgery, they fully loaded the operated limb. No patient developed malunion, nonunion, infection or venous thrombosis. The average time from the first operation to the removal of the external fixator was 19 weeks. Radiographic and clinical outcomes were satisfactory in all patients. 1. The Ilizarov method allows for successful stabilization of stress fractures of the tibia. 2. It may be a good alternative to internal stabilization, especially in patients with multiple comorbidities which affect bone quality and may impair soft tissue healing.

Stress fractures: definition, diagnosis and treatment.

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Astur, Diego Costa; Zanatta, Fernando; Arliani, Gustavo Gonçalves; Moraes, Eduardo Ramalho; Pochini, Alberto de Castro; Ejnisman, Benno

2016-01-01

Stress fractures were first described in Prussian soldiers by Breithaupt in 1855. They occur as the result of repeatedly making the same movement in a specific region, which can lead to fatigue and imbalance between osteoblast and osteoclast activity, thus favoring bone breakage. In addition, when a particular region of the body is used in the wrong way, a stress fracture can occur even without the occurrence of an excessive number of functional cycles. The objective of this study was to review the most relevant literature of recent years in order to add key information regarding this pathological condition, as an updating article on this topic.

Risk factors for stress fracture among young female cross-country runners.

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Kelsey, Jennifer L; Bachrach, Laura K; Procter-Gray, Elizabeth; Nieves, Jeri; Greendale, Gail A; Sowers, Maryfran; Brown, Byron W; Matheson, Kim A; Crawford, Sybil L; Cobb, Kristin L

2007-09-01

To identify risk factors for stress fracture among young female distance runners. Participants were 127 competitive female distance runners, aged 18-26, who provided at least some follow-up data in a randomized trial among 150 runners of the effects of oral contraceptives on bone health. After completing a baseline questionnaire and undergoing bone densitometry, they were followed an average of 1.85 yr. Eighteen participants had at least one stress fracture during follow-up. Baseline characteristics associated (Pstress fracture occurrence were one or more previous stress fractures (rate ratio [RR] [95% confidence interval]=6.42 (1.80-22.87), lower whole-body bone mineral content (RR=2.70 [1.26-5.88] per 1-SD [293.2 g] decrease), younger chronologic age (RR=1.42 [1.05-1.92] per 1-yr decrease), lower dietary calcium intake (RR=1.11 [0.98-1.25] per 100-mg decrease), and younger age at menarche (RR=1.92 [1.15-3.23] per 1-yr decrease). Although not statistically significant, a history of irregular menstrual periods was also associated with increased risk (RR=3.41 [0.69-16.91]). Training-related factors did not affect risk. The results of this and other studies indicate that risk factors for stress fracture among young female runners include previous stress fractures, lower bone mass, and, although not statistically significant in this study, menstrual irregularity. More study is needed of the associations between stress fracture and age, calcium intake, and age at menarche. Given the importance of stress fractures to runners, identifying preventive measures is of high priority.

Fixation orientation in ankle fractures with syndesmosis injury.

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Nimick, Craig J; Collman, David R; Lagaay, Pieter

2013-01-01

Accurate reduction of the syndesmosis has been shown to be an important prognostic factor for functional outcome in ankle injuries that disrupt the syndesmosis. The purpose of the present case series was to assess the fixation orientation and the position of the fibula within the tibial incisura after open reduction and internal fixation of ankle fractures with syndesmosis injury. Computed tomography was used to assess the accuracy of the reduction. Twelve patients were included in the present case series. A ratio representing the relationship between the tibia and fibula and the orientation of the syndesmotic fixation was measured preoperatively and postoperatively and compared with the uninjured contralateral ankle, representing the patient's normal anatomy. The measurements were accomplished electronically to one tenth of 1 mm using Stentor Intelligent Informatics, I-site, version 3.3.1 (Phillips Electronics; Andover, MA). Posteriorly oriented syndesmotic fixation caused posterior translation of the fibula with respect to the tibia and anteriorly oriented syndesmotic fixation caused anterior translation. Copyright © 2013. Published by Elsevier Inc.

NextGen Stress & Fracture for Lightweight Structures

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National Aeronautics and Space Administration — The dream in stress and fracture analysis has always been to be able to simulate cracks initiating and then propagating in a stress field in a metal or composite...

Stress- and Chemistry-Mediated Permeability Enhancement/Degradation in Stimulated Critically-Stressed Fractures

Energy Technology Data Exchange (ETDEWEB)

Derek Elsworth; Abraham S. Grader; Chris Marone; Phillip Halleck; Peter Rose; Igor Faoro; Joshua Taron; André Niemeijer; Hideaki Yasuhara

2009-03-30

This work has investigated the interactions between stress and chemistry in controlling the evolution of permeability in stimulated fractured reservoirs through an integrated program of experimentation and modeling. Flow-through experiments on natural and artificial fractures in Coso diorite have examined the evolution of permeability under paths of mean and deviatoric stresses, including the role of dissolution and precipitation. Models accommodating these behaviors have examined the importance of incorporating the complex couplings between stress and chemistry in examining the evolution of permeability in EGS reservoirs. This document reports the findings of experiment [1,2] and analysis [3,4], in four sequential chapters.

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

Science.gov (United States)

Kahanov, Leamor; Eberman, Lindsey E; Games, Kenneth E; Wasik, Mitch

2015-01-01

Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence. PMID:25848327

X-Ray Exam: Lower Leg (Tibia and Fibula)

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... Staying Safe Videos for Educators Search English Español X-Ray Exam: Lower Leg (Tibia and Fibula) KidsHealth / For ... Muscles, and Joints Broken Bones Getting an X-ray (Video) X-Ray (Video) View more Partner Message About Us ...

A Discrete Fracture Network Model with Stress-Driven Nucleation and Growth

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Lavoine, E.; Darcel, C.; Munier, R.; Davy, P.

2017-12-01

The realism of Discrete Fracture Network (DFN) models, beyond the bulk statistical properties, relies on the spatial organization of fractures, which is not issued by purely stochastic DFN models. The realism can be improved by injecting prior information in DFN from a better knowledge of the geological fracturing processes. We first develop a model using simple kinematic rules for mimicking the growth of fractures from nucleation to arrest, in order to evaluate the consequences of the DFN structure on the network connectivity and flow properties. The model generates fracture networks with power-law scaling distributions and a percentage of T-intersections that are consistent with field observations. Nevertheless, a larger complexity relying on the spatial variability of natural fractures positions cannot be explained by the random nucleation process. We propose to introduce a stress-driven nucleation in the timewise process of this kinematic model to study the correlations between nucleation, growth and existing fracture patterns. The method uses the stress field generated by existing fractures and remote stress as an input for a Monte-Carlo sampling of nuclei centers at each time step. Networks so generated are found to have correlations over a large range of scales, with a correlation dimension that varies with time and with the function that relates the nucleation probability to stress. A sensibility analysis of input parameters has been performed in 3D to quantify the influence of fractures and remote stress field orientations.

Postpartum osteoporosis associated with proximal tibial stress fracture

Energy Technology Data Exchange (ETDEWEB)

Clemetson, I.A.; Anderson, S.E. [Department of Radiology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Popp, A.; Lippuner, K. [Department of Osteology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Ballmer, F. [Knee and Sports Medicine Unit, Lindenhofspital Bern, 3012, Bern (Switzerland)

2004-02-01

A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture. (orig.)

Postpartum osteoporosis associated with proximal tibial stress fracture

International Nuclear Information System (INIS)

Clemetson, I.A.; Anderson, S.E.; Popp, A.; Lippuner, K.; Ballmer, F.

2004-01-01

A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture. (orig.)

Novel management of distal tibial and fibular fractures with Acumed fibular nail and minimally invasive plating osteosynthesis technique: A case report.

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Wang, Tie-Jun; Ju, Wei-Na; Qi, Bao-Chang

2017-03-01

Anatomical characteristics, such as subcutaneous position and minimal muscle cover, contribute to the complexity of fractures of the distal third of the tibia and fibula. Severe damage to soft tissue and instability ensure high risk of delayed bone union and wound complications such as nonunion, infection, and necrosis. This case report discusses management in a 54-year-old woman who sustained fractures of the distal third of the left tibia and fibula, with damage to overlying soft tissue (swelling and blisters). Plating is accepted as the first choice for this type of fracture as it ensures accurate reduction and rigid fixation, but it increases the risk of complications. Closed fracture of the distal third of the left tibia and fibula (AO: 43-A3). After the swelling was alleviated, the patient underwent closed reduction and fixation with an Acumed fibular nail and minimally invasive plating osteosynthesis (MIPO), ensuring a smaller incision and minimal soft-tissue dissection. At the 1-year follow-up, the patient had recovered well and had regained satisfactory function in the treated limb. The Kofoed score of the left ankle was 95. Based on the experience from this case, the operation can be undertaken safely when the swelling has been alleviated. The minimal invasive technique represents the best approach. Considering the merits and good outcome in this case, we recommend the Acumed fibular nail and MIPO technique for treatment of distal tibial and fibular fractures.

Free fibular strut graft in neglected femoral neck fractures in adult

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Azam Md Quamar

2009-01-01

Full Text Available Background: Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula. The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group. Materials and Methods: Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years, operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks. Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view. Results: Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20° (mean 15° of varus. Nonunion occurred in three patients (9.37%, and aseptic necrosis occurred in another six patients (18.75%. Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria. Conclusion: Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula

Measurement of residual stresses using fracture mechanics weight functions

International Nuclear Information System (INIS)

Fan, Y.

2000-01-01

A residual stress measurement method has been developed to quantify through-the-thickness residual stresses. Accurate measurement of residual stresses is crucial for many engineering structures. Fabrication processes such as welding and machining generate residual stresses that are difficult to predict. Residual stresses affect the integrity of structures through promoting failures due to brittle fracture, fatigue, stress corrosion cracking, and wear. In this work, the weight function theory of fracture mechanics is used to measure residual stresses. The weight function theory is an important development in computational fracture mechanics. Stress intensity factors for arbitrary stress distribution on the crack faces can be accurately and efficiently computed for predicting crack growth. This paper demonstrates that the weight functions are equally useful in measuring residual stresses. In this method, an artificial crack is created by a thin cut in a structure containing residual stresses. The cut relieves the residual stresses normal to the crack-face and allows the relieved residual stresses to deform the structure. Strain gages placed adjacent to the cut measure the relieved strains corresponding to incrementally increasing depths of the cut. The weight functions of the cracked body relate the measured strains to the residual stresses normal to the cut within the structure. The procedure details, such as numerical integration of the singular functions in applying the weight function method, will be discussed

Measurement of residual stresses using fracture mechanics weight functions

International Nuclear Information System (INIS)

Fan, Y.

2001-01-01

A residual stress measurement method has been developed to quantify through-the-thickness residual stresses. Accurate measurement of residual stresses is crucial for many engineering structures. Fabrication processes such as welding and machining generate residual stresses that are difficult to predict. Residual stresses affect the integrity of structures through promoting failures due to brittle fracture, fatigue, stress corrosion cracking, and wear. In this work, the weight function theory of fracture mechanics is used to measure residual stresses. The weight function theory is an important development in computational fracture mechanics. Stress intensity factors for arbitrary stress distribution on the crack faces can be accurately and efficiently computed for predicting crack growth. This paper demonstrates that the weight functions are equally useful in measuring residual stresses. In this method, an artificial crack is created by a thin cut in a structure containing residual stresses. The cut relieves the residual stresses normal to the crack-face and allows the relieved residual stresses to deform the structure. Strain gages placed adjacent to the cut measure the relieved strains corresponding to incrementally increasing depths of the cut. The weight functions of the cracked body relate the measured strains to the residual stresses normal to the cut within the structure. The procedure details, such as numerical integration of the singular functions in applying the weight function method, will be discussed. (author)

The Contribution of SPECT/CT in the Diagnosis of Stress Fracture of the Proximal Tibia.

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Okudan, Berna; Coşkun, Nazım; Arıcan, Pelin

2018-02-01

Stress fractures are injuries most commonly seen in the lower limbs and are usually caused by repetitive stress. While the distal and middle third of the tibia is the most frequent site for stress fractures (almost 50%), stress fractures of the proximal tibia is relatively rare and could be confused with other types of tibial fractures, thus altering management plans for the clinician. Early diagnosis of stress fractures is also important to avoid complications. Imaging plays an important role in the diagnosis of stress fractures, especially bone scan. Combined with single-photon emission computed tomography/computed tomography (SPECT/CT) it is an important imaging technique for stress fractures in both upper and lower extremities, and is widely preferred over other imaging techniques. In this case, we present the case of a 39-year-old male patient diagnosed with stress fracture of the proximal tibia and demonstrate the contribution of CT scan fused with SPECT imaging in the early diagnosis of stress fracture prior to other imaging modalities.

Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study of 736 subjects.

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Weber, Donald; Dulai, Sukhdeep K; Bergman, Joseph; Buckley, Richard; Beaupre, Lauren A

2014-11-01

To evaluate the association between time to surgery, antibiotic administration, Gustilo grade, fracture location, and development of deep infection in open fractures. Prospective cohort between 2001 and 2009. Three Level 1 Canadian trauma centers. A total of 736 (791 fractures) subjects were enrolled and 686 subjects (93%; 737 fractures) provided adequate follow-up data (1-year interview and/or clinical follow-up >90 days). Demographics, injury information, time to surgery, and antibiotics were recorded. Subjects were evaluated using standardized data forms until the fracture(s) healed. Phone interviews were undertaken 1 year after the fracture. Infection requiring unplanned surgical debridement and/or sustained antibiotic therapy. Tibia/fibula fractures were most common (n = 413, 52%), followed by upper extremity (UE) (n = 285, 36%), and femoral (n = 93, 12%) fractures. Infection developed in 46 fractures (6%). The median time to surgery was 9 hours 4 minutes (interquartile range, 6 hours 39 minutes to 12 hours 33 minutes) and 7 hours 39 minutes (interquartile range, 6 hours 10 minutes to 9 hours 54 minutes) for those without and with infection, respectively (P = 0.04). Gustilo grade 3B/3C fractures accounted for 17 of 46 infections (37%) (P developed infections (P = 0.001). Multivariate regression found no association between infection and time to surgery [odds ratio (OR), 0.97; 95% confidence interval (95% CI), 0.90-1.06] or antibiotics (OR, 1.0; 95% CI, 0.90-1.05). Grades 3A (OR, 6.37; 95% CI, 1.37-29.56) and 3B/3C (OR, 12.87; 95% CI, 2.72-60.95) relative to grade 1 injuries and tibia/fibula (OR, 3.91; 95% CI, 1.33-11.53) relative to UE fractures were significantly associated with infection. Infection after open fracture was associated with increasing Gustilo grade or tibia/fibula fractures but not time to surgery or antibiotics. Prognostic level I. See instructions for authors for a complete description of levels of evidence.

Expected Time to Return to Athletic Participation After Stress Fracture in Division I Collegiate Athletes.

Science.gov (United States)

Miller, Timothy L; Jamieson, Marissa; Everson, Sonsecharae; Siegel, Courtney

2017-12-01

Few studies have documented expected time to return to athletic participation after stress fractures in elite athletes. Time to return to athletic participation after stress fractures would vary by site and severity of stress fracture. Retrospective cohort study. Level 3. All stress fractures diagnosed in a single Division I collegiate men's and women's track and field/cross-country team were recorded over a 3-year period. Site and severity of injury were graded based on Kaeding-Miller classification system for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with patient sex and site and severity grade of injury. Fifty-seven stress fractures were diagnosed in 38 athletes (mean age, 20.48 years; range, 18-23 years). Ten athletes sustained recurrent or multiple stress fractures. Thirty-seven injuries occurred in women and 20 in men. Thirty-three stress fractures occurred in the tibia, 10 occurred in the second through fourth metatarsals, 3 occurred in the fifth metatarsal, 6 in the tarsal bones (2 navicular), 2 in the femur, and 5 in the pelvis. There were 31 grade II stress fractures, 11 grade III stress fractures, and 2 grade V stress fractures (in the same patient). Mean time to return to unrestricted sport participation was 12.9 ± 5.2 weeks (range, 6-27 weeks). No significant differences in time to return were noted based on injury location or whether stress fracture was grade II or III. The expected time to return to full unrestricted athletic participation after diagnosis of a stress fracture is 12 to 13 weeks for all injury sites. Athletes with grade V (nonunion) stress fractures may require more time to return to sport.

Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

International Nuclear Information System (INIS)

Williams, T.R.; Puckett, M.L.; Shin, A.Y.; Gorman, J.D.; Denison, G.

2002-01-01

Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

Incidence and Time to Return to Training for Stress Fractures during Military Basic Training

Directory of Open Access Journals (Sweden)

Alexander M. Wood

2014-01-01

Full Text Available Currently, little is known about the length of time required to rehabilitate patients from stress fractures and their return to preinjury level of physical activity. Previous studies have looked at the return to sport in athletes, in a general population, where rehabilitation is not as controlled as within a captive military population. In this study, a longitudinal prospective epidemiological database was assessed to determine the incidence of stress fractures and the time taken to rehabilitate recruits to preinjury stage of training. Findings demonstrated a background prevalence of 5% stress fractures in Royal Marine training; femoral and tibial stress fractures take 21.1 weeks to return to training with metatarsal stress fractures being the most common injury taking 12.2 weeks. Rehabilitation from stress fractures accounts for 814 weeks of recruit rehabilitation time per annum. Stress fracture incidence is still common in military training; despite this stress fracture recovery times remain constant and represent a significant interruption in training. It takes on average 5 weeks after exercise specific training has restarted to reenter training at a preinjury level, regardless of which bone has a stress fracture. Further research into their prevention, treatment, and rehabilitation is required to help reduce these burdens.

Fracture mechanical treatment of bridging stresses in ceramics

International Nuclear Information System (INIS)

Fett, T.; Munz, D.

1993-12-01

Failure of ceramic materials often starts from cracks which can originate at pores, inclusions or can be generated during surface treatment. Fracture occurs when the stress intensity factor of the most serious crack in a component reaches a critical value K lc , the fracture toughness of the material. In case of ideal brittle materials the fracture toughness is independent of the crack extension and, consequently, identical with the stress intensity factor K l0 necessary for the onset of stable crack growth. It is a well-known fact that failure of several ceramics is influenced by an increasing crack-growth resistance curve. Several effects are responsible for this behaviour. Crack-border interactions in the wake of the advancing crack, residual stress fields in the crack region of transformation-toughened ceramics, the generation of a micro-crack zone ahead the crack tip and crack branching. The effect of increasing crack resistance has consequences on many properties of ceramic materials. In this report the authors discuss the some aspects of R-curve behaviour as the representation by stress intensity factors or energies and the influence on the compliance using the bridging stress model. (orig.) [de

The effect of stress fracture interventions in a single elite infantry training unit (1983-2015).

Science.gov (United States)

Milgrom, Charles; Finestone, Aharon S

2017-10-01

Stress fractures can be seen as an undesired byproduct of demanding physical training. The threshold value of stress that places an individual bone at high risk for stress fracture has not been identified. In a prospective study of stress fractures in 1983, a 31% incidence was found during demanding Israeli infantry basic training by bone scan criteria. Within a subgroup of these recruits, an elite infantry unit was found to have a 40% incidence. Since then and until 2015, eight additional induction companies of the same elite infantry unit were prospectively monitored for stress fractures during their basic training. In all of the studies, stress fracture surveillance and the examining orthopedist were the same. A retrospective review of all nine studies and of eight training changes was performed to look for a temporal trend in stress fracture incidence and to see if these might be related to training changes. There was a statistically significant trend for lower radiological proven stress fractures (p=0.0001) and radiological proven stress fractures plus clinical stress fractures (p=0.0013), as well as lower stress fracture severity by radiological criteria (p=0.0001) between 1983 and 2015. The only training change that was associated, by multivariate logistic regression, with a decreased incidence of stress fracture was restricting training to the authorized training protocol (odds ratio, 3874; 95% CI, 1.526 to 9.931; p=0.004). Increased recruit weight was found by multivariate analysis to be associated with lower stress fracture incidence (odds ratio 1.034; 95% CI, 1.00 to 1.070; p=0.051). Moving the training to a base with flatter terrain and reducing the formal marching distance by 1/3 was associated with a decrease in high grade stress fractures (odds ratio, 10.03; 95% CI, 3.5 to 28.4; p=0.0001). Neither the combined changes of enforcing a seven hour a night sleep regimen, training in more comfortable boots and adding a physical therapist to the unit nor

Multiple stress fractures in a young female runner.

Science.gov (United States)

Dusek, T; Pećina, M; Loncar-Dusek, M; Bojanic, I

2004-01-01

The effect of exercise on female's bone metabolism has received much attention in recent years. We report on unusual case of a female runner with low body mass and amenorrhea, who suffered 4 stress fractures. Three of the stress fractures occurred during her sports career, and the fourth occurred 7 years after the cessation of sports activities. It seems that exercise-induced amenorrhea together with food restriction in the young age may cause long-term consequences on bone metabolism.

The Contribution of SPECT/CT in the Diagnosis of Stress Fracture of the Proximal Tibia

Directory of Open Access Journals (Sweden)

Berna Okudan

2018-02-01

Full Text Available Stress fractures are injuries most commonly seen in the lower limbs and are usually caused by repetitive stress. While the distal and middle third of the tibia is the most frequent site for stress fractures (almost 50%, stress fractures of the proximal tibia is relatively rare and could be confused with other types of tibial fractures, thus altering management plans for the clinician. Early diagnosis of stress fractures is also important to avoid complications. Imaging plays an important role in the diagnosis of stress fractures, especially bone scan. Combined with single-photon emission computed tomography/computed tomography (SPECT/CT it is an important imaging technique for stress fractures in both upper and lower extremities, and is widely preferred over other imaging techniques. In this case, we present the case of a 39-year-old male patient diagnosed with stress fracture of the proximal tibia and demonstrate the contribution of CT scan fused with SPECT imaging in the early diagnosis of stress fracture prior to other imaging modalities.

Fracture predictions for cracks exposed to superimposed normal and shear stresses

International Nuclear Information System (INIS)

Richard, H.A.

1985-01-01

The author developed a special device and a fracture mechanics specimen and proposed a procedure for determining the fracture toughness when Mixed Mode and Mode II stresses are applied. This device makes it possible to generate pure normal stresses, superimposed normal and shearing stresses as well as pure shearing stresses in the cross section of the crack in the specimen, as desired. The so-called CTS fracture mechanics specimen has an edge crack. The load is transferred statically determind from the device to the specimen by means of six studs altogether. The experiments described, which were carried out with specimens made of the brittle materials PMMA (Plexiglas) and Araldit B, clearly show that it is possible to evaluate the validity of the individual fracture hypotheses by suitable experiments. It is also found that the fracture behaviour of different materials varies considerably both in quality and quantity. In conclusion, a practice-oriented fracture criterion is indicated which enables a practice-conforming evaluation of Mixed-Mode crack problems, as is shown by way of examples. (orig./HP) [de

Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction

NARCIS (Netherlands)

Schepers, Rutger H.; Kraeima, Joep; Vissink, Arjan; Lahoda, Lars U.; Roodenburg, Jan L. N.; Reintsema, Harry; Raghoebar, Gerry M.; Witjes, Max J.

Background: We compared the pre-operative 3D-surgical plan with the surgical outcome of complex two-stage secondary reconstruction of maxillofacial defects using inserted implants in the prefabricated fibula graft. Methods: Eleven reconstructions of maxillofacial defects with prefabricated fibulas

Congenital (infantile) pseudarthrosis of the fibula associated with osteofibrous dysplasia

International Nuclear Information System (INIS)

Hisaoka, Masanori; Hashimoto, Hiroshi; Ohguri, Takayuki; Aoki, Takatoshi; Okamoto, Sumika; Ishida, Tsuyoshi; Tanaka, Hidetoshi; Okimoto, Nobukazu; Nakamura, Toshitaka

2004-01-01

We describe a recently noted association of congenital (infantile) pseudarthrosis of the lower leg with osteofibrous dysplasia. The patient was a 2-year-old boy who presented with a deformed left ankle joint and three cutaneous cafe-au-lait spots. Radiography demonstrated pseudarthrosis of the left distal fibula and a round lucent lesion adjacent to the proximal part of the pseudarthrosis. Histologically, the surgically removed fibula with pseudarthrosis showed a fibromatosis-like fibrovascular proliferation and nonspecific reparative changes. The focal lucent area demonstrated a fibro-osseous lesion, which was histologically identical to osteofibrous dysplasia. This case provides further evidence that osteofibrous dysplasia may be associated with congenital (infantile) pseudarthrosis of the lower leg. (orig.)

Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas

DEFF Research Database (Denmark)

Petersen, Michael Mørk; Hovgaard, Dorrit; Elberg, Jens Jørgen

2010-01-01

We evaluated the results of limb-sparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients (mean age at operation 13.6 years (range 4.1-24.2 years), female/male = 6/2) with bone sarcomas (BS) (osteosarcoma/Ewing's sarcoma/chondrosarcoma= 4....../3/1) operated on form 2000 to 2006. The bone defects reconstructed were proximal femoral diaphysis and epiphysis (n = 2), humeral diaphysis (n = 2), humeral proximal diaphysis and epiphysis (n = 1), femoral diaphysis (n = 1), ulnar diaphysis (n = 1), and tibial diaphysis (n = 1). One patient with Ewing......'s sarcoma had an early hip disarticulation, developed multiple metastases, and died 9 months after the operation. The remaining patients (n = 7) are all alive 50 months (range 26-75 months) after surgery. During the follow-up the following major complications were seen: 1-2 fractures (n = 4), pseudarthrosis...

Stress fracture in posterior aspect of the tibia

International Nuclear Information System (INIS)

Moon, Tae Yong; Jung, Hyun Woo; Park, Chung Hun; Chun, Kyung Ah; Koo, Bong Sig; Lee, Sang Yong

1999-01-01

To determine correlation between stress fracture of the posterior tibia and flexor digitorum longus muscle injury caused by athletic or sporting activity during adolescence. Eleven cases diagnosed as stress fracture after X-ray and MR imaging of the lower leg were reviewed. With regard to each fracture, the following features were noted : age, sex, and athletic or sporting activity of the patient, and site. Using MR imaging techniques, axial and sagittal T1 and T2 weighted imaged were obtained in all cases and T1-Gd DTPA images in seven. The activities undertaken were running (n=3), football (n=2), ballet (n=2), taekwando (n=1), badminton (n=1), field hockey (n=1), and basketball (n=1). MR images revealed localized cortical thickness (n=11), linear intramedullary callus showing a low signal on T1 and T2 weighted images (n=9), marrow hyperemia (n=7), and flexor digitorum longus muscle injury showing a high signal on T1-Gd DTPA and T2 weighted image (n=7). Stress fracture of the posterior tibia might be induced by flexor digitorum longus muscle activity induced by athletic or sporting activities during adolescence

Stress fracture in posterior aspect of the tibia

Energy Technology Data Exchange (ETDEWEB)

Moon, Tae Yong; Jung, Hyun Woo; Park, Chung Hun [Pusan National Univ. College of Medicine, Pusan (Korea, Republic of); Chun, Kyung Ah [Catholic Univ Hospital, Pusan (Korea, Republic of); Koo, Bong Sig [Donga Univ. Hospital, Pusan (Korea, Republic of); Lee, Sang Yong [Chunbuk Natinoal Univ. Hospital, Chunju (Korea, Republic of)

1999-01-01

To determine correlation between stress fracture of the posterior tibia and flexor digitorum longus muscle injury caused by athletic or sporting activity during adolescence. Eleven cases diagnosed as stress fracture after X-ray and MR imaging of the lower leg were reviewed. With regard to each fracture, the following features were noted : age, sex, and athletic or sporting activity of the patient, and site. Using MR imaging techniques, axial and sagittal T1 and T2 weighted imaged were obtained in all cases and T1-Gd DTPA images in seven. The activities undertaken were running (n=3), football (n=2), ballet (n=2), taekwando (n=1), badminton (n=1), field hockey (n=1), and basketball (n=1). MR images revealed localized cortical thickness (n=11), linear intramedullary callus showing a low signal on T1 and T2 weighted images (n=9), marrow hyperemia (n=7), and flexor digitorum longus muscle injury showing a high signal on T1-Gd DTPA and T2 weighted image (n=7). Stress fracture of the posterior tibia might be induced by flexor digitorum longus muscle activity induced by athletic or sporting activities during adolescence.

Stress fracture risk factors in female football players and their clinical implications.

Science.gov (United States)

Warden, Stuart J; Creaby, Mark W; Bryant, Adam L; Crossley, Kay M

2007-08-01

A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading, which results in structural fatigue, and resultant signs and symptoms of localised pain and tenderness. Reports of stress fractures in female football players are not prevalent; however, they are probably under-reported and their importance lies in the morbidity that they cause in terms of time lost from participation. By considering risk factors for stress fractures in female football players it may be possible to reduce the impact of these troublesome injuries. Risk factors for stress fractures in female football players include intrinsic risk factors such as gender, endocrine, nutritional, physical fitness and neuromusculoskeletal factors, as well as extrinsic risk factors such as training programme, equipment and environmental factors. This paper discusses these risk factors and their implications in terms of developing prevention and management strategies for stress fractures in female football players.

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

Science.gov (United States)

Low, Sara; Kern, Michael; Atanda, Alfred

2016-01-01

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

Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases

International Nuclear Information System (INIS)

Williams, M.; Timsit, M.A.; Karneff, A.; Pertuiset, E.

1999-01-01

We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively. (orig.)

Bilateral First Rib Stress Fractures in a Basketball Player

Directory of Open Access Journals (Sweden)

Abidin (Radyoloji Kilincer

2016-04-01

Full Text Available I read the article published by Aydogdu et al with a great interest. I congratulate them for this successfully written case report. Additionally, I want to focus an important point about the case they presented is that the diagnosis in that case is likely stress fracture. It is understood from the text and title that they avoided to make a diagnosis of stress fracture in the case, despite of history of lifting heavy weights for three days. And also I decided to mention through this article to an example of our case with bilateral first rib old fractures.

Acoustic Emission Based Surveillance System for Prediction of Stress Fractures

Science.gov (United States)

2007-09-01

aging are susceptible to such fractures in contexts of osteoporosis, diabetes, cerebral palsy, fibrous dysplasia and osteogenesis imperfecta . This...disease, or, healthy people who have excessive exercise regimes (soldiers and athletes) experience these fractures [2]. Stress fractures interrupt

Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.

Science.gov (United States)

Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-Ichi

2017-06-18

To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

[Surgery guided by customized devices: reconstruction with a free fibula flap].

Science.gov (United States)

Schouman, T; Bertolus, C; Chaine, C; Ceccaldi, J; Goudot, P

2014-02-01

The reconstruction of jaws with a free fibula flap can be anticipated virtually. The simulation can be transferred to the operating theater using customized devices obtained from computer-assisted design and manufacturing in a complete digital workflow. Several alternatives are available, from cutting guides to customized titanium osteosynthesis plates, to obtain the best accuracy and reproducibility of reconstruction. Moreover, these new processes allow integrating prosthetic planning concomitantly with reconstruction. We present the virtual three-dimensional planning method for jaw reconstruction with a free fibula flap and the various alternatives of surgery guided by customized devices provided by this planning. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Vascularized fibular graft in infected tibial bone loss

Directory of Open Access Journals (Sweden)

C Cheriyan Kovoor

2011-01-01

Full Text Available Background : The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials and Methods : 15 male patients with mean age 33.7 years (range 18 - 56 years of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 - 20 cm. The mean length of the graft was 16.7 cm (range 11.5 - 21 cm. The osteoseptocutaneous flap (bone flap with attached overlying skin flap from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 - 164 months. The Pearson correlation coefficient (r was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture. Results : Graft

Influence of Bone Remodeling Inhibition on the Development of Experimental Stress Fractures

National Research Council Canada - National Science Library

Schaffler, Mitchell B

2005-01-01

.... Using a bisphosphonate (BIS) to suppress remodeling in the rabbit tibial stress fracture model, we found that antiresorptive therapy reduced the intensity of the stress fracture response in this model...

The diagnosis of stress fractures of runners by an isotope scintigraphy

International Nuclear Information System (INIS)

Karvonen, J.; Nieminen, M.

1988-01-01

By means of isotope scintigraphy the suspected stress fractures in the lower limb bones of ten competitive runners were verified in nine cases (9/10). In all cases the X-rays were normal. By conservative treatment avoiding excessive stress, the intensive local isotope uptake in the bone and pain symptoms of the stress fracture disappeared after 2-4 months. (orig.)

[Fractures of the lower leg in professional skiers].

Science.gov (United States)

Mückley, T; Kruis, C; Schütz, T; Brucker, P; Bühren, V

2004-03-01

Fractures of the lower leg due to skiing accidents remain an important concern. Few studies have focussed on the special demands of professional athletes who sustain these injuries. We present our experience with three cases of lower leg fractures in competitive professional downhill skiers and discuss management and treatment concepts. We performed limited reamed compression nailing in all the patients presented because it offers the advantages of high mechanical stability and optimized fragment apposition. Plate osteosynthesis of the fibula is not required in most typical fractures. All patients resumed ski training. Two of them returned to World Cup. Only one achieved her pre-injury World Cup level of performance and success. In conclusion, a successful return for professional skiers with lower leg fractures is feasible using an optimized treatment strategy.

Mechanisms Underlying Stress Fracture and the Influence of Sex and Race/Ethnicity

Science.gov (United States)

2017-10-01

AWARD NUMBER: W81XWH-16-1-0652 TITLE: Mechanisms Underlying Stress Fracture and the Influence of Sex and Race/Ethnicity PRINCIPAL INVESTIGATOR...5a. CONTRACT NUMBER W81XWH-16-1-0652 Mechanisms Underlying Stress Fracture and the Influence of Sex and Race/Ethnicity 5b. GRANT NUMBER W81XWH...to stress fracture risk. In particular, in Study 1, we will perform advanced skeletal imaging along with gait-assessments in subjects with history of

Acetabular roof stress fracture: a rare cause of hip pain in children ...

African Journals Online (AJOL)

Stress fracture of acetabular roof is an unusual cause of hip pain. It is considered as an underdiagnosed entity. People who are more susceptible to experience this fracture are athletes, soldiers and dancers. We present the case of an 11 year old girl with a roof acetabular stress fracture for which the diagnosis and ...

Investigations on the influence of the stress state on fracture-mechanical values

International Nuclear Information System (INIS)

Schmidt, P.

1979-01-01

Fracture toughness obtained from specimen can be applied to construction elements only when the same stress state exists. In standardised fracture-mechanical tests plain strain is realised. Using the stress intensity factor, a critical crack length or a critical load can be obtained. Above these values a crack propagates in an unstable way. The specimen are tested under uni-axial load. In this paper investigations have been made whether a biaxial load increases the stress state over the plain strain and whether consequently a decrease of the critical fracture toughness and a shift of the temperatures Tsub(g)sub(y) and Tsub(s) results which characterise the fracture behaviour of steel. In order to answer these questions the tests were made which induced due to their geometry an additional nominal stress parallel to the crack front in spite of uni-axial loading. The results were compared with those from specimen without an additional nominal stress and having in their cross section under same test conditions nearly the same plain strain. The fracture toughness of both specimen types were compared at temperatures between 142 K and 252 K and correlated to other material-characterising values. The tests were completed by stress analysis and by comparing the crack opening displacement. Due to the additional stress, Tsub(g)sub(y) was found to be 20 K higher than for the reference specimen. The fracture toughness decreases significantly in certain temperature ranges. The plastic stress concentration factor was comperatively higher and the remaining plastic crack opening decreases up to 25%. (orig.) [de

Value of lateral blood pool imaging in patients with suspected stress fractures of the tibia.

Science.gov (United States)

Mohan, Hosahalli K; Clarke, Susan E M; Centenara, Martin; Lucarelli, Amanda; Baron, Daniel; Fogelman, Ignac

2011-03-01

To critically evaluate the use of lateral blood pool imaging in athletes with lower limb pain and with a clinical suspicion of stress fracture. Two experienced nuclear medicine physicians evaluated 3-phase bone scans using 99mTc-methylene diphosphonate performed in 50 consecutive patients referred from a specialist sports injury clinic for suspected tibial stress fracture. The vascularity to the tibia as seen on the blood pool (second phase) images in the anterior/posterior views was compared with the lateral/medial view assessments. Stress fractures were presumed to be present when on the delayed images (third phase) there was a focal or fusiform area of increased tracer uptake involving the tibial cortex. Shin splints which are a recognized cause of lower limb pain in athletes mimicking stress fracture were diagnosed if increased tracer uptake was seen extending along the posterior tibial surface with no significant focal or fusiform area of uptake within this. Inter-reviewer agreement for the assessment of vascularity was also assessed using Cohen's Kappa scores. Twenty-four stress fractures in 24 patients and 66 shin splints in 40 patients were diagnosed. In 18 patients stress fracture and shin splints coexisted. In 10 patients no tibial pathology was identified. Of the 24 patients diagnosed with stress fractures, lateral/medial blood pool imaging was superior in the assessment of blood pool activity (P tibial stress fractures, lateral views of the tibia provide the optimal method for evaluation of vascularity. Prospective studies with quantitative or semi-quantitative assessment of skeletal vascularity could provide supplementary information relating to the pathophysiology of stress fractures, for example, the time scale of vascular changes after a tibial stress fracture, and potentially could have clinical relevance as to the assessment of the severity of stress fractures and their prognosis.

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report.

Science.gov (United States)

Lu, Cheng-Chang; Chen, Shen-Kai; Wang, Chih-Wei; Chou, Pei-Hsi

2006-05-01

Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures. Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.

STRESS FRACTURE OF THE ULNA IN A BREAK-DANCER

Directory of Open Access Journals (Sweden)

Yu-Hsu Chen

2008-12-01

Full Text Available Break dancing is a popular activity in teenagers and is associated with severe trauma to bones and tissues. We report the first known case of a break dancer with an ulnar stress fracture. Such injuries occur in a variety of sports due to substantial stress on the ulna and repetitive excessive rotation of the forearm. In this study we describe a patient who experienced an ulnar stress fracture during break dancing training. The diagnosis was established by history and physical examination. Initial radiographic findings were negative. However, radiographs taken 3 months after initial presented revealed callus formation over the ulnar shaft. This suggested that readjustment is required in break dancing training protocols. It is important to increase awareness of this injury among physicians to expedite the diagnosis and to prevent the possibility of conversion to an overt fracture in the future

Avoiding secondary skin graft donor site morbidity in the fibula free flap harvest.

Science.gov (United States)

Kim, Paul D; Fleck, Terry; Heffelfinger, Ryan; Blackwell, Keith E

2008-12-01

To compare donor site morbidity in patients who have undergone fibula free flap reconstruction in which the skin graft was taken from the expected cutaneous paddle of the fibula with the known complications of the popular technique of obtaining a split-thickness skin graft (STSG) from a secondary donor site. Cohort study. The tertiary care centers at Loma Linda University Medical Center and University of California, Los Angeles, Medical Center. From September 1, 2006, to March 30, 2007, 30 patients underwent fibula free flap harvest by 2 surgeons at separate tertiary care centers. Twenty-one of those procedures took place at the University of California, Los Angeles, and 9 at Loma Linda University. Patients included 15 men (50%) and 15 women (50%), with a mean age of 58 (range, 19-88) years. All 30 patients underwent fibula free flap harvest with a split-thickness skin graft (graft thickness, 0.04 cm), obtained from osteocutaneous paddle using a 5.1-cm-wide dermatome, as well as oral cavity and oropharyngeal reconstruction with the de-epithelialized skin paddle. Measures of donor site morbidity, including graft failure and wound breakdown, and measures of recipient site morbidity, including flap failure, hardware complications, intraoral complications, and the need for additional surgery. Of the 30 patients who underwent this procedure, 4 had partial skin graft failures, for a complete skin graft survival of 87%. There were no complete skin graft losses. Regarding the fibula osteocutaneous free flap, there were no complete flap losses, 1 skin paddle necrosis that required debridement, 2 postoperative orocutaneous fistulas, 1 case of infected/extruded hardware, and 1 adhesion formation that required additional surgery for lysis of adhesion and placement of the split-thickness skin graft. The outlined novel technique has similar rates of free flap survival and skin graft take compared with previously described methods. Harvesting the skin graft over the expected

Stress fractures of the rib arising from the manufactory assembly line

International Nuclear Information System (INIS)

Arima, Toru; Iwasaki, Masayuki

2007-01-01

We investigated stress injuries of the rib arising from the assembly line. The patients, all males, were 20 in number and divided into two groups; those with stress fracture (n=13) and those with ''pre-fracture'' (n=7). The former group with the average age of 37 years was involved by a single fracture in 10 patients and multiple fractures in 3, ranging from 5th to 8th ribs, with the affected side on the right in 9 and the left in 4. All 13 fractures occurred in the posterior half of the rib, in which 5 were located in its lateral portion, 5 in the middle, and 3 in the posterior. The latter group with the average age of 32 years were involved on the right side in 4 and the left in 3. The working pattern causing rib injuries was either repeated raising of the upper extremity or forward pushing of the shoulder girdle. The symptom was back pain, and aggravated especially in elevation of the arm, deep breathing and sneezing. Local tenderness over the fracture site was noted in all cases. X-ray findings at initial examination revealed fractures in most cases and 3D-CT was employed in 9 questionable cases to assess fracture conditions. In the ''pre-fracture'' group, although the fracture was not recognized on X-ray, the diagnosis was made as an impending fracture based on the localized tenderness on the rib. As to treatment, bust band fixation and work load reduction were performed. Stress fractures of the rib have been occasionally reported in sports medicine, but not so much in industrial medicine. This specific injury has been treated in literature as muscle strain because of the absence of apparent trauma. It is important to recognize the underlying pathology to make the correct diagnosis. In the early stage of rib fractures, 3D-CT was more useful than X-ray in making diagnosis and assessing the bony union. As to the pathomechanism of this condition, it was postulated that repeated raising or forward pushing of the arm applying excessive traction to the origin of the

Epidemiology of stress fracture injuries among US high school athletes, 2005-2006 through 2012-2013.

Science.gov (United States)

Changstrom, Bradley G; Brou, Lina; Khodaee, Morteza; Braund, Cortney; Comstock, R Dawn

2015-01-01

High school athletes in the United States sustain millions of injuries annually, approximately 10% of which are fractures. However, there is no clear estimate of the number of stress fractures sustained by high school athletes annually despite reports that stress fractures account for 0.7% to 20% of injuries seen in sports medicine clinics. This suggests a high utilization of resources for a potentially preventable injury. In addition, stress fractures have been associated with low energy availability and disordered eating in young athletes, highlighting the importance of early recognition and intervention. To investigate stress fracture rates and patterns in a large national sample of US high school athletes. Descriptive epidemiologic study. Data from High School RIO (Reporting Information Online), a national sports injury surveillance study, were analyzed to describe rates and patterns of stress fracture injury sustained from 2005-2006 through 2012-2013, across sports and by sex. From 2005-2006 through 2012-2013, a total of 51,773 injuries were sustained during 25,268,873 athlete-exposures, of which 389 (0.8%) were stress fractures, resulting in an overall stress fracture rate of 1.54 per 100,000 athlete-exposures. Rates per 100,000 athlete-exposures were highest in girls' cross country (10.62), girls' gymnastics (7.43), and boys' cross country (5.42). In sex-comparable sports, girls sustained more stress fractures (63.3%) than did boys (36.7%) and had higher rates of stress fracture (2.22 vs 1.27; rate ratio, 1.75; 95% CI, 1.38-2.23). The most commonly injured sites were the lower leg (40.3% of all stress fractures), foot (34.9%), and lower back/lumbar spine/pelvis (15.2%). Management was nonsurgical in 98.7% of the cases, and 65.3% of injuries resulted in ≥3 weeks of time loss, medical disqualification, or an end to the season before athletes could return to play. Although a rare injury, stress fractures cause considerable morbidity for high school athletes

Association of stressful life events with incident falls and fractures in older men: the Osteoporotic Fractures in Men (MrOS) Study

Science.gov (United States)

Fink, Howard A.; Kuskowski, Michael A.; Marshall, Lynn M.

2014-01-01

Background: small, retrospective studies suggest that major life events and/or sudden emotional stress may increase fall and fracture risk. The current study examines these associations prospectively. Methods: a total of 5,152 men aged ≥65 years in the Osteoporotic Fractures in Men study self-reported data on stressful life events for 1 year prior to study Visit 2. Incident falls and fractures were ascertained for 1 year after Visit 2. Fractures were centrally confirmed. Results: a total of 2,932 (56.9%) men reported ≥1 type of stressful life event. In men with complete stressful life event, fall and covariate data (n = 3,949), any stressful life event was associated with a 33% increased risk of incident fall [relative risk (RR) 1.33, 95% confidence interval (CI) 1.19–1.49] and 68% increased risk of multiple falls (RR = 1.68, 95% CI = 1.40–2.01) in the year following Visit 2 after adjustment for age, education, Parkinson's disease, diabetes, stroke, instrumental activities of daily living (IADL) impairment, chair stand time, walk speed, multiple past falls, depressive symptoms and antidepressant use. Risk increased with the number of types of stressful life events. Though any stressful life event was associated with a 58% increased age-adjusted risk for incident fracture, this association was attenuated and no longer statistically significant after additional adjustment for total hip bone mineral density, fracture after age 50, Parkinson's disease, stroke and IADL impairment. Conclusions: in this cohort of older men, stressful life events significantly increased risk of incident falls independent of other explanatory variables, but did not independently increase incident fracture risk. PMID:24002237

Quantitative analysis of scintigraphic findings in tibial stress fractures in Thoroughbred racehorses.

Science.gov (United States)

Valdés-Martínez, Alejandro; Seiler, Gabriela; Mai, Wilfried; Bolt, David M; Mudge, Margaret; Dukti, Sarah A; Hubert, Jeremy D

2008-07-01

To develop a quantitative method of interpreting tibial scintigrams of Thoroughbred racehorses with tibial stress fractures that may facilitate diagnosis of fractures and to provide prognostic information regarding future performance of affected horses. 35 Thoroughbred racehorses. Static bone-phase scintigrams of tibial stress fractures were quantitatively analyzed by use of ratios of the mean radionuclide counts per pixel in a region of interest (ROI) drawn around the area of increased uptake of radiopharmaceutical to mean counts per pixel in a second ROI drawn around an apparently normal area of the tibial diaphysis. In horses with unilateral fractures, ratios for the contralateral tibia were determined by use of 2 ROIs drawn at the same positions as the ROIs in the fractured tibia. Ratios were compared between fractured versus apparently normal tibias, between horses that returned to racing versus those that did not, and among horses with various grades of lameness. The association between ratios for fractured tibias and intervals between diagnosis and return to racing was also assessed. Mean ratio of ROIs in apparently normal tibias was 1.35 (95% confidence interval [CI], 1.21 to 1.50); that in tibias with stress fractures was 3.55 (95% CI, 2.50 to 4.60). These ratios were significantly different. None of the associations between ratios for fractured tibias and grades of lameness or performance outcomes were significant. Tibial stress fracture scintigrams can be quantitatively analyzed. A prospective study with a controlled rehabilitation period is necessary to evaluate the possible applications of this method.

Bone lesions from overload: shin splint and stress fracture

International Nuclear Information System (INIS)

Una Gorospe; Jon Andoni; Isla Gallego, Concepcion; Santana Borbones, Aranzazu; Perera Romero, Carmen; Allende Riera, Ana J

2005-01-01

There are many stress injuries in the lower extremities due to exercise, and the case we present is an example of two injuries which may present in children or young adults who train excessively. The patient complains of pain and tightness on exercise. The underlying pathology is probably rupture of insertion fibres of the tibial and soleus (Sharpey's fibres) muscles. Probably, there is also periostitis and myositis. Stress fractures and shin splints are often present at the same time in different stages, and both are typical pathologies due to excessive training. Scintigraphy allows identification and early management of shin splints and stress fractures (au)

Surgical treatment of refractory tibial stress fractures in elite dancers: a case series.

Science.gov (United States)

Miyamoto, Ryan G; Dhotar, Herman S; Rose, Donald J; Egol, Kenneth

2009-06-01

Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers' careers. Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing. Case series; Level of evidence, 4. Between 1992 and 2006, 1757 dancers were evaluated at a dance medicine clinic; 24 dancers (1.4%) had 31 tibial stress fractures. Of that subset, 7 (29.2%) elite dancers with 8 tibial stress fractures were treated operatively with either intramedullary nailing or drilling and bone grafting. Six of the patients were followed up closely until they were able to return to dance. One patient was available only for follow-up phone interview. Data concerning their preoperative treatment regimens, operative procedures, clinical union, radiographic union, and time until return to dance were recorded and analyzed. The mean age of the surgical patients at the time of stress fracture was 22.6 years. The mean duration of preoperative symptoms before surgical intervention was 25.8 months. Four of the dancers were male and 3 were female. All had failed nonoperative treatment regimens. Five patients (5 tibias) underwent drilling and bone grafting of the lesion, and 2 patients (3 tibias) with completed fractures or multiple refractory stress fractures underwent intramedullary nailing. Clinical union was achieved at a mean of 6 weeks and radiographic union at 5.1 months. Return to full dance activity was at an average of 6.5 months postoperatively. Surgical intervention for tibial stress fractures in dancers who have not responded to nonoperative management allowed for resolution of symptoms and return to dancing with minimal morbidity.

Case report 491: Stress fracture of the right sacrum

Energy Technology Data Exchange (ETDEWEB)

Hoang, T.A.; Nguyen, T.H.; Daffner, R.H.; Lupetin, A.R.; Deeb, Z.L.

1988-07-01

A case of stress fracture of the right sacrum in a postpartum woman has been presented. Key features in making the diagnosis include a history of pain in the sacrum, considerable weight gain during the pregnancy and pronounced increased physical activity in the immediate postpartum period. CT, particularly, and MRI were critical in making the diagnosis. A low signal area on the T-1 neglected image was considered characteristic for the sacral fracture. In the CT studies a vertical lucency thru a zone of sclerosis is classical for a fracture, whether an insufficiency fracture or a fatigue fracture.

Talar body fatigue stress fractures: three cases observed in elite female gymnasts

International Nuclear Information System (INIS)

Rossi, F.; Dragoni, S.

2005-01-01

To introduce and emphasize the clinical and radiological findings of three talar body fatigue stress fractures in competitive athletes. Clinical and radiographic skeletal records of 24,562 athletes taken between 1962 and 2002 were retrospectively reviewed. Among these, 6851 files related to acute foot and ankle injuries or chronic post-traumatic sequelae were found. There were 925 (3.76%) stress fatigue fractures selected from the whole collection. Among these there were three cases (0.32%) of talar body stress fractures diagnosed in elite female gymnasts 15 - 17 years old. The negative first radiograph become positive 4-6 weeks later. Scintigraphy was positive at an early stage and consistent for the diagnosis. CT and MRI gave positive results 1-2 weeks after the beginning of symptoms which were always greatly diagnostic. The sports medicine literature lacks reports of talar body fatigue stress fractures. The poor initial sensitivity of radiography makes it problematic to establish an early diagnosis. A wise combination of scintigraphy, CT and MRI has therefore to be relied upon. Familiarity with this rare location for a stress fracture may prevent delayed diagnosis and long-lasting damage, both of which are important factors in competitive athletes. (orig.)

Talar body fatigue stress fractures: three cases observed in elite female gymnasts

Energy Technology Data Exchange (ETDEWEB)

Rossi, F. [National Institute of Sports Medicine of the Italian Olympic Committee, Rome (Italy); Dragoni, S. [National Institute of Sports Medicine of the Italian Olympic Committee, Rome (Italy); Istituto Nazionale di Medicina dello Sport, Rome (Italy)

2005-07-01

To introduce and emphasize the clinical and radiological findings of three talar body fatigue stress fractures in competitive athletes. Clinical and radiographic skeletal records of 24,562 athletes taken between 1962 and 2002 were retrospectively reviewed. Among these, 6851 files related to acute foot and ankle injuries or chronic post-traumatic sequelae were found. There were 925 (3.76%) stress fatigue fractures selected from the whole collection. Among these there were three cases (0.32%) of talar body stress fractures diagnosed in elite female gymnasts 15 - 17 years old. The negative first radiograph become positive 4-6 weeks later. Scintigraphy was positive at an early stage and consistent for the diagnosis. CT and MRI gave positive results 1-2 weeks after the beginning of symptoms which were always greatly diagnostic. The sports medicine literature lacks reports of talar body fatigue stress fractures. The poor initial sensitivity of radiography makes it problematic to establish an early diagnosis. A wise combination of scintigraphy, CT and MRI has therefore to be relied upon. Familiarity with this rare location for a stress fracture may prevent delayed diagnosis and long-lasting damage, both of which are important factors in competitive athletes. (orig.)

Identification of natural fractures and in situ stress at Rantau Dedap geothermal field

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Artyanto, Andika; Sapiie, Benyamin; Idham Abdullah, Chalid; Permana Sidik, Ridwan

2017-12-01

Rantau Dedap Area is a geothermal field which is located in Great Sumatra Fault (GSF). The fault and fracture are main factor in the permeability of the geothermal system. However, not all faults and fractures have capability of to flow the fluids. Borehole image log is depiction of the borehole conditions, it is used to identify the natural fractures and drilling induced fracture. Both of them are used to identify the direction of the fracture, direction of maximum horizontal stress (SHmax), and geomechanics parameters. The natural fractures are the results of responses to stress on a rock and permeability which controlling factor in research area. Breakouts is found in this field as a trace of drilling induced fracture due to in situ stress work. Natural fractures are strongly clustered with true strike trending which first, second, and third major direction are N170°E - N180°E (N-S), N60°E - N70°E (NE-SW), and N310°E - N320°E (NW-SE), while the dominant dip is 80° -90°. Based on borehole breakout analysis, maximum horizontal stress orientation is identified in N162°E - N204°E (N-S) and N242°E (NE-SW) direction. It’s constantly similar with regional stress which is affected by GSF. Several parameters have been identified and analyzed are SHmax, SHmin, and Sy. It can be concluded that Rantau Dedap Geothermal Field is affected by strike-slip regime. The determination of in situ stress and natural fractures are important to study the pattern of permeability which is related to the fault in reservoir of this field.

Femoral neck stress fractures (fnsf) in military recruits

International Nuclear Information System (INIS)

Majeed, N.U.; Naqvi, A.N.; Majeed, H.

2012-01-01

Objective: To identify patterns of Femoral Neck Stress Fractures (FNSF), its presentation and outcome of its treatment in PMA (Pakistan Military Academy) cadets. These findings would help suggest guidelines for their appropriate management. Study design: Case Series Place and duration of study: CMH Abbottabad and CMH Rawalpindi from May 2005 to January 2008. Materials and Methods: Twenty cases (20 hips in 18 patients) of FNSF were included in the study. Only male cadets from Pakistan Military Academy (PMA) were included. Diagnosis was made clinically and was confirmed by radiographs or bone scan. Incomplete fractures were managed conservatively where as complete fractures were fixed surgically. Results: All compression fractures healed conservatively where as tension fractures needed surgical fixation in all the cases, except one where fracture remained incomplete. Rest of tension fractures converted from incomplete fractures to complete fractures and hence needed surgical stabilization. There was no problem of avascular necrosis of femoral head (AVNFH) in any patient. Conclusion: FNSF are uncommon injuries with potentially serious complications and are difficult to diagnose clinically. When diagnosed early and managed appropriately, they carry good prognosis. (author)

Stress fracture of the second proximal phalanx of the foot in teenage athletes: Unrecognized location of stress fracture

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Satoshi Yamaguchi

2017-10-01

Conclusion: Although a rare injury, it is important that clinicians be aware of this type of stress fracture, as a timely diagnosis can avoid the need for surgical treatment and allow an early return to play.

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

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

International Nuclear Information System (INIS)

Dunn, Andrew J.; Campbell, Robert S.D.; Mayor, Peter E.; Rees, Dai

2008-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2008-05-15

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

Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen

Energy Technology Data Exchange (ETDEWEB)

Craig, Joseph G.; Widman, David; Holsbeeck, Marnix van [Department of Radiology, Henry Ford Hospital, Detroit, MI 48202 (United States)

2003-01-01

We reviewed the MR appearances of six cases of longitudinal stress fracture of the lower extremity.Results. One fracture was in the femur and five were in the tibia. Four of the tibial fractures showed edema starting in the mid-tibia at the level of the nutrient foramen with the fracture on the anteromedial cortex. The other tibial fracture started at the nutrient foramen. Three fractures (two tibial and the femur fracture) showed eccentric marrow edema; all fractures showed either eccentric periosteal reaction or soft tissue edema.Conclusion. Primary diagnosis of longitudinal stress fracture is made by finding a vertical cleft on one or more axial images. Secondary signs of position of the nutrient foramen and patterns of edema may be useful. (orig.)

Distinct hip and rearfoot kinematics in female runners with a history of tibial stress fracture.

Science.gov (United States)

Milner, Clare E; Hamill, Joseph; Davis, Irene S

2010-02-01

Cross-sectional controlled laboratory study. To investigate the kinematics of the hip, knee, and rearfoot in the frontal and transverse planes in female distance runners with a history of tibial stress fracture. Tibial stress fractures are a common overuse injury in runners, accounting for up to half of all stress fractures. Abnormal kinematics of the lower extremity may contribute to abnormal musculoskeletal load distributions, leading to an increased risk of stress fractures. Thirty female runners with a history of tibial stress fracture were compared to 30 age-matched and weekly-running-distance-matched control subjects with no previous lower extremity bony injuries. Kinematic and kinetic data were collected using a motion capture system and a force platform, respectively, as subjects ran in the laboratory. Selected variables of interest were compared between the groups using a multivariate analysis of variance (MANOVA). Peak hip adduction and peak rearfoot eversion angles were greater in the stress fracture group compared to the control group. Peak knee adduction and knee internal rotation angles and all joint angles at impact peak were similar between the groups. Runners with a previous tibial stress fracture exhibited greater peak hip adduction and rearfoot eversion angles during the stance phase of running compared to healthy controls. A consequence of these mechanics may be altered load distribution within the lower extremity, predisposing individuals to stress fracture.

A new coal-permeability model: Internal swelling stress and fracture-matrix interaction

Energy Technology Data Exchange (ETDEWEB)

Liu, H.H.; Rutqvist, J.

2009-10-01

We have developed a new coal-permeability model for uniaxial strain and constant confining stress conditions. The model is unique in that it explicitly considers fracture-matrix interaction during coal deformation processes and is based on a newly proposed internal-swelling stress concept. This concept is used to account for the impact of matrix swelling (or shrinkage) on fracture-aperture changes resulting from partial separation of matrix blocks by fractures that do not completely cut through the whole matrix. The proposed permeability model is evaluated with data from three Valencia Canyon coalbed wells in the San Juan Basin, where increased permeability has been observed during CH{sub 4} gas production, as well as with published data from laboratory tests. Model results are generally in good agreement with observed permeability changes. The importance of fracture-matrix interaction in determining coal permeability, demonstrated in this work using relatively simple stress conditions, underscores the need for a dual-continuum (fracture and matrix) mechanical approach to rigorously capture coal-deformation processes under complex stress conditions, as well as the coupled flow and transport processes in coal seams.

Medial supracondylar stress fracture in an adolescent pitcher

Energy Technology Data Exchange (ETDEWEB)

Chang, Eric Y.; Chung, Christine B. [VA San Diego Healthcare System, San Diego, CA (United States); University of California, San Diego Medical Center, San Diego, CA (United States); Fronek, Jan [Scripps Healthcare, La Jolla, CA (United States)

2014-01-15

We report the occurrence of a medial supracondylar stress fracture in an adolescent pitcher. To our knowledge, this fracture has not been described in the literature, and awareness of this entity allows initiation of therapy and precludes further unnecessary work-up. The radiographic, computed tomography, and magnetic resonance imaging appearances are reviewed and the mechanism of injury is discussed. (orig.)

Preventive osteopathic manipulative treatment and stress fracture incidence among collegiate cross-country athletes.

Science.gov (United States)

Brumm, Lynn F; Janiski, Carrie; Balawender, Jenifer L; Feinstein, Adam

2013-12-01

Stress fractures are common among athletes, particularly distance runners, with many theories regarding the etiologic process of stress fractures and various studies identifying risk factors or suggesting preventive techniques. To our knowledge, no previous studies have discussed the possible causative effects of somatic dysfunction or the preventive capabilities of osteopathic manipulative treatment (OMT). To apply a preventive OMT protocol for cross-country athletes to reduce the incidence of stress fractures. Cohort study. Examinations of cross-country athletes at an NCAA (National Collegiate Athletic Association) Division I university were performed by supervising physician-examiners and first- and second-year osteopathic medical students during several consecutive academic years. Athletes re-enrolled in the study each year they continued to be eligible. The intervention included osteopathic structural examination and OMT that focused on somatic dysfunction identified in the pelvis, sacrum, and lower extremities. More than 1800 participant examinations were performed on 124 male and female participants by 3 supervising physician-examiners and 141 osteopathic medical students over the course of 5 consecutive academic years (2004-2005 to 2008-2009). Data from these academic years were compared with data from the previous 8 academic years (1996-1997 to 2003-2004). An average of 20 new participants enrolled yearly. The number of annual stress fractures per team ranged from 0 to 6 for male participants and 1 to 6 for female participants. The cumulative annual incidence of stress fractures for male participants demonstrated a statistically significant decrease from 13.9% (20 of 144) before intervention to 1.0% (1 of 105) after intervention, resulting in a 98.7% relative reduction in stress-fracture diagnosis (P=.019). The cumulative annual incidence for female participants showed a minimal decrease from 12.9% (23 of 178) before intervention to 12.0% (17 of 142) after

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

OpenAIRE

Kahanov, Leamor; Eberman,Lindsey; Games,Kenneth; Wasik,Mitch

2015-01-01

Leamor Kahanov,1 Lindsey E Eberman,2 Kenneth E Games,2 Mitch Wasik2 1College of Health Science, Misericordia University, Dallas, PA, USA; 2Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA Abstract: Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing ...

Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A Case Report

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Tan TJL

2015-11-01

Full Text Available Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

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

International Nuclear Information System (INIS)

Greaney, R.B.; Gerber, F.H.; Laughlin, R.L.; Kmet, J.P.; Metz, C.D.; Kilcheski, T.S.; Rao, B.R.; Silverman, E.D.

1983-01-01

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

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

Science.gov (United States)

Lacazette, A.; Vermilye, J. M.

2014-12-01

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

Stress fractures in athletes. How to spot this underdiagnosed injury.

Science.gov (United States)

Sallis, R E; Jones, K

1991-05-01

Stress fractures are an increasingly common injury in competitive athletes, especially runners. Amenorrheic athletes are at particularly high risk. A radionuclide bone scan should be considered when the index of suspicion for stress fracture is high. Plain radiographs are of little use in establishing the diagnosis in the early stages of the injury. Early diagnosis and prompt institution of conservative therapy allow for a favorable outcome in most cases. Avoidance of or reduced participation in the inciting activity is important for pain control. Certain stress fractures, such as those involving the femoral neck, should be monitored closely and treated aggressively with internal fixation when conservative measures fail. Runners who have exercise-induced amenorrhea should be advised to decrease their training intensity to a level where menses resume. Cyclic therapy with conjugated estrogens and progesterone should also be considered, as should daily calcium supplementation.

Sport related stress fracture of the clavicle with non-union: Case report and review

Science.gov (United States)

Constantinou, Demitri; Kastanos, Konstantinos

2008-01-01

Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery. PMID:21264151

[Study on accuracy of virtual surgical planning in free fibula mandibular reconstruction by using SurgiCase software].

Science.gov (United States)

Yan, Guangqi; Wang, Xue; Tan, Xuexin; Wang, Xukai; Yang, Mingliang; Lu, Li

2013-08-01

To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction. Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm x 5 cm to 16 cm x 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm x 3 cm to 16 cm x 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm x 5 cm to 16 cm x 6 cm. Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm. SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.

Bilateral Tibial Stress Fractures in a Young Man Associated with Idiopathic Osteoporosis - Case Report

Directory of Open Access Journals (Sweden)

Selahattin Özyürek

2010-12-01

Full Text Available Stress fractures are defined as a partial or complete fracture of bone due to an inability to endure a non-violent stress. Two factors have been proposed to explain the aetiology of stress fractures: muscle fatigue, and direct muscle action. We want to point to third factor with our case report: Osteoporosis. (From the World of Osteoporosis 2010;16:58-60

Fine needle aspiration cytology of chondroblastoma of the fibula

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Kamal Malukani

2014-01-01

Full Text Available Chondroblastoma is a rare benign cartilaginous tumor typically seen in long bones, especially femur, tibia and proximal humerus. Extracortical soft tissue invasion or metastasis is rarely seen. We report here a unique case of chondroblastoma of the fibula with extracortical soft tissue invasion. Differential diagnosis on cytology is discussed.

Prediction of retained residual stresses in laboratory fracture mechanics specimens extracted from welded components

International Nuclear Information System (INIS)

Hurlston, R.G.; Sherry, A.H.; James, P.; Sharples, J.K.

2015-01-01

The measurement of weld material fracture toughness properties is important for the structural integrity assessment of engineering components. However, welds can contain high levels of residual stress and these can be retained in fracture mechanics specimens, particularly when machined from non-stress relieved welds. Retained residual stresses can make the measurement of valid fracture toughness properties difficult. This paper describes the results of analytical work undertaken to investigate factors that can influence the magnitude and distribution of residual stresses retained in fracture mechanics specimen blanks extracted from as-welded ferritic and austenitic stainless steel plates. The results indicate that significant levels of residual stress can be retained in specimen blanks prior to notching, and that the magnitude and distribution of stress is dependent upon material properties, specimen geometry and size, and extraction location through the thickness of the weld. Finite element modelling is shown to provide a useful approach for estimating the level and distributions of retained residual stresses. A new stress partitioning approach has been developed to estimate retained stress levels and results compare favourably with FE analysis and available experimental data. The approach can help guide the selection of specimen geometry and machining strategies to minimise the level of residual stresses retained in fracture mechanics specimen blanks extracted from non stress-relieved welds and thus improve the measurement of weld fracture toughness properties. - Highlights: • A simplified method for generating realistic weld residual stresses has been developed. • It has been shown that significant levels of residual stress can be retained within laboratory fracture mechanics specimens. • The level and distribution is dependant upon material, specimen type, specimen size and extraction location. • A method has been developed to allow estimates of the

STRESS FRACTURE OF THE FIRST RIB IN A HIGH SCHOOL WEIGHT LIFTER

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Hiroyuki Fujioka

2009-06-01

Full Text Available A 17-year-old boy, who played a weight lifting in high school, sustained stress fracture of the first rib without any causes. We successfully treated first rib stress fracture with limitation of using the upper extremity and with using low-intensity pulsed ultrasound

The value of MR imaging of PDFASAT sequence in the diagnosis of extremities occult fractures

International Nuclear Information System (INIS)

Lu Lingquan; Xu Mingshen; Wu Qianzhi; Mao Chunnan; Wang Shuzi; Zhou Xingfan; Wang Liping

2004-01-01

Objective: To investigate the value of MR imaging of proton density weighted-fat saturated (PDFASAT) sequence in detecting the occult fracture of extremities. Methods: Thirty-one patients with acute trauma were studied using radiography and MR imaging within 45 days. MR sequences included FSE T 1 WI, T 2 WI, and PDFASAT. 21 occult fractures occurred in the knee joint, 6 in the hip joint, 1 in the elbow joint, 2 in the shoulder, and 1 in the ankle. Results: All 31 cases had normal radiographic results. 10 cases with proximal fibula, 4 with proximal tibia and 7 with femur condyle occult fractures were found in 21 knee joint acute trauma cases. 2 cases with intertrochanteric, 2 with femoral neck and 2 with cotyle occult fractures were found in 6 hip joint trauma cases. 2 proximal humerus occult fractures were found in 2 shoulder cases. 1 distal humerus and 1 distal fibula occult fracture was found in elbow and ankle cases. MR imaging demonstrated irregular linear low signal in the subcortical region on both T 1 WI and T 2 WI, and high signal changes around low signal were seen on T 2 WI in some cases. The high signal in PDFASAT sequence was more remarkable and wider than that on both T 1 WI and T 2 WI. Conclusion: MR imaging could determine the diagnosis of acute and chronic occult fractures. MRI should be the next choice when plain films fail to reveal suspected fractures in setting of suggestive symptoms and positive physical examination. PDFASAT would be the best effective sequence among the T 1 WI, T 2 WI, and PDFASAT. (author)

STAFAN, Fluid Flow, Mechanical Stress in Fractured Rock of Nuclear Waste Repository

International Nuclear Information System (INIS)

Huyakorn, P.; Golis, M.J.

1989-01-01

1 - Description of program or function: STAFAN (Stress And Flow Analysis) is a two-dimensional, finite-element code designed to model fluid flow and the interaction of fluid pressure and mechanical stresses in a fractured rock surrounding a nuclear waste repository. STAFAN considers flow behavior of a deformable fractured system with fracture-porous matrix interactions, the coupling effects of fluid pressure and mechanical stresses in a medium containing discrete joints, and the inelastic response of the individual joints of the rock mass subject to the combined fluid pressure and mechanical loading. 2 - Restrictions on the complexity of the problem: STAFAN does not presently contain thermal coupling, and it is unable to simulate inelastic deformation of the rock mass and variably saturated or two-phase flow in the fractured porous medium system

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

Science.gov (United States)

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

2013-06-01

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

Bilateral stress fracture of femoral neck in non-athlete - case report

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Ubiratan Stefani de Oliveira

Full Text Available ABSTRACT Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.

The effects of the local fracture stress and carbides on the cleavage fracture characteristics of Mn-Mo-Ni low alloy steels in the transition region

International Nuclear Information System (INIS)

Yang, Won Jon; Huh, Moo Young; Roh, Sung Joo; Lee, Bong Sang; Oh, Yong Jun; Hong, Jun Hwa

2000-01-01

In the ductile-brittle transition temperature region of SA508 C1.3 Mn-Mo-Ni low alloy steels, the relationship of the local fracture stress and carbides influencing the cleavage fracture behavior was investigated. Based on the ASTM E1921-97 standard method, the reference transition temperatures were determined by three point bending fracture toughness tests. A local fracture stress σ f * , was determined from a theoretical stress distribution in front of crack tip using the cleavage initiation distance measured in each fractured specimen surface. The local fracture stress values showed a strong relationship with toughness characteristics of the materials and those were larger in the materials of smaller carbide size. Quantitative analysis of carbides showed that carbides larger than a certain size are mainly responsible for the cleavage fracture in the ductile-brittle transition temperature region. (author)

Longitudinal stress fracture of the femur: A rare presentation

International Nuclear Information System (INIS)

Bilreiro, Carlos; Bahia, Carla; Castro, Miguel Oliveira e

2016-01-01

We present the case of an 80 year old woman with hip pain, caused by a longitudinal femoral insufficiency stress fracture, depicted with radiographs, CT and MR. This type of fracture is very rare, with only a few cases reported. We conducted a literature review and compared the findings with the present case

Review of possible correlations between in situ stress and PFL fracture transmissivity data at Forsmark

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Martin, Derek (University of Alberta (United States)); Follin, Sven (SF GeoLogic AB (Sweden))

2011-11-15

In laboratory samples, the fracture transmissivity decreases significantly as the confining stress increases. While these experimental relationships are widely accepted and validated on laboratory samples, it is unknown if such relationships exist in situ or if these relationships can be scaled from the centimetre-scale laboratory tests to the metre-scale of in situ fractures. The purpose of this work is to assess the relationship between the structural-hydraulic data gathered in deep, cored boreholes at Forsmark and the in situ stress state acting on the these fractures. In conclusion, there does not appear to be sufficient evidence from these analyses to support the notion that the magnitude of the flow along the fractures at Forsmark is solely controlled by the in situ stress acting on the fracture. This should not be surprising because the majority of the fractures formed more than 1 billion years ago and the current in situ stress state has only been active for the past 12 million years. It is more likely that the transmissivity values are controlled by fracture roughness, open channels within the fracture, fracture stiffness and fracture infilling material

Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study.

Science.gov (United States)

Takeda, Takashi; Imoto, Yoko; Nagasawa, Hiroyo; Takeshita, Atsuko; Shiina, Masami

2016-10-18

To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes. Cross-sectional study. Osaka, Japan. A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25-38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career. Premenstrual symptoms and the occurrence of stress fracture. The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed 'Work efficiency or productivity, home responsibilities', 'Relationships with coworkers or family' and 'Athletic performance in training or competition' more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of 'Overeating or food cravings', 'Physical symptoms' and 'Performance in training or competition' in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, 'Physical symptoms' was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62). The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

L5 radiculopathy due to sacral stress fracture

International Nuclear Information System (INIS)

Aylwin, Anthony; Saifuddin, Asif; Tucker, Stuart

2003-01-01

We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely. (orig.)

External fixation of tibial pilon fractures and fracture healing.

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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.

Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review.

Science.gov (United States)

Chaudhry, Zaira S; Raikin, Steven M; Harwood, Marc I; Bishop, Meghan E; Ciccotti, Michael G; Hammoud, Sommer

2017-12-01

Although most anterior tibial stress fractures heal with nonoperative treatment, some may require surgical management. To our knowledge, no systematic review has been conducted regarding surgical treatment strategies for the management of chronic anterior tibial stress fractures from which general conclusions can be drawn regarding optimal treatment in high-performance athletes. This systematic review was conducted to evaluate the surgical outcomes of anterior tibial stress fractures in high-performance athletes. Systematic review; Level of evidence, 4. In February 2017, a systematic review of the PubMed, MEDLINE, Cochrane, SPORTDiscus, and CINAHL databases was performed to identify studies that reported surgical outcomes for anterior tibial stress fractures. Articles meeting the inclusion criteria were screened, and reported outcome measures were documented. A total of 12 studies, published between 1984 and 2015, reporting outcomes for the surgical treatment of anterior tibial stress fractures were included in this review. All studies were retrospective case series. Collectively, surgical outcomes for 115 patients (74 males; 41 females) with 123 fractures were evaluated in this review. The overall mean follow-up was 23.3 months. The most common surgical treatment method reported in the literature was compression plating (n = 52) followed by drilling (n = 33). Symptom resolution was achieved in 108 of 123 surgically treated fractures (87.8%). There were 32 reports of complications, resulting in an overall complication rate of 27.8%. Subsequent tibial fractures were reported in 8 patients (7.0%). Moreover, a total of 17 patients (14.8%) underwent a subsequent procedure after their initial surgery. Following surgical treatment for anterior tibial stress fracture, 94.7% of patients were able to return to sports. The available literature indicates that surgical treatment of anterior tibial stress fractures is associated with a high rate of symptom resolution and return

Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction.

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van Gemert, Johannes; Holtslag, Irene; van der Bilt, Andries; Merkx, Matthias; Koole, Ron; Van Cann, Ellen

2015-06-01

Segmental resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. Using the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after segmental resection of the lateral mandible. Thirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after segmental resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. Reconstruction of segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of segmental defects of the lateral mandible. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Couple stresses and the fracture of rock.

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Atkinson, Colin; Coman, Ciprian D; Aldazabal, Javier

2015-03-28

An assessment is made here of the role played by the micropolar continuum theory on the cracked Brazilian disc test used for determining rock fracture toughness. By analytically solving the corresponding mixed boundary-value problems and employing singular-perturbation arguments, we provide closed-form expressions for the energy release rate and the corresponding stress-intensity factors for both mode I and mode II loading. These theoretical results are augmented by a set of fracture toughness experiments on both sandstone and marble rocks. It is further shown that the morphology of the fracturing process in our centrally pre-cracked circular samples correlates very well with discrete element simulations. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Rehabilitation and return to running after lower limb stress fractures.

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Liem, Brian C; Truswell, Hallie J; Harrast, Mark A

2013-01-01

Lower limb stress fractures are common injuries in runners. In terms of treatment, much of the medical literature has focused primarily on rest and cessation of running, but little has been written about the rehabilitation and functional progression of runners following a lower limb stress fracture. This article reviews the scientific evidence behind common rehabilitation concepts used for runners recovering from these injuries and also discusses sport-specific training modalities such as deep water running and antigravity treadmill training. Overall this article is intended to be a practical resource for clinicians to guide runners in functional rehabilitation and return to running following lower limb stress injury.

Stress fractures of the ribs and upper extremities: causation, evaluation, and management.

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Miller, Timothy L; Harris, Joshua D; Kaeding, Christopher C

2013-08-01

Stress fractures are common troublesome injuries in athletes and non-athletes. Historically, stress fractures have been thought to predominate in the lower extremities secondary to the repetitive stresses of impact loading. Stress injuries of the ribs and upper extremities are much less common and often unrecognized. Consequently, these injuries are often omitted from the differential diagnosis of rib or upper extremity pain. Given the infrequency of this diagnosis, few case reports or case series have reported on their precipitating activities and common locations. Appropriate evaluation for these injuries requires a thorough history and physical examination. Radiographs may be negative early, requiring bone scintigraphy or MRI to confirm the diagnosis. Nonoperative and operative treatment recommendations are made based on location, injury classification, and causative activity. An understanding of the most common locations of upper extremity stress fractures and their associated causative activities is essential for prompt diagnosis and optimal treatment.

Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

LENUS (Irish Health Repository)

Murphy, Colin G

2012-01-31

The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study

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Ellen A. Almirol

2016-09-01

Conclusions: In this randomized, pilot study, brief administration of TPTD showed anabolic effects that TPTD may help hasten fracture healing in premenopausal women with lower-extremity stress fractures. Larger prospective studies are warranted to determine the effects of TPTD treatment on stress fracture healing in premenopausal women.

Implications of recent developments in the plastic fracture mechanics field to the PCI stress corrosion problem

International Nuclear Information System (INIS)

Smith, E.

1980-01-01

Fractographic observations on irradiated Zircaloy cladding stress corrosion fracture surfaces are considered against the background of recent developments in the plastic fracture mechanics field. Dimples have been observed on the fracture surfaces of failed cladding, even though the cracks in metallographic sections are tight, i.e., crack propagation is associated with a low crack tip opening angle. This result is interpreted as providing evidence for an environmentally assisted ductile mode of fracture. The presence of this fracture mode forms the basis of an argument, which adds further support for the view that power ramp stress corrosion cladding failures are caused by stress concentrations that produce stress gradients in the cladding. (orig.)

Immediate effects of modified landing pattern on a probabilistic tibial stress fracture model in runners.

Science.gov (United States)

Chen, T L; An, W W; Chan, Z Y S; Au, I P H; Zhang, Z H; Cheung, R T H

2016-03-01

Tibial stress fracture is a common injury in runners. This condition has been associated with increased impact loading. Since vertical loading rates are related to the landing pattern, many heelstrike runners attempt to modify their footfalls for a lower risk of tibial stress fracture. Such effect of modified landing pattern remains unknown. This study examined the immediate effects of landing pattern modification on the probability of tibial stress fracture. Fourteen experienced heelstrike runners ran on an instrumented treadmill and they were given augmented feedback for landing pattern switch. We measured their running kinematics and kinetics during different landing patterns. Ankle joint contact force and peak tibial strains were estimated using computational models. We used an established mathematical model to determine the effect of landing pattern on stress fracture probability. Heelstrike runners experienced greater impact loading immediately after landing pattern switch (Ptibial strains and the risk of tibial stress fracture in runners with different landing patterns (P>0.986). Immediate transitioning of the landing pattern in heelstrike runners may not offer timely protection against tibial stress fracture, despite a reduction of impact loading. Long-term effects of landing pattern switch remains unknown. Copyright © 2016 Elsevier Ltd. All rights reserved.

Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

Energy Technology Data Exchange (ETDEWEB)

Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

2003-08-01

The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

International Nuclear Information System (INIS)

Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A.

2003-01-01

The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

Stress fractures of the humerus, radius, and tibia in horses: clinical features and radiographic and/or scintigraphic appearance

International Nuclear Information System (INIS)

Mackey, V.S.; Trout, D.R.; Meagher, D.M.; Hornof, W.J.

1987-01-01

The medical records, radiographic and nuclear scintigraphic findings of 26 racing horses with 27 stress fracture episodes of the humerus, radius, or tibia were reviewed. The purposes of this study were to describe the radiographic and/or scintigraphic features of stress fractures of the humerus, radius, or tibia, and to evaluate the signalment and history of horses in which stress fracture occurred. Stress fractures of the three long bones examined were primarily seen in 2- and 3-year-old male Thoroughbred horses; commonly, the onset of lameness was immediately following training gallops or racing. There were 13 humeral stress fracture episodes in 12 horses. Ten were in the proximal caudolateral cortex, and three were in the distal craniomedial cortex. Radical stress fractures were seen in three horses, all in the midshaft radius. Tibial stress fractures were diagnosed in 11 horses. They were located in the proximal lateral tibia in six horses, the distal caudolateral tibia in three horses, and the midshaft tibia in three horses. Fifteen stress fractures were diagnosed with radiography alone, one was diagnosed with scintigraphy alone, nine were diagnosed with radiographs and scintigraphy, and, in two horses, radiographs were negative, but the scintigraphic findings were consistent with stress fracture

Stress and gas hydrate-filled fracture distribution, Krishna-Godavari Basin, India

Energy Technology Data Exchange (ETDEWEB)

Cook, A.; Goldberg, D. [Lamont-Doherty Earth Observatory of Columbia Univ., Palisades, NY (United States)

2008-07-01

The first expedition of the Indian National Gas Hydrate Program (NGHP) was launched in the summer of 2006 to characterize the presence of gas hydrates on the continental margins of India. This paper presented a study from the NGHP expedition that found high resistivity fractures in unconsolidated clay sediments on logging-while-drilling (LWD) borehole resistivity images. Gas hydrate-filled and conductive fractures appearing on LWD resistivity images in holes 5A, 5B, 6A, 7A and 10 were analysed and discussed. Fracture orientation and shallow sediment stress orientations were determined for each hole. The paper described how to determine which sections of a log are hydrate bearing as well as how to calculate the predicted water saturated resistivity. It was concluded that holes 5A, 5B, 6A and 7A contained well-ordered, high-angle fractures, from which horizontal stress directions could be accurately resolved. However, these stress directions, contradicted the orientations normally seen on a passive margin, and may be the result of local bathymetry variations. 6 refs., 1 tab., 11 figs.

Photoelastic stress analysis assisted evaluation of fracture toughness in hydrothermally aged epoxies

Directory of Open Access Journals (Sweden)

G. Pitarresi

2014-10-01

Full Text Available The present work has investigated the fracture toughness of a model DGEBA epoxy system subject to Hidro-Thermal aging. A Photoelastic Stress Analysis technique has been implemented, showing the evolution of stresses arising throughout the water uptake process due to the non-uniform swelling of the material. Gravimetric and Dynamic Mechanical Thermal Analyses have further complemented the characterization, showing the onset of plasticization effects with aging. The correlation of all previous characterizations has allowed to conclude that an increase of KIC fracture toughness is obtained at the fully saturated condition. In particular Photoelasticity has also revealed the onset of relevant swelling induced stresses during the first stages of water absorption, leading to an increase of fracture toughness due to compressive stresses settling near the crack tip. A stress free condition is instead reestablished at the later stages of absorption, suggesting that the increased toughness of the saturated material is an effect of the modifications induced by aging on the polymer structure.

Early and late complications in the reconstructed mandible with free fibula flaps.

Science.gov (United States)

van Gemert, Johannes T M; Abbink, Jan H; van Es, Robert J J; Rosenberg, Antoine J W P; Koole, Ron; Van Cann, Ellen M

2018-03-01

Evaluation of mandibular reconstructions with free fibula flaps. Identification of factors associated with major recipient site complications, that is, necessitating surgical intervention under general anaesthesia. Seventy-nine reconstructions were included. The following factors were analyzed: fixation type, number of osteotomies, site of defect (bilateral/unilateral), surgeon, sex, ASA classification, continuous smoking, pathological N-stage, age, defect size, flap ischemic time, and postoperative radiotherapy. Proportional hazards regression was used to test the effect on the time between reconstruction and intervention. Sixty-nine (87%) of the 79 fibula flaps were successful at the last follow-up. Forty-eight major recipient site complications occurred in 41 reconstructions. Nineteen complications required surgical intervention within six weeks and were mostly vascular problems, necessitating immediate intervention. These early complications were associated with defects crossing the midline, with an estimated relative risk of 5.3 (CI 1.1-20, P = 0.01). Twenty-nine complications required surgical intervention more than 6 weeks after the reconstruction. These late complications generally occurred after months or years, and were associated with smoking, with an estimated relative risk of 2.8 (CI 1.0-8.3, P = 0.05). Fibula flaps crossing the midline have a higher risk of early major recipient site complications than unilateral reconstructions. Smoking increases the risk of late complications. © 2018 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.

Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

Science.gov (United States)

Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

2012-03-01

Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

Stress fracture as a complication of autogenous bone graft harvest from the distal tibia.

Science.gov (United States)

Chou, Loretta B; Mann, Roger A; Coughlin, Michael J; McPeake, William T; Mizel, Mark S

2007-02-01

Autogenous bone graft from the distal tibia provides cancellous bone graft for foot and ankle operations, and it has osteogenic and osteoconductive properties. The site is in close proximity to the foot and ankle, and published retrospective studies show low morbidity from the procedure. One-hundred autografts were obtained from the distal tibia between 2000 and 2003. In four cases the distal tibial bone graft harvest resulted in a stress fracture. There were three women and one man. The average time of diagnosis of the stress fracture from the operation was 1.8 months. All stress fractures healed with a short course (average 2.4 months) of cast immobilization. This study demonstrated that a stress fracture from the donor site of autogenous bone graft of the distal tibia occurs and can be successfully treated nonoperatively.

Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury.

Science.gov (United States)

Pakarinen, Harri

2012-12-01

sensitivity and specificity of both clinical tests were calculated using the standard 7.5-Nm external rotation stress test as reference. Outcome was assessed after a minimum of one year of follow-up. Olerud-Molander (OM) scoring system, RAND 36-Item Health Survey, and VAS to measure pain and function were used as outcome measures in all studies. In study 1, 85 (53%) fractures were treated operatively using the stability based fracture classification. Non-operatively treated patients reported less pain and better OM (good or excellent 89% vs. 71%) and VAS functional scores compared to operatively treated patients although they experienced more displacement of the distal fibula (0 mm 30% vs. 69%; 0-2 mm 65% vs. 25%) after treatment. No non-operatively treated patients required operative fracture fixation during follow-up. In study 2, AITFL exploration and suture lead to equal functional outcome (OM mean, 77 vs. 73) to no exploration or fixation. In study 3, the hook test had a sensitivity of 0.25 and a specificity of 0.98. The external rotation stress test had a sensitivity of 0.58 and a specificity of 0.9. Both tests had excellent interobserver reliability; the agreement was 99% for the hook test and 98% for the stress test. There was no statistically significant difference in functional scores (OM mean, 79.6 vs. 83.6) or pain between syndesmosis transfixation and no fixation groups (Study 4). Our results suggest that a simple stability-based fracture classification is useful in choosing between non-operative and operative treatment of ankle fractures; approximately half of the ankle fractures can be treated non-operatively with success. Our observations also suggest that relevant syndesmosis injuries are rare in ankle fractures due to an SER mechanism of injury. According to our research, syndesmotic repair or fixation in SER ankle fracture has no influence on functional outcome or pain after minimum one year compared with no fixation.

Scintigraphic diagnosis of stress-induced incomplete fractures of the proximal tibia

International Nuclear Information System (INIS)

Collier, B.D.; Johnson, R.P.; Carrera, G.F.; Akhtar, K.; Isitman, A.T.

1984-01-01

Incomplete stress fractures of the proximal tibial diaphysis can be diagnosed by bone scintigraphy. The scintigraphic appearance of incomplete rather than complete tibial stress fractures is apparently reported for the first time in this article. With no treatment other than restricted activity, this injury heals rapidly and completely in 4 to 6 weeks. The major threat to the patient's welfare is unfounded suspicion of tumor or infection which may lead to biopsy or inappropriate therapy

Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

Science.gov (United States)

Sutton, John R.; Nilson, Karen L.

1989-01-01

Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis

Directory of Open Access Journals (Sweden)

Keishi Maruo

2015-01-01

Full Text Available Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture.

Fracture toughness and stress relief response of irradiated Type 347/348 stainless steel

International Nuclear Information System (INIS)

Haggag, F.M.

1985-01-01

A test program has experimentally determined: (1) The fracture toughness of Type 347/348 stainless steel (SS) specimens with high values of irradiation fluence (2.3 to 4.8 x 10 22 n/cm 2 , E > 1.0 MeV) and experiencing different levels of irradiation creep (0.0, 0.6, 1.1, 1.8%), (2) the effect of thermal stress relief on fracture toughness recovery for the highly irradiated material, and (3) the mechanisms associated with fracture toughness recovery due to thermal stress relief. The postirradiation fracture toughness tests and tensile tests were conducted at 427 0 C

Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature.

Science.gov (United States)

Baker, Jonathan C; Demertzis, Jennifer L

2016-06-01

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture.

Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Baker, Jonathan C.; Demertzis, Jennifer L. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Musculoskeletal Section, St Louis, MO (United States)

2016-06-15

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

International Nuclear Information System (INIS)

Baker, Jonathan C.; Demertzis, Jennifer L.

2016-01-01

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

The impact of in-situ stress and outcrop-based fracture geometry on hydraulic aperture and upscaled permeability in fractured reservoirs

DEFF Research Database (Denmark)

Bisdom, Kevin; Bertotti, Giovanni; Nick, Hamid

2016-01-01

explicitly, we quantify equivalent permeability, i.e. combined matrix and stress-dependent fracture flow. Fracture networks extracted from a large outcropping pavement form the basis of these models. The results show that the angle between fracture strike and σ 1 has a controlling impact on aperture...

Stress fractures of the proximal tibia in runners

International Nuclear Information System (INIS)

Daffner, R.H.; Martinez, S.; Gehweiler, J.A.; Harrelson, J.M.

1982-01-01

Stress fractures developed along the popliteal-solean line of the posteromedial surface of the tibia in 4 patients as the result of running. Radionuclide bone scans may be useful in early diagnosis of such injuries

Prediction of tectonic stresses and fracture networks with geomechanical reservoir models

International Nuclear Information System (INIS)

Henk, A.; Fischer, K.

2014-09-01

This project evaluates the potential of geomechanical Finite Element (FE) models for the prediction of in situ stresses and fracture networks in faulted reservoirs. Modeling focuses on spatial variations of the in situ stress distribution resulting from faults and contrasts in mechanical rock properties. In a first methodological part, a workflow is developed for building such geomechanical reservoir models and calibrating them to field data. In the second part, this workflow was applied successfully to an intensively faulted gas reservoir in the North German Basin. A truly field-scale geomechanical model covering more than 400km 2 was built and calibrated. It includes a mechanical stratigraphy as well as a network of 86 faults. The latter are implemented as distinct planes of weakness and allow the fault-specific evaluation of shear and normal stresses. A so-called static model describes the recent state of the reservoir and, thus, after calibration its results reveal the present-day in situ stress distribution. Further geodynamic modeling work considers the major stages in the tectonic history of the reservoir and provides insights in the paleo stress distribution. These results are compared to fracture data and hydraulic fault behavior observed today. The outcome of this project confirms the potential of geomechanical FE models for robust stress and fracture predictions. The workflow is generally applicable and can be used for modeling of any stress-sensitive reservoir.

Prediction of tectonic stresses and fracture networks with geomechanical reservoir models

Energy Technology Data Exchange (ETDEWEB)

Henk, A.; Fischer, K. [TU Darmstadt (Germany). Inst. fuer Angewandte Geowissenschaften

2014-09-15

This project evaluates the potential of geomechanical Finite Element (FE) models for the prediction of in situ stresses and fracture networks in faulted reservoirs. Modeling focuses on spatial variations of the in situ stress distribution resulting from faults and contrasts in mechanical rock properties. In a first methodological part, a workflow is developed for building such geomechanical reservoir models and calibrating them to field data. In the second part, this workflow was applied successfully to an intensively faulted gas reservoir in the North German Basin. A truly field-scale geomechanical model covering more than 400km{sup 2} was built and calibrated. It includes a mechanical stratigraphy as well as a network of 86 faults. The latter are implemented as distinct planes of weakness and allow the fault-specific evaluation of shear and normal stresses. A so-called static model describes the recent state of the reservoir and, thus, after calibration its results reveal the present-day in situ stress distribution. Further geodynamic modeling work considers the major stages in the tectonic history of the reservoir and provides insights in the paleo stress distribution. These results are compared to fracture data and hydraulic fault behavior observed today. The outcome of this project confirms the potential of geomechanical FE models for robust stress and fracture predictions. The workflow is generally applicable and can be used for modeling of any stress-sensitive reservoir.

Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children.

Science.gov (United States)

Gourineni, Prasad; Gupta, Asheesh

2011-10-01

Tillaux and Triplane fractures occur in children predominantly from external rotation mechanism. We hypothesized that in displaced fractures, the talus would shift laterally along with the distal fibula and the distal tibial epiphyseal fragment increasing the medial joint space. Consecutive cases evaluated retrospectively. Level I and Level II centers. Twenty-two skeletally immature patients with 14 displaced Triplane fractures and eight displaced Tillaux fractures were evaluated for medial joint space widening. Measurement of fracture displacement and medial joint space widening before and after intervention. Thirteen Triplane and six Tillaux fractures (86%) showed medial space widening of 1 to 9 mm and equal to the amount of fracture displacement. Reduction of the fracture reduced the medial space to normal. There were no known complications. Medial space widening of the ankle may be a sign of ankle fracture displacement. Anatomic reduction of the fracture reduces the medial space and may improve the results in Tillaux and Triplane fractures.

Post-Traumatic Periprosthetic Tibial and Fibular Fracture After Total Ankle Arthroplasty: A Case Report.

Science.gov (United States)

Brock, Amanda K; Tan, Eric W; Shafiq, Babar

Periprosthetic fractures after total ankle arthroplasty are uncommon, with most cases occurring intraoperatively. We describe a post-traumatic periprosthetic fracture of the distal tibia and fibula after total ankle arthroplasty that was treated with minimally invasive plate osteosynthesis. It is important for orthopedic surgeons not only to recognize the risk factors for postoperative periprosthetic total ankle arthroplasty fractures, but also to be familiar with the treatment options available to maximize function and minimize complications. The design of the tibial prosthesis and surgical techniques required to prepare the ankle joint for implantation are important areas of future research to limit the risk of periprosthetic fractures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Understanding the etiology of the posteromedial tibial stress fracture.

Science.gov (United States)

Milgrom, Charles; Burr, David B; Finestone, Aharon S; Voloshin, Arkady

2015-09-01

Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45° rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage. Copyright © 2015 Elsevier Inc. All rights reserved.

Heat induced fracturing of rock in an existing uniaxial stress field

International Nuclear Information System (INIS)

Mathis, J.; Stephansson, O.; Bjarnason, B.; Hakami, H.; Herdocia, A.; Mattila, U.; Singh, U.

1986-01-01

This study was initiated under the premise that it may be possible to determine the state of stress in the earth's crust by heat induced fracturing of the rock surrounding a borehole. The theory involved is superficially simple, involving the superposition of the stress field around a borehole due to the existing virgin stresses and the uniform stress field of thermally loaded rock as induced by a heater. Since the heat stress field is uniform, varying only in magnitude and gradient as a function of heater input, fracturing should be controlled by the non-uniform virgin stress field. To determine if the method was, in fact, feasible, a series of laboratory test were conducted. These tests consisted of physically loading center drilled cubes of rock, 0.3 m on a side, uniaxially from 0 to 25 MPa. The blocks were then thermally loaded with a nominally rated 3.7 kW heater until failure occurred. Results from these laboratory tests were then compared to analytical studies of the problem, i.e., finite element and discrete theoretical analysis. Overall, results were such that the method is likely eliminated as a stress measurement technique. The immediate development of a thermal compressive zone on the borehole wall overlaps the tensile zone created by the uniaxial stress field, forcing the failure is thus controlled largely by the power input of the heater, being retarded by the small compressive stresses genrated by the uniaxial stress field. This small retardation effect is of such low magnitude that the retardation effect is of such low magnitude that the fracture time is relatively insensitive to the local virgin stress field. (authors)

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.

Unusual stress fracture in an adolescent baseball pitcher affecting the trochlear groove of the olecranon

International Nuclear Information System (INIS)

Blake, Joseph J.; Block, John J.; Kan, J.H.; Hannah, Gene A.

2008-01-01

Stress fractures of the proximal ulna are known to occur in throwing athletes. Most cases extend to involve the olecranon, and cases limited to the trochlear groove are rare. In this report we present a 17-year-old elite baseball pitcher with a stress fracture of the trochlear groove of the proximal ulna. Diagnosis was made by demonstration of characteristic signal changes on MRI of the elbow. The fracture occurred at the cortical notch, also known as the pseudodefect of the trochlear groove. This case suggests that the cortical notch serves as an area of weakness predisposing pitchers to development of a stress fracture. (orig.)

Fatigue Stress Fracture of the Talar Body: An Uncommon Cause of Ankle Pain.

Science.gov (United States)

Kim, Young Sung; Lee, Ho Min; Kim, Jong Pil; Moon, Han Sol

2016-01-01

Fatigue stress fractures of the talus are rare and usually involve the head of the talus in military recruits. We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Biomechanical study: resistance comparison of posterior antiglide plate and lateral plate on synthetic bone models simulating Danis-Weber B malleolar fractures

Directory of Open Access Journals (Sweden)

Bruna Buscharino

2013-06-01

Full Text Available OBJECTIVE : The purpose of this study was to compare different positions of plates in lateral malleolar Danis-Weber B fractures on synthetic bone: a lateral plate and a posterior antiglide plate. METHODS : Short oblique fractures of distal fibula at the level of the syndesmosys were simulated with a fibular osteotomy in sixteen synthetic fibula bones (Synbone®. Eight fractures were fixed with lateral plating associated with an independent lag screw, and the other eight were fixed with posterior antiglide plating with a lag screw through the plate. A strain gage was installed at the center of each plate at the osteotomy site. Supination and external rotation forces were applied to each of the two groups at the bend. RESULTS : The lateral position plate group suffered more deformity in response to supination forces compared to the group with the posterior antiglide plate, but this result was not statistically significant. In the tests with external rotation forces, the posterior antiglide plating group had significantly higher resistance (p < 0.05. CONCLUSION : When subjected to external rotation forces, osteosynthesis with posterior antiglide plate models simulating type B fractures of the lateral malleolus of the ankle is more resistant than that of the neutralization plate.

MINIMUM INCISION PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR DISTAL FIBULAR FRACTURES: A PROSPECTIVE STUDY

Directory of Open Access Journals (Sweden)

Ramkumar Reddy

2015-09-01

Full Text Available Distal fibular fractures are usually communitted and most of the times osteoporotic especially if they are occurring in females and in geriatric age group. These fractures are usu ally associated with other fractures, which necessitates them to be fixed accurately. Owing to the fact that distal fragment is subcutaneous with scanty soft tissue over bone, which pose these fracture fixations become difficult by open methods in view of wound healing. A prospective study of 26 patients with distal fibular fractures were treated with MIPPO with hook plate were healed with less complications and better outcome. With this background we suggest a minimally invasive incision over proximal frag ment where sufficient soft tissue cover is present. From there pushing the special hook plate subperiosteally to distal fragment, hooking the tip of fibula and fixing the proximal fragment after reduction gives a simple and effective stable fixation

Stress fractures of the ribs in elite competitive rowers: a report of nine cases

Energy Technology Data Exchange (ETDEWEB)

Dragoni, S. [Institute of Sport Medicine and Science of the Italian Olympic Committee, Department of Radiology, Rome (Italy); Giombini, A.; Ripani, M. [University of Motor Sciences, Department of Health, Rome (Italy); Di Cesare, A. [University of Rome ' ' La Sapienza' ' , Department of Physical Medicine and Rehabilitation, Rome (Italy); Magliani, G. [Medical Department of the Italian State Police, Rome (Italy)

2007-10-15

The objective was to report the clinical and imaging patterns of nine cases of stress fractures of the rib diagnosed in Italian Olympic rowers. Nine patients with stress fractures of the rib detected from 103 (8.7%) Italian team rowers competing between May 2000 and May 2006 were identified based on the database of a sports medicine institute. All athletes were male. They were aged between 17 and 31 years (mean: 24.4). Patient weight, fracture location, rowing side and imaging methods employed were noted. The diagnosis was made based on history, clinical examination and Tc-99m MDP bone scintigraphy. Eight of the 9 fractures were located anterolaterally between the fourth and ninth rib. In 1 of the 5 athletes with standard radiographs, a fracture line was visible and in 4 there was callus formation. In 2 athletes sonography was performed, which detected discontinuity of the rib surface and callus formation (1 case each). Stress fractures of the ribs are relatively common in competitive rowers. They are characterized by increasing lateral chest pain and typical scintigraphic, radiographic and sonographic findings. (orig.)

Stress fractures of the ribs in elite competitive rowers: a report of nine cases

International Nuclear Information System (INIS)

Dragoni, S.; Giombini, A.; Ripani, M.; Di Cesare, A.; Magliani, G.

2007-01-01

The objective was to report the clinical and imaging patterns of nine cases of stress fractures of the rib diagnosed in Italian Olympic rowers. Nine patients with stress fractures of the rib detected from 103 (8.7%) Italian team rowers competing between May 2000 and May 2006 were identified based on the database of a sports medicine institute. All athletes were male. They were aged between 17 and 31 years (mean: 24.4). Patient weight, fracture location, rowing side and imaging methods employed were noted. The diagnosis was made based on history, clinical examination and Tc-99m MDP bone scintigraphy. Eight of the 9 fractures were located anterolaterally between the fourth and ninth rib. In 1 of the 5 athletes with standard radiographs, a fracture line was visible and in 4 there was callus formation. In 2 athletes sonography was performed, which detected discontinuity of the rib surface and callus formation (1 case each). Stress fractures of the ribs are relatively common in competitive rowers. They are characterized by increasing lateral chest pain and typical scintigraphic, radiographic and sonographic findings. (orig.)

Crack-jump mechanism of microvein formation and its implications for stress cyclicity during extension fracturing

Science.gov (United States)

Caputo, Riccardo; Hancock, Paul L.

1998-11-01

It is well accepted and documented that faulting is produced by the cyclic behaviour of a stress field. Some extension fractures, such as veins characterised by the crack-seal mechanism, have also been presumed to result from repeated stress cycles. In the present note, some commonly observed field phenomena and relationships such as hackle marks and vein and joint spacing, are employed to argue that a stress field can also display cyclic behaviour during extensional fracturing. Indeed, the requirement of critical stress conditions for the occurrence of extensional failure events does not accord with the presence of contemporaneously open nearby parallel fractures. Therefore, because after each fracture event there is stress release within the surrounding volume of rock, high density sets of parallel extensional fractures also strongly support the idea that rocks undergo stress cyclicity during jointing and veining. A comparison with seismological data from earthquakes with dipole mechanical solutions, confirms that this process presently occurs at depth in the Earth crust. Furthermore, in order to explain dense sets of hair-like closely spaced microveins, a crack-jump mechanism is introduced here as an alternative to the crack-seal mechanism. We also propose that as a consequence of medium-scale stress cyclicity during brittle deformation, the re-fracturing of a rock mass occurs in either one or the other of these two possible ways depending on the ratio between the elastic parameters of the sealing material and those of the host rock. The crack-jump mechanism occurs when the former is stronger.

99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis

Directory of Open Access Journals (Sweden)

Jauković Ljiljana

2008-01-01

Full Text Available Background. Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. Case report. We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. Conclusion. Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activites.

Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study

OpenAIRE

Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-ichi

2017-01-01

AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fract...

Classification of fractures in the area of the ankle joint for practical surgical conceras

International Nuclear Information System (INIS)

Gay, B.

1983-01-01

For practical surgical concerns we require radiological diagnosis of all injuries, indication for conservative or operative therapy and prognostic evidence in order to classify fractures of the ankle joint. Due to the fact that joint stability is ensured by the fibula and syndesmosis, we prefer classification according to Weber. Fracture types A, B and C are classified according to radiological findings, the pertinent concomitant injuries introduced and differentiated from the special forms of the ''interligamentary fracture'' and ''flake fractures''. Due to the frequency of injury in children of the distal, tibial epiphyseal cartilage we select classification according to Aitken for practical purposes, which differentiates basically between separation and fracture of the epiphysis and makes for prognosis about disturbances in growth. Delimited from ''crush injury'' the Aitken classification is compared to other conventional forms of classification in tabular form. (orig.) [de

Navicular stress fractures treated with minimally invasive fixation

Directory of Open Access Journals (Sweden)

Korula Mani Jacob

2013-01-01

Early intervention with minimally invasive surgery has significantly less morbidity and a reliable early return to active sports and is therefore the best option in high-performance athletes. Materials and Methods: Nine athletes with ten stress fractures of the navicular treated at our institution between April 1991 and October 2000. The mean age of the patients was 22.8 years (range 18-50 years. All patients were treated by minimally invasive screw fixation and early weight bearing mobilization without a cast. The average followup was 7 years (range 2-11 years. Results: Seven of the nine patients returned to their pre-fracture level of sporting activity at an average of 5 months (range 3-9 months. One patient returned to full sporting activity following a delay of 2 years due to an associated tibial stress fracture and one patient had an unsatisfactory result. Long term review at an average of 7 years showed that six of these eight patients who returned to sports remained symptom free with two patients experiencing minimal intermittent discomfort after prolonged activity. Conclusions: We recommend percutaneous screw fixation as a reliable, low morbidity procedure allowing early return to full sporting activity without long term complications or recurrences.

Fracture transmissivity as a function of normal and shear stress: first results in Opalinus Clay

International Nuclear Information System (INIS)

Cuss, R.J.; Milodowski, A.; Noy, D.J.; Harrington, J.F.

2010-01-01

Document available in extended abstract form only. Rock-mass failure around openings is usually observed in the form of a highly complex fracture network (EDZ), which is heterogeneous in distribution around a circular tunnel opening because of the heterogeneous stress distribution. The orientation of stress with respect to the fracture network is known to be important. The complex heterogeneous stress trajectory and heterogeneous fracture network results in a broad range of stresses and stress directions acting on the open fracture network. During the open stage of a repository, stress will slowly alter as shear movements occur along the fractures, as well as other time-dependent phenomena. As the repository is back filled, the stress field is further altered as the backfill settles and changes volume because of re-saturation. Therefore, a complex and wide ranging stress regime and stress history will result. In a purely mechanical sense, fracture transmissivity is a function of normal stress, shear stress, and fracture aperture. The Selfrac test from Mont Terri showed the change in transmissivity with effective normal stress. This work showed that fracture transmissivity decreased with increasing normal load and that an effective normal stress of 2.5 MPa is sufficient to yield a transmissivity similar to that seen in intact Opalinus clay (OPA). Therefore fracture closure because of normal stresses has been proven to be a quite efficient mechanism in OPA. A new shear rig was designed to investigate the detail of fracture transmissivity in OPA. The experimental configuration uses two prepared blocks that are 60 x 60 mm in size and approximately 20 mm thick. The first test sample had machine ground surfaces in contact with each other, with pore fluid being delivered through the centre of the top block directly to the fracture surface. The experimental programme included two distinct stages. In the first normal load was altered to investigate fracture transmissivity

Factors associated with recurrent fifth metatarsal stress fracture.

Science.gov (United States)

Lee, Kyung-tai; Park, Young-uk; Jegal, Hyuk; Kim, Ki-chun; Young, Ki-won; Kim, Jin-su

2013-12-01

Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution. The records of 168 consecutive cases of fifth metatarsal stress fracture (163 patients) treated by modified tension band wiring from March 2002 to June 2011 were evaluated retrospectively. Mean length of follow-up was 23.6 months (range, 10-112 months). Forty-nine cases classified as Torg III were bone grafted initially also. All enrolled patients were elite athletes. Eleven patients experienced nonunion and 18 refracture. The 11 nonunion cases were bone grafted. The 157 patients (excluding nonunion cases) were allocated to either a refracture group or a union group. Clinical features, such as age, weight, fracture classification, time to union, and reinjury history, were compared. Radiological parameters representing cavus deformity and fifth metatarsal head protrusion were compared to evaluate the influence of structural abnormalities. Mean group weights were significantly different (P = .041), but mean ages (P = .879), fracture grades (P = .216, P = .962), and time from surgery to rehabilitation (P = .539) were similar. No significant intergroup differences were found for talocalcaneal (TC) angle (P = .470), calcaneal pitch (CP) angle (P = .847), or talo-first metatarsal (T-MT1) angle (P = .407) on lateral radiographs; for fifth metatarsal lateral deviation (MT5-LD) angle (P = .623) on anteroposterior (AP) radiographs; or for MT5-LD angle (P = .065) on the 30-degree medial oblique radiographs. However, the mean fourth-fifth intermetatarsal (IMA4-5) angle on AP radiographs was significantly greater in the refracture group, and for Torg II cases, mean weight (P = .042), IMA4-5 angle on AP radiographs (P = .014), and MT5-LD angle (P = .043) on 30-degree medial

Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes.

Science.gov (United States)

Zbeda, Robert M; Sculco, Peter K; Urch, Ekaterina Y; Lazaro, Lionel E; Borens, Olivier; Williams, Riley J; Lorich, Dean G; Wellman, David S; Helfet, David L

2015-07-01

Anterior tibial stress fractures are associated with high rates of delayed union and nonunion, which can be particularly devastating to a professional athlete who requires rapid return to competition. Current surgical treatment strategies include intramedullary nailing, which has satisfactory rates of fracture union but an associated risk of anterior knee pain. Anterior tension band plating is a biomechanically sound alternative treatment for these fractures. Tension band plating of chronic anterior tibial stress fractures leads to rapid healing and return to physical activity and avoids the anterior knee pain associated with intramedullary nailing. Case series; Level of evidence, 4. Between 2001 and 2013, there were 13 chronic anterior tibial stress fractures in 12 professional or collegiate athletes who underwent tension band plating after failing nonoperative management. Patient charts were retrospectively reviewed for demographics, injury history, and surgical details. Radiographs were used to assess time to osseous union. Follow-up notes and phone interviews were used to determine follow-up time, return to training time, and whether the patient was able to return to competition. Cases included 13 stress fractures in 12 patients (9 females, 3 males). Five patients were track-and-field athletes, 4 patients played basketball, 2 patients played volleyball, and 1 was a ballet dancer. Five patients were Division I collegiate athletes and 7 were professional or Olympic athletes. Average age at time of surgery was 23.6 years (range, 20-32 years). Osseous union occurred on average at 9.6 weeks (range, 5.3-16.9 weeks) after surgery. Patients returned to training on average at 11.1 weeks (range, 5.7-20 weeks). Ninety-two percent (12/13) eventually returned to preinjury competition levels. Thirty-eight percent (5/13) underwent removal of hardware for plate prominence. There was no incidence of infection or nonunion. Anterior tension band plating for chronic tibial stress

Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees.

Science.gov (United States)

Krauss, Margot R; Garvin, Nadia U; Boivin, Michael R; Cowan, David N

2017-02-01

Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures. The incidence of, and excess health care utilization for, stress fracture and non-stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits. Cohort study; Level of evidence, 3. All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005-September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service. Among the weight-qualified women, unfit participants had a higher non-stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non-stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1

Autotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible

NARCIS (Netherlands)

Mensink, G.; Karagozoglu, K. H.; Strackee, S. D.; van Teeseling, R. A.; Smeele, L. E.; Becking, A. G.

2011-01-01

A 10-year-old female patient with a fibula transplant in her left hemimandible due to ameloblastoma treatment was referred for combined orthodontic and surgical planning and treatment to observe and prevent expected asymmetric facial development and malocclusion, because the premolars and molars on

New model for surface fracture induced by dynamical stress

OpenAIRE

Andersen, J. V.; Lewis, L. J.

1997-01-01

We introduce a model where an isotropic, dynamically-imposed stress induces fracture in a thin film. Using molecular dynamics simulations, we study how the integrated fragment distribution function depends on the rate of change and magnitude of the imposed stress, as well as on temperature. A mean-field argument shows that the system becomes unstable for a critical value of the stress. We find a striking invariance of the distribution of fragments for fixed ratio of temperature and rate of ch...

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

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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.

Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study.

Science.gov (United States)

Almirol, Ellen A; Chi, Lisa Y; Khurana, Bharti; Hurwitz, Shelley; Bluman, Eric M; Chiodo, Christopher; Matzkin, Elizabeth; Baima, Jennifer; LeBoff, Meryl S

2016-09-01

In this pilot, placebo-controlled study, we evaluated whether brief administration of teriparatide (TPTD) in premenopausal women with lower-extremity stress fractures would increase markers of bone formation in advance of bone resorption, improve bone structure, and hasten fracture healing according to magnetic resonance imaging (MRI). Premenopausal women with acute lower-extremity stress fractures were randomized to injection of TPTD 20-µg subcutaneous (s.c.) (n = 6) or placebo s.c. (n = 7) for 8 weeks. Biomarkers for bone formation N-terminal propeptide of type I procollagen (P1NP) and osteocalcin (OC) and resorption collagen type-1 cross-linked C-telopeptide (CTX) and collagen type 1 cross-linked N-telopeptide (NTX) were measured at baseline, 4 and 8 weeks. The area between the percent change of P1NP and CTX over study duration is defined as the anabolic window. To assess structural changes, peripheral quantitative computed topography (pQCT) was measured at baseline, 8 and 12 weeks at the unaffected tibia and distal radius. The MRI of the affected bone assessed stress fracture healing at baseline and 8 weeks. After 8 weeks of treatment, bone biomarkers P1NP and OC increased more in the TPTD- versus placebo-treated group (both p ≤ 0.01), resulting in a marked anabolic window (p ≤ 0.05). Results from pQCT demonstrated that TPTD-treated women showed a larger cortical area and thickness compared to placebo at the weight bearing tibial site, while placebo-treated women had a greater total tibia and cortical density. No changes at the radial sites were observed between groups. According to MRI, 83.3% of the TPTD- and 57.1% of the placebo-treated group had improved or healed stress fractures (p = 0.18). In this randomized, pilot study, brief administration of TPTD showed anabolic effects that TPTD may help hasten fracture healing in premenopausal women with lower-extremity stress fractures. Larger prospective studies are warranted to determine

Critical cleavage fracture stress characterization of A508 nuclear pressure vessel steels

International Nuclear Information System (INIS)

Wu, Sujun; Jin, Huijin; Sun, Yanbin; Cao, Luowei

2014-01-01

The critical cleavage fracture stress of SA508 Gr.4N and SA508 Gr.3 low alloy reactor pressure vessel (RPV) steels was studied through the combination of experiments and finite element method (FEM) analysis. The results showed that the value of the local cleavage fracture stress, σ F , of SA508 Gr.4N steel was significantly higher than that of SA508 Gr.3 steel. Detailed microstructural analysis was carried out using FEGSEM which revealed much smaller grains, finer and more homogenous carbide particles formed in SA508 Gr.4N steel. Compared with the SA508 Gr.3 steel currently used in the nuclear industry, the SA508 Gr.4N steel possesses higher strength and notch toughness as well as improved cleavage fracture behavior, and is considered a better candidate RPV steel for the next generation nuclear reactors. - Highlights: • Critical cleavage fracture stress was calculated through experiments and FEM. • Effects of both grain and carbide particle sizes on σ F were discussed. • The SA508 Gr.4N steel is a better candidate for the next generation nuclear reactors

A constitutive equation for creep fracture under constant, variable or cyclic positive stress

International Nuclear Information System (INIS)

Snedden, J.D.

1977-01-01

Prediction of creep fracture of metals under variable stress is one of the most difficult problems of applied mechanics. At NEL this problem is under investigation using an approach in which creep is represented by two macroscopic components: an anelastic (reversible) component and a plastic (irreversible) component. Under variable loading conditions, the anelastic component's behaviour will be most important and, if an experimental programme is logically planned, the structural processes responsible will be implicit in the resulting constitutive equation describing the material's behaviour. The present paper deals with the development and application of a constitutive equation for creep fracture of RR58 Aluminium alloy at 180 0 C under variable stress and such a constitutive equation can be extrapolated to cover long-time behaviour just as with conventional constant stress creep fracture equations. Constant stress, in fact, is one of the boundary conditions of the general constitutive equation, representing zero prior damage. The other boundary condition is that of 'cadence loading' in which the stress is completely removed and then re-applied in a cyclic fashion. (Auth.)

The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004-2005 Through 2013-2014 Academic Years.

Science.gov (United States)

Rizzone, Katherine H; Ackerman, Kathryn E; Roos, Karen G; Dompier, Thomas P; Kerr, Zachary Y

2017-10-01

  Stress fractures are injuries caused by cumulative, repetitive stress that leads to abnormal bone remodeling. Specific populations, including female athletes and endurance athletes, are at higher risk than the general athletic population. Whereas more than 460 000 individuals participate in collegiate athletics in the United States, no large study has been conducted to determine the incidence of stress fractures in collegiate athletes.   To assess the incidence of stress fractures in National Collegiate Athletic Association (NCAA) athletes and investigate rates and patterns overall and by sport.   Descriptive epidemiology study.   National Collegiate Athletic Association institutions.   National Collegiate Athletic Association athletes.   Data were analyzed from the NCAA Injury Surveillance Program for the academic years 2004-2005 through 2013-2014. We calculated rates and rate ratios (RRs) with 95% confidence intervals (CIs).   A total of 671 stress fractures were reported over 11 778 145 athlete-exposures (AEs) for an overall injury rate of 5.70 per 100 000 AEs. The sports with the highest rates of stress fractures were women's cross-country ( 28.59/100  000 AEs), women's gymnastics ( 25.58/100  000 AEs), and women's outdoor track ( 22.26/100  000 AEs). Among sex-comparable sports (baseball/softball, basketball, cross-country, ice hockey, lacrosse, soccer, swimming and diving, tennis, indoor track, and outdoor track), stress fracture rates were higher in women (9.13/100 000 AEs) than in men (4.44/100 000 AEs; RR = 2.06; 95% CI = 1.71, 2.47). Overall, stress fracture rates for these NCAA athletes were higher in the preseason (7.30/100 000 AEs) than in the regular season (5.12/100 000 AEs; RR = 1.43; 95% CI = 1.22, 1.67). The metatarsals (n = 254, 37.9%), tibia (n = 147, 21.9%), and lower back/lumbar spine/pelvis (n = 81, 12.1%) were the most common locations of injury. Overall, 21.5% (n = 144) of stress fractures were

CHARACTERIZATION OF IN-SITU STRESS AND PERMEABILITY IN FRACTURED RESERVOIRS

Energy Technology Data Exchange (ETDEWEB)

Daniel R. Burns; M. Nafi Toksoz

2002-12-31

We have extended a three-dimensional finite difference elastic wave propagation model previously developed at the Massachusetts Institute of Technology (MIT) Earth Resources Laboratory (ERL) for modeling and analyzing the effect of fractures on seismic waves. The code has been translated into C language and parallelized [using message passing interface (MPI)] to allow for larger models to be run on Linux PC computer clusters. We have also obtained another 3-D code from Lawrence Berkeley Laboratory, which we will use for verification of our ERL code results and also to run discrete fracture models. Testing of both codes is underway. We are working on a new finite difference model of borehole wave propagation for stressed formations. This code includes coordinate stretching to provide stable, variable grid sizes that will allow us to model the thin fluid annulus layers in borehole problems, especially for acoustic logging while drilling (LWD) applications. We are also extending our analysis routines for the inversion of flexural wave dispersion measurements for in situ stress estimates. Initial results on synthetic and limited field data are promising for a method to invert cross dipole data for the rotation angle and stress state simultaneously. A meeting is being scheduled between MIT and Shell Oil Company scientists to look at data from a fractured carbonate reservoir that may be made available to the project. The Focus/Disco seismic processing system from Paradigm Geophysical has been installed at ERL for field data analysis and as a platform for new analysis modules. We have begun to evaluate the flow properties of discrete fracture distributions through a simple 2D numerical model. Initial results illustrate how fluid flow pathways are very sensitive to variations in the geometry and apertures of fracture network.

Allogenic bone rods with freeze drying and gamma rays irradiation for treatment of fracture

International Nuclear Information System (INIS)

Zhou Zhenbin

1999-01-01

Opened reduction and internal fixation are the usual treatment of fracture, but both methods need a second operation for removal implants. The benefits of the bone rods are that they can avoid the removement of internal fixation and will be absorbed spontaneously. The bone rods are made of allogeneic compact bones with freeze-drying and gamma rays irradiation supplied by Shanxi Provincial Tissue Bank. The purpose of this study is to evaluate allograft reaction, the stability of the internal fixation, osteoinduction in the treatment of fracture using allogeneic bone rods with freeze drying and gamma rays irradiation. From May 1997 to May 1998, fourteen cases (male 12, female 2) of treatment were reviewed. The mean age was 37.3 (21-5 1). There were 3 medial malleolus fractures, 7 tibia and fibula fractures, 1 ulna and radius fracture, 1 lateral condyle of humerus fracture. The clinical results were satisfactory. Because the strength of the bone rods are weaker than that of screws, the bone rods are only indicated in the fixation of cancellous bones fracture and unloaded bone fracture. It can be used as a supplementary fixation of loaded bone. It is not indicated for fixation of comminuted fracture. More than two bone rods may be used in the fixation of fracture in order to get stability of the fracture and decrease stress between rods which will prevent the break of the bone rods. Allogeneic bone rods with freeze-drying and gamma rays irradiation can be used as implants of non-immunogenicity. There are no allograft reactions in all cases (including fever, leukocytosis, exudation or swelling in the wound). Although plenty of experimental studies have showed that freeze drying with gamma rays irradiation (below 50 KGy) would not destroy BMP of bone allograft, but there is no osteoinduction in our cases. The healing of a fracture and bridging external callus are similar as other operations. This new technique may have the following advantages compare with the screws: 1

Natural Fractures Characterization and In Situ Stresses Inference in a Carbonate Reservoir—An Integrated Approach

Directory of Open Access Journals (Sweden)

Ali Shafiei

2018-02-01

Full Text Available In this paper, we characterized the natural fracture systems and inferred the state of in situ stress field through an integrated study in a very complex and heterogeneous fractured carbonate reservoir. Relative magnitudes and orientations of the in-situ principal stresses in a naturally fractured carbonate heavy oil field were estimated with a combination of available data (World Stress Map, geological and geotectonic evidence, outcrop studies and techniques (core analysis, borehole image logs and Side View Seismic Location. The estimates made here using various tools and data including routine core analysis and image logs are confirmatory to estimates made by the World Stress Map and geotectonic facts. NE-SW and NW-SE found to be the dominant orientations for maximum and minimum horizontal stresses in the study area. In addition, three dominant orientations were identified for vertical and sub-vertical fractures atop the crestal region of the anticlinal structure. Image logs found useful in recognition and delineation of natural fractures. The results implemented in a real field development and proved practical in optimal well placement, drilling and production practices. Such integrated studies can be instrumental in any E&P projects and related projects such as geological CO2 sequestration site characterization.

Pace bowlers in cricket with history of lumbar stress fracture have increased risk of lower limb muscle strains, particularly calf strains.

Science.gov (United States)

Orchard, John; Farhart, Patrick; Kountouris, Alex; James, Trefor; Portus, Marc

2010-01-01

To assess whether a history of lumbar stress fracture in pace bowlers in cricket is a risk factor for lower limb muscle strains. This was a prospective cohort risk factor study, conducted using injury data from contracted first class pace bowlers in Australia during seasons 1998-1999 to 2008-2009 inclusive. There were 205 pace bowlers, 33 of whom suffered a lumbar stress fracture when playing first class cricket. Risk ratios ([RR] with 95% confidence intervals[CI]) were calculated to compare the seasonal incidence of various injuries between bowlers with a prior history of lumbar stress fracture and those with no history of lumbar stress fracture. Risk of calf strain was strongly associated with prior lumbar stress fracture injury history (RR = 4.1; 95% CI: 2.4-7.1). Risks of both hamstring strain (RR = 1.5; 95% CI: 1.03-2.1) and quadriceps strain (RR = 2.0; 95% CI: 1.1-3.5) were somewhat associated with history of lumbar stress fracture. Risk of groin strain was not associated with history of lumbar stress fracture (RR = 0.7; 95% CI: 0.4-1.1). Other injuries showed little association with prior lumbar stress fracture, although knee cartilage injuries were more likely in the non-stress fracture group. Bony hypertrophy associated with lumbar stress fracture healing may lead to subsequent lumbar nerve root impingement, making lower limb muscle strains more likely to occur. Confounders may be responsible for some of the findings. In particular, bowling speed is likely to be independently correlated with risk of lumbar stress fracture and risk of muscle strain. However, as the relationship between lumbar stress fracture history and calf strain was very strong, and that there is a strong theoretical basis for the connection, it is likely that this is a true association.

Stress localization in BCC polycrystals and its implications on the probability of brittle fracture

Energy Technology Data Exchange (ETDEWEB)

Vincent, Ludovic [CEA, DEN, SRMA, 91191 Gif sur Yvette Cedex (France); Gelebart, Lionel, E-mail: lionel.gelebart@cea.fr [CEA, DEN, SRMA, 91191 Gif sur Yvette Cedex (France); Dakhlaoui, Rim; Marini, Bernard [CEA, DEN, SRMA, 91191 Gif sur Yvette Cedex (France)

2011-07-15

Highlights: {yields} Intergranular stress distributions in a bainitic steel. {yields} Comparison of local mean stress field with neutron diffraction results. {yields} Application of the local stress distribution in a brittle fracture model. - Abstract: The evaluation of the reliability of pressure vessels in nuclear plants relies on the evaluation of failure probability models. Micromechanical approaches are of great interest to refine their description, to better understand the underlying mechanisms leading to failure, and finally to improve the prediction of these models. The main purpose of this paper is to introduce the stress heterogeneities arising within the polycrystal in a probabilistic modeling of brittle fracture. Stress heterogeneities are evaluated from Finite-Element simulations performed on a large number of Statistical Volume Elements. Results are validated both on the measured averaged behavior and on the averaged stresses measured by neutron diffraction in five specific orientations. A probabilistic model for brittle fracture is then presented accounting for the carbide distribution and the stress distribution evaluated previously inside an elementary volume V{sub 0}. Results are compared to a 'Beremin type' approach, assuming a homogeneous stress state inside V{sub 0}.

Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

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Tatsuro Sasaji

2016-01-01

Full Text Available While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.

Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine

International Nuclear Information System (INIS)

Ganiyusufoglu, A.K.; Onat, L.; Karatoprak, O.; Enercan, M.; Hamzaoglu, A.

2010-01-01

Aim: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. Materials and methods: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. Results: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. Conclusion: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Ganiyusufoglu, A.K., E-mail: kursady33@yahoo.co [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Onat, L. [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Karatoprak, O.; Enercan, M.; Hamzaoglu, A. [Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul (Turkey)

2010-11-15

Aim: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. Materials and methods: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. Results: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. Conclusion: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

Bilateral stress fractures of femoral neck in non-athletes: a report of four cases

Directory of Open Access Journals (Sweden)

Naik Monappa A

2013-04-01

Full Text Available 【Abstract】Femoral neck stress fractures (FNSFs are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers with-out underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and sub-trochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular ne-crosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in pa-tients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation. Key words: Fractures, stress; Femoral neck fractures; Coxa vara; Osteotomy

Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures.

Science.gov (United States)

Yong, Jennifer R; Silder, Amy; Montgomery, Kate L; Fredericson, Michael; Delp, Scott L

2018-05-18

Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures. Copyright © 2018 Elsevier Ltd. All rights reserved.

Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report.

Science.gov (United States)

Ozdemir, Guzelali; Azboy, Ibrahim; Yilmaz, Baris

2016-01-01

Periprosthetic fractures around the knee after total knee arthroplasty can be seen in the femur, tibia and patella. The tibial fractures are rare cases. Our case with bilateral tibial stress fracture developed after total knee arthroplasty (TKA) is the first of its kind in the literature. 75-year-old male patient with bilateral knee osteoarthritis had not benefited from conservative treatment methods previously applied. Left TKA was applied. In the second month postoperatively, periprosthetic tibial fracture was identified and osteosynthesis was implemented with locked tibia proximal plate-screw. Bone union in 12 weeks was observed in his follow-ups. After 15 months of his first operation, TKA was applied to the right knee. Postoperatively in the second month, as in the first operation, periprosthetic tibial fracture was detected. Osteosynthesis with locking plate-screw was applied and union in 12 weeks was observed in his follow-up. He was seen mobilized independently and without support in the last control of the case made in the 24th month after the second operation. The number of TKA applications is expected to increase in the future. The incidence of periprosthetic fractures should also be expected to increase in these cases. Periprosthetic tibial fractures after TKA are rarely seen. The treatment of periprosthetic fractures around the knee after TKA can be difficult. In the case of persistent pain in the upper end of the tibia after the surgery, stress fracture should be considered. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Stresses, fatigue and fracture analysis in the tube sheets

International Nuclear Information System (INIS)

Billon, F.

1986-05-01

The purpose of the present work is to study the behaviour of the nuclear PWR steam generator tube sheet. But the methods developed in this field can easily be generalized in order to study tube sheets from any other type of heat exchangers. The aim of the stress analysis of these sheets is to verify their correct design, to quantify the risk of fatigue damage in the areas submitted to a high stress concentration and through the fracture mechanic, to make sure there is no risk of fast fracture resulting from initiated or pre-existing defects. This analysis necessarily relates to the calculation of stresses in all parts of the multidrilled area, mainly around the holes where they are concentrated. However the tube sheets are so complexe structures that their direct modelization cannot be envisaged within the context of the finite element method. We then must refer to the concept of equivalent medium in order to calculate the nominal stresses. Then using the stresses multiple fonctions appropriate to the net geometry, we can calculate the actual stresses concentrated around the holes. The method depends on the behaviour of the elementary volume which represents the behaviour of the multidrilled medium. This approach must allow to correctly take account of the ''thermal skin effect'', which is a phenomenon particular to the tube sheets with thermal loads. It must as well be generalized in order to analyse the irregular ligaments which affect the periodical stresses distribution and locally overconcentrate them [fr

Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners.

Science.gov (United States)

Nieves, Jeri W; Melsop, Kathryn; Curtis, Meredith; Kelsey, Jennifer L; Bachrach, Laura K; Greendale, Gail; Sowers, Mary Fran; Sainani, Kristin L

2010-08-01

To identify nutrients, foods, and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners. Two-year, prospective cohort study. Observational data were collected in the course of a multicenter randomized trial of the effect of oral contraceptives on bone health. One hundred and twenty-five female competitive distance runners ages 18-26 years. Dietary variables were assessed with a food frequency questionnaire. Bone mineral density and content (BMD/BMC) of the spine, hip, and total body were measured annually by dual x-ray absorptiometry (DEXA). Stress fractures were recorded on monthly calendars, and had to be confirmed by radiograph, bone scan, or magnetic resonance imaging. Seventeen participants had at least one stress fracture during follow-up. Higher intakes of calcium, skim milk, and dairy products were associated with lower rates of stress fracture. Each additional cup of skim milk consumed per day was associated with a 62% reduction in stress fracture incidence (P stress fracture rate. Potassium intake was also associated with greater gains in hip and whole-body BMD. Copyright © 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Marrow changes in anorexia nervosa masking the presence of stress fractures on MR imaging

Energy Technology Data Exchange (ETDEWEB)

Tins, B.; Cassar-Pullicino, V. [Department of Radiology, RJAH Orthopaedic and District Hospital, Oswestry (United Kingdom)

2006-11-15

Patients with anorexia nervosa (AN) usually have abnormal bone and bone marrow metabolism resulting in osteopenia and serous bone marrow change. There is an increased risk of stress/insufficiency fractures and these can be the first presentation of AN. This case report describes a patient with previously undiagnosed AN who presented with foot pain. The serous bone marrow changes of AN were found to mask the MR imaging features of stress fractures, as both had low T1w and high T2w and STIR signal intensities. Contrast enhancement was not helpful but actually masked fractures. Scintigraphy was helpful. The radiologist might be the first clinician to raise the possibility of AN and should be aware of the difficulties in diagnosing stress fractures in bones with underlying serous bone marrow change. In this severe case of AN even the heel fat pad and the fat pad in Kager's triangle had undergone serous change.

Marrow changes in anorexia nervosa masking the presence of stress fractures on MR imaging

International Nuclear Information System (INIS)

Tins, B.; Cassar-Pullicino, V.

2006-01-01

Patients with anorexia nervosa (AN) usually have abnormal bone and bone marrow metabolism resulting in osteopenia and serous bone marrow change. There is an increased risk of stress/insufficiency fractures and these can be the first presentation of AN. This case report describes a patient with previously undiagnosed AN who presented with foot pain. The serous bone marrow changes of AN were found to mask the MR imaging features of stress fractures, as both had low T1w and high T2w and STIR signal intensities. Contrast enhancement was not helpful but actually masked fractures. Scintigraphy was helpful. The radiologist might be the first clinician to raise the possibility of AN and should be aware of the difficulties in diagnosing stress fractures in bones with underlying serous bone marrow change. In this severe case of AN even the heel fat pad and the fat pad in Kager's triangle had undergone serous change

Residual stress effects in LMFBR fracture assessment procedures

International Nuclear Information System (INIS)

Hooton, D.G.

1984-01-01

Two post-yield fracture mechanics methods, which have been developed into fully detailed failure assessment procedures for ferritic structures, have been reviewed from the point of view of the manner in which as-welded residual stress effects are incorporated, and comparisons then made with finite element and theoretical models of centre-cracked plates containing residual/thermal stresses in the form of crack-driving force curves. Applying the procedures to austenitic structures, comparisons are made in terms of failure assessment curves and it is recommended that the preferred method for the prediction of critical crack sizes in LMFBR austenitic structures containing as-welded residual stresses is the CEGB-R6 procedure based on a flow stress defined at 3% strain in the parent plate. When the prediction of failure loads in such structures is required, it is suggested that the CEGB-R6 procedure be used with residual/thermal stresses factored to give a maximum total stress of flow stress magnitude

Multiple fractures and impaired bone metabolism in Wolfram syndrome: a case report.

Science.gov (United States)

Catalano, Antonino; Bellone, Federica; Cicala, Giuseppe; Giandalia, Annalisa; Morabito, Nunziata; Cucinotta, Domenico; Russo, Giuseppina Tiziana

2017-01-01

Wolfram Syndrome (WS) is a rare and lethal disease characterized by optic atrophy, diabetes mellitus, diabetes insipidus, and hearing loss. To date, osteoporotic related fractures have not been reported in affected patients. Here, we describe the case of a man affected by WS complicated by several bone fragility fractures. A 50-year-old Caucasian man was hospitalized because of tibia and fibula fractures. His clinical features included diabetes mellitus, diabetes insipidus, optic atrophy and deafness that were consistent with an unrecognized WS diagnosis, which was confirmed by the identification of a specific mutation in gene WFS1 encoding wolframin. Bone mineral density by phalangeal quantitative ultrasound demonstrated severe osteoporosis, with high serum levels of surrogate markers of bone turn-over. Previously unidentified rib fractures were also detected. To the best of our knowledge, this is the first report of osteoporotic related fractures in a patient affected by WS. Although no effective treatments are currently available to delay the progression of the disease, this case report suggests to evaluate fracture risk in the diagnostic work-up of WS.

Stress, Flow and Particle Transport in Rock Fractures

Energy Technology Data Exchange (ETDEWEB)

Koyama, Tomofumi

2007-09-15

The fluid flow and tracer transport in a single rock fracture during shear processes has been an important issue in rock mechanics and is investigated in this thesis using Finite Element Method (FEM) and streamline particle tracking method, considering evolutions of aperture and transmissivity with shear displacement histories under different normal stresses, based on laboratory tests. The distributions of fracture aperture and its evolution during shear were calculated from the initial aperture fields, based on the laser-scanned surface roughness features of replicas of rock fracture specimens, and shear dilations measured during the coupled shear-flow-tracer tests in laboratory performed using a newly developed testing apparatus in Nagasaki University, Nagasaki, Japan. Three rock fractures of granite with different roughness characteristics were used as parent samples from which nine plaster replicas were made and coupled shear-flow tests was performed under three normal loading conditions (two levels of constant normal loading (CNL) and one constant normal stiffness (CNS) conditions). In order to visualize the tracer transport, transparent acrylic upper parts and plaster lower parts of the fracture specimens were manufactured from an artificially created tensile fracture of sandstone and the coupled shear-flow tests with fluid visualization was performed using a dye tracer injected from upstream and a CCD camera to record the dye movement. A special algorithm for treating the contact areas as zero-aperture elements was used to produce more accurate flow field simulations by using FEM, which is important for continued simulations of particle transport, but was often not properly treated in literature. The simulation results agreed well with the flow rate data obtained from the laboratory tests, showing that complex histories of fracture aperture and tortuous flow channels with changing normal stresses and increasing shear displacements, which were also captured

Pace bowlers in cricket with history of lumbar stress fracture have increased risk of lower limb muscle strains, particularly calf strains

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John Orchard

2010-09-01

Full Text Available John Orchard1, Patrick Farhart2, Alex Kountouris3, Trefor James3, Marc Portus31School of Public Health, University of Sydney, Australia; 2Punjab Kings XI team, Indian Premier League, India; 3Cricket Australia, Melbourne, AustraliaObjective: To assess whether a history of lumbar stress fracture in pace bowlers in cricket is a risk factor for lower limb muscle strains.Methods: This was a prospective cohort risk factor study, conducted using injury data from contracted first class pace bowlers in Australia during seasons 1998–1999 to 2008–2009 inclusive. There were 205 pace bowlers, 33 of whom suffered a lumbar stress fracture when playing first class cricket. Risk ratios ([RR] with 95% confidence intervals[CI] were calculated to compare the seasonal incidence of various injuries between bowlers with a prior history of lumbar stress fracture and those with no history of lumbar stress fracture.Results: Risk of calf strain was strongly associated with prior lumbar stress fracture injury history (RR = 4.1; 95% CI: 2.4–7.1. Risks of both hamstring strain (RR = 1.5; 95% CI: 1.03–2.1 and quadriceps strain (RR = 2.0; 95% CI: 1.1–3.5 were somewhat associated with history of lumbar stress fracture. Risk of groin strain was not associated with history of lumbar stress fracture (RR = 0.7; 95% CI: 0.4–1.1. Other injuries showed little association with prior lumbar stress fracture, although knee cartilage injuries were more likely in the non-stress fracture group.Conclusion: Bony hypertrophy associated with lumbar stress fracture healing may lead to subsequent lumbar nerve root impingement, making lower limb muscle strains more likely to occur. Confounders may be responsible for some of the findings. In particular, bowling speed is likely to be independently correlated with risk of lumbar stress fracture and risk of muscle strain. However, as the relationship between lumbar stress fracture history and calf strain was very strong, and that there is a

Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury.

Science.gov (United States)

Mohammed, R; Syed, S; Metikala, S; Ali, Sa

2011-09-01

With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation. 12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise. At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred. We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.

[Osteosynthesis of Weber B ankle fractures using the one-third tubular plate and refixation of the syndesmosis].

Science.gov (United States)

Spering, C; Lesche, V; Dresing, K

2015-08-01

Anatomical reconstruction and recovery to complete range of function of the upper ankle joint. Therefore, the most stable but least invasive osteosynthesis is required to enable the patient early functional mobilization. Supination and pronation fracture with luxation mechanism of the upper ankle joint with or without rupture of the syndesmosis. Open fracture of the distal fibula including displaced and instable fractures. Severe peripheral arterial occlusive disease; contaminated open fractures (≥ 2nd degree); pediatric fractures with open epiphyseal plate. Supine position with ipsilateral slightly elevated hip and knee. Incision of about 8 cm length along the dorsal edge of the distal fibula. When reaching the lateral malleolus, a slight ventral angulation is necessary. Open reduction through this posterolateral approach. Secure the reposition using an interfragmentary lag screw and anatomically adjusted third tubular plate. Followed by a revision of the syndesmosis and transfixation using a tricortical position screw. Mobilization on day 1 after surgery with reduced weight-bearing when position screw is not applied; when position screw is implanted with ground contact for 6 weeks. Removal of position screw under local anesthesia after 6 weeks and pain-controlled full weight-bearing. Removal of metal after 1.5 years. Open reduction using the third tubular plate and an interfragmentary lag screw through a dorsolateral approach used in 90 % of all Weber B fractures in our clinic. Additional revision of a ruptured syndesmosis performed in 70 % and transfixation through a position screw in 40 %. Persisting instability in the upper ankle joint significantly reduced after surgical treatment compared to a conservative approach. Revisions necessary in 3.7 % of patients and pseudarthrosis diagnosed in 0.9 %. It has been shown that the preoperative x-ray and clinical examination is limited in detecting a ruptured syndesmosis.

Femoral Neck Stress Fractures in Children Younger Than 10 Years of Age.

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Boyle, Matthew J; Hogue, Grant D; Heyworth, Benton E; Ackerman, Kathryn; Quinn, Bridget; Yen, Yi-Meng

2017-03-01

Femoral neck stress fractures are rare in healthy children, with only 9 cases previously reported. The present article reviews our institutional experience with femoral neck stress fractures in children younger than 10 years of age, to highlight the unique features of this condition. We undertook a retrospective review of clinical records of patients who had been treated at our institution for an idiopathic femoral neck stress fracture between 2000 and 2014. To focus on children rather than adolescents, the World Health Organization's definition of adolescent as a person between 10 and 19 years of age was used; we thereby limited our analysis to patients younger than 10 years of age. The study included 6 patients (3 males, 3 females) treated for an idiopathic femoral neck stress fracture, with a mean age at diagnosis of 7.7 years (range, 5.2 to 8.9 y). All patients presented with a limp, which worsened with activity and had persisted for a mean of 5 weeks (range, 2 to 9 wk). None of the patients had experienced an increase in activity level or sporting volume before symptom onset. On examination, 3 patients experienced pain with terminal hip flexion and 3 patients demonstrated pain-free hip range of motion. Plain radiography demonstrated inferior femoral neck cortical disruption, suggesting a compression-type stress fracture mechanism. The diagnosis was confirmed by cross-sectional imaging in all cases. All patients were initially treated with 6 to 8 weeks of non-weight-bearing followed by 4 to 6 weeks of partial weight-bearing, leading to complete healing in 4 patients. Two patients demonstrated incomplete healing and were managed with spica casting for an additional 6 weeks. Our case series illustrates the unique features of this rare condition in children, with a history and examination profile distinct from those of adolescents and adults. Compliance with weight-bearing restrictions is difficult in this population and hip spica casting may be required to permit

Stress fracture of hamate's hook: case report with emphasis to the imaging findings

International Nuclear Information System (INIS)

Carvalho, Leonardo Fontenelle de; Vianna, Evandro Miguelote; Domingues, Romulo; Domingues, Romeu Cortes; Metsavaht, Leonardo

2007-01-01

Stress fractures of the hook of the hamate are related to sports that use devices such as golf clubs, rackets and baseball bats. Because usually there is no history of obvious trauma, the diagnosis necessitates better knowledge of the lesion and high index of suspicion. The authors report a case of stress fracture of the hook of the hamate in a golf player with diagnosis and follow-up done with magnetic resonance and multislice computer tomography. (author)

Study on fracture and stress corrosion cracking behavior of casing sour service materials

International Nuclear Information System (INIS)

Sequera, C.; Gordon, H.

2003-01-01

Present work describes sulphide stress corrosion cracking and fracture toughness tests performed to high strength sour service materials of T-95, C-100 and C-110 oil well tubular grades. P-110 was considered as a reference case, since it is one of the high strength materials included in specification 5CT of American Petroleum Institute, API. Sulphide stress corrosion cracking, impact and fracture toughness values obtained in the tests show that there is a correspondence among them. A decreasing classification order was established, namely C-100, T-95, C-110 and P-110. Special grades steels studied demonstrated a better behavior in the evaluated properties than the reference case material grade: P-110. Results obtained indicate that a higher sulphide stress corrosion cracking resistance is related to a higher toughness. The fracture toughness results evidence the hydrogen influence on reducing the toughness values. (author)

Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?

National Research Council Canada - National Science Library

Hoffman, Andrew

2004-01-01

A convenience sample based on availability of tibial stress fracture cases a% local Sports Medicine Clinics will be selected over 4 years until forty subjects (20 male, 20 female) have been treated...

tibialization of the fibula in a child with chronic osteomyelitis of the ...

African Journals Online (AJOL)

used in tibial reconstruction after resection of Ewing's sarcoma (6). A case report from Congo detailed how a 10-centimeter tibial bone loss was treated by inter- tibiofibula bone grafting, resulting in tibialization of the fibula. The patient was reviewed after 10 years; and the clinical result was satisfactory and stable (7).

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

Science.gov (United States)

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

2018-02-01

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

Stress fracture of the medial clavicle secondary to nervous tic

International Nuclear Information System (INIS)

Yamada, K.; Sugiura, H.; Suzuki, Y.

2004-01-01

The clinical and radiological characteristics of swelling in the region of the medial clavicle may suggest the presence of a neoplastic or inflammatory lesion. This report describes a 27-year-old man with a painful tumor-like lesion over the medial clavicle, which was found to be a stress fracture caused by a nervous tic resulting from mental stress. (orig.)

Increased Oxidative Stress Response in Granulocytes from Older Patients with a Hip Fracture May Account for Slow Regeneration

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Zhiyong Wang

2014-01-01

Full Text Available Proximal femur fracture, a typical fracture of the elderly, is often associated with morbidity, reduced quality of life, impaired physical function and increased mortality. There exists evidence that responses of the hematopoietic microenvironment to fractures change with age. Therefore, we investigated oxidative stress markers and oxidative stress-related MAPK activation in granulocytes from the young and the elderly with and without fractured long bones. Lipid peroxidation levels were increased in the elderly controls and patients. Aged granulocytes were more sensitive towards oxidative stress induced damage than young granulocytes. This might be due to the basally increased expression of SOD-1 in the elderly, which was not further induced by fractures, as observed in young patients. This might be caused by an altered MAPK activation. In aged granulocytes basal p38 and JNK activities were increased and basal ERK1/2 activity was decreased. Following fracture, JNK activity decreased, while ERK1/2 and p38 activities increased in both age groups. Control experiments with HL60 cells revealed that the observed p38 activation depends strongly on age. Summarizing, we observed age-dependent changes in the oxidative stress response system of granulocytes after fractures, for example, altered MAPK activation and SOD-1 expression. This makes aged granulocytes vulnerable to the stress stimuli of the fracture and following surgery.

Plastic deformation and fracture behavior of zircaloy-2 fuel cladding tubes under biaxial stress

International Nuclear Information System (INIS)

Maki, Hideo; Ooyama, Masatosi

1975-01-01

Various combinations of biaxial stress were applied on five batches of recrystallized zircaloy-2 fuel cladding tubes with different textures; elongation in both axial and circumferential directions of the specimen was measured continuously up to 5% plastic deformation. The anisotropic theory of plasticity proposed by Hill was applied to the resulting data, and anisotropy constants were obtained through the two media of plastic strain loci and plastic strain ratios. Comparison of the results obtained with the two methods proved that the plastic strain loci provide data that are more effective in predicting quantitatively the plastic deformation behavior of the zircaloy-2 tubes. The anisotropy constants change their value with progress of plastic deformation, and judicious application of the effective stress and effective strain obtained on anisotropic materials will permit the relationship between stress and strain under various biaxialities of stresses to be approximated by the work hardening law. The test specimens used in the plastic deformation experiments were then stressed to fracture under the same combination of biaxial stress as in the proceeding experiments, and the deformation in the fractured part was measured. The result proved that the tilt angle of the c-axis which serves as the index of texture is related to fracture ductility under biaxial stress. Based on this relationship, it was concluded that material with a tilt angle ranging from 10 0 to 15 0 is the most suitable for fuel cladding tubes, from the viewpoint of fracture ductility, at least in the case of unirradiated material. (auth.)

BISPHOSPHONATE INDUCED STRESS FRACTURE OF BILATERAL FEMUR: A CASE REPORT

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Saidapur

2015-08-01

Full Text Available Osteoporosis is a common problem affecting people after 4 - 5 decade of life. There are various treatment options available for Osteoporosis and Bisphosphonates are widely used. Bisphosphonates work by blocking osteoclast mediated bone resorption and can be given in oral and injectable forms. R ecent studies have brought to light the risk of sub trochanteric stress fracture secondary to bisphosphonate therapy. Here we are presenting a case with bilateral sub trochanteric fracture following prolonged bisphosphonate therapy

Hydraulic fracturing rock stress measurement at Haestholmen, Finland

International Nuclear Information System (INIS)

Ljunggren, C.; Klasson, H.

1992-12-01

This report presents hydraulic fracturing measurements in two boreholes located on the Haestholmen island near Loviisa, Finland. The aim of the measurements was to provide stress data, forming input for the design of an underground facility for disposal of low- and medium-level waste as well as future plant decommissioning radioactive waste from the IVO reactor units situated on Haestholmen. The theoretical background to the hydrofracturing method is summarized, as is the equipment and experimental procedures used in the present case. All results obtained are presented and critically discussed. The final stress parameters presented are magnitudes and directions of the maximum and minimum horizontal stresses. Testing was successfully completed according to schedule in both boreholes.(orig.)

A Scaphoid Stress Fracture in a Female Collegiate-Level Shot-Putter and Review of the Literature

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Jessica M. Kohring

2016-01-01

Full Text Available Scaphoid stress fractures are rare injuries that have been described in young, high-level athletes who exhibit repetitive loading with the wrist in extension. We present a case of an occult scaphoid stress fracture in a 22-year-old female Division I collegiate shot-putter. She was successfully treated with immobilization in a thumb spica splint for 6 weeks. Loaded wrist extension activities can predispose certain high-level athletes to sustain scaphoid stress fractures, and a high index of suspicion in this patient population may aid prompt diagnosis and management of this rare injury.

Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

National Research Council Canada - National Science Library

Hoffman, Andrew

2002-01-01

A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

National Research Council Canada - National Science Library

Hoffman, Andrew

2003-01-01

A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

Theoretical and Experimental Investigation of Characteristics of Single Fracture Stress-Seepage Coupling considering Microroughness

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Shengtong Di

2017-01-01

Full Text Available Based on the results of the test among the joint roughness coefficient (JRC of rock fracture, mechanical aperture, and hydraulic aperture proposed by Barton, this paper deduces and proposes a permeability coefficient formula of single fracture stress-seepage coupling considering microroughness by the introduction of effect variables considering the microparticle size and structural morphology of facture surface. Quasi-sandstone fracture of different particle size is made by the laboratory test, and the respective modification is made on the coupled shear-seepage test system of JAW-600 rock. Under this condition, the laboratory test of stress-seepage coupling of fracture of different particle size is carried out. The test results show that, for the different particle-sized fracture surface of the same JRC, the permeability coefficient is different, which means the smaller particle size, the smaller permeability coefficient, and the larger particle size, the larger permeability coefficient; with the increase of cranny hydraulic pressure, the permeability coefficient increases exponentially, and under the same cranny hydraulic pressure, there is relation of power function between the permeability coefficient and normal stress. Meanwhile, according to the theoretical formula, the microroughness coefficient of the fractures with different particle size is obtained by the calculation, and its accuracy and validity are verified by experiments. The theoretical verification values are in good agreement with the measured values.

kISMET: Stress analysis and intermediate-scale hydraulic fracturing at the Sanford Underground Research Facility

Science.gov (United States)

Dobson, P. F.; Oldenburg, C. M.; Wu, Y.; Cook, P. J.; Kneafsey, T. J.; Nakagawa, S.; Ulrich, C.; Siler, D. L.; Guglielmi, Y.; Ajo Franklin, J. B.; Rutqvist, J.; Daley, T. M.; Birkholzer, J. T.; Wang, H. F.; Lord, N.; Haimson, B. C.; Sone, H.; Vigilante, P.; Roggenthen, W.; Doe, T.; Lee, M.; Ingraham, M. D.; Huang, H.; Mattson, E.; Johnson, T. C.; Zhou, J.; Zoback, M. D.; Morris, J.; White, J. A.; Johnson, P. A.; Coblentz, D. D.; Heise, J.

2017-12-01

In 2015, we established a field test facility at the Sanford Underground Research Facility (SURF), and in 2016 we carried out in situ hydraulic fracturing experiments to characterize the stress field, understand the effects of crystalline rock fabric on fracturing, and gain experience in monitoring using geophysical methods. The kISMET (permeability (k) and Induced Seismicity Management for Energy Technologies) project test site was established in the West Access Drift at the 4850 ft level, 1478 m below ground in phyllite of the Precambrian Poorman Formation. The kISMET team drilled and cored five near-vertical boreholes in a line on 3 m spacing, deviating the two outermost boreholes slightly to create a five-spot pattern around the test borehole centered in the test volume 40 m below the drift invert (floor) at a total depth of 1518 m. Laboratory measurements of core from the center test borehole showed P-wave velocity heterogeneity along each core indicating strong, fine-scale ( 1 cm or smaller) changes in the mechanical properties of the rock. Tensile strength ranges between 3‒7.5 MPa and 5‒12 MPa. Pre-fracturing numerical simulations with a discrete element code were carried out to predict fracture size and magnitude of microseismicity. Field measurements of the stress field were made using hydraulic fracturing, which produced remarkably uniformly oriented fractures suggesting rock fabric did not play a significant role in controlling fracture orientation. Electrical resistivity tomography (ERT) and continuous active seismic source monitoring (CASSM) were deployed in the four monitoring boreholes, and passive seismic accelerometer-based measurements in the West Access Drift were carried out during the generation of a larger fracture (so-called stimulation test). ERT was not able to detect the fracture created, nor did the accelerometers in the drift, but microseismicity was detected for the first (deepest) hydraulic-fracturing stress measurement. Analytical

Comparison of stress fractures of male and female recruits during basic training in the Israeli anti-aircraft forces.

Science.gov (United States)

Gam, Arnon; Goldstein, Liav; Karmon, Yuval; Mintser, Igor; Grotto, Itamar; Guri, Alex; Goldberg, Avishay; Ohana, Nissim; Onn, Erez; Levi, Yehezkel; Bar-Dayan, Yaron

2005-08-01

In military basic training, stress fractures are a common orthopedic problem. Female recruits have a significantly higher incidence of stress fractures than do male recruits. Because the Israeli Defense Forces opened traditionally male roles in combat units to female recruits, their high risk for stress fractures is of concern. To compare the prevalence of stress fractures during Israeli Defense Forces anti-aircraft basic training among otherwise healthy young male and female recruits, in terms of anatomic distribution and severity. Ten mixed gender batteries, including 375 male recruits and 138 female recruits, carried out basic training in the Israeli anti-aircraft corps between November 1999 and January 2003. Each battery was monitored prospectively for 10 weeks of a basic training course. During that time, recruits who were suspected of having an overuse injury went through a protocol that included an orthopedic specialist physical examination followed by a radionuclide technetium bone scan, which was assessed by consultant nuclear medicine experts. The assessment included the anatomic site and the severity of the fractures, labeled as either high severity or low severity. Stress fractures were significantly more common among female recruits than among male recruits. A total of 42 male (11.2%) and 33 female (23.91%) recruits had positive bone scans for stress fractures (female:male relative ratio, 2.13; p < 0.001). Pelvic, femur, and tibia fractures were significantly more common among female recruits than among male recruits (p < 0.005). Female recruits had significantly more severe fractures in the tibia (p < 0.05). However, there was no significant difference in the severity of stress fractures in the femur or metatarsals between male and female recruits, as assessed by radionuclide uptake. We recommend that different training programs be assigned according to gender, in which female recruits would have a lower level of target strain or a more moderate

Virtual stress testing of fracture stability in soldiers with severely comminuted tibial fractures.

Science.gov (United States)

Petfield, Joseph L; Hayeck, Garry T; Kopperdahl, David L; Nesti, Leon J; Keaveny, Tony M; Hsu, Joseph R

2017-04-01

Virtual stress testing (VST) provides a non-invasive estimate of the strength of a healing bone through a biomechanical analysis of a patient's computed tomography (CT) scan. We asked whether VST could improve management of patients who had a tibia fracture treated with external fixation. In a retrospective case-control study of 65 soldier-patients who had tibia fractures treated with an external fixator, we performed VST utilizing CT scans acquired prior to fixator removal. The strength of the healing bone and the amount of tissue damage after application of an overload were computed for various virtual loading cases. Logistic regression identified computed outcomes with the strongest association to clinical events related to nonunion within 2 months after fixator removal. Clinical events (n = 9) were associated with a low tibial strength for compression loading (p fracture patients who can safely resume weight bearing. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:805-811, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Hamate hook stress fracture in a professional bowler: Case report of an unusual causal sport.

Science.gov (United States)

How Kit, N; Malherbe, M; Hulet, C

2017-02-01

Stress fracture of the hook of the hamate is uncommon and is usually seen in sports involving a club, racquet or bat (i.e., golf, tennis or baseball). It is caused by direct blunt trauma. We report an unusual case of stress fracture with non-union in a 23-year-old professional bowler, probably caused by endogenous constraints, 1 year after the start of symptoms. Treatment consisted of surgical resection of the hook of the hamate. Multimodal imaging of this fracture is reviewed. Copyright © 2016. Published by Elsevier Masson SAS.

Proximal tibia stress fracture with Osteoarthritis of knee - Radiological and functional analysis of one stage TKA with long stem.

Science.gov (United States)

Soundarrajan, Dhanasekaran; Rajkumar, Natesan; Dhanasekararaja, Palanisamy; Rajasekaran, Shanmuganathan

2018-01-01

Proximal tibia stress fractures with knee osteoarthritis pose a challenging situation. We evaluated the radiological and functional outcome of one-stage total knee arthroplasty (TKA) and long stem for patients with varied grades of knee arthritis and proximal tibia stress fractures.  Methods: We analysed 20 patients from April 2012 to March 2017 with proximal tibia stress fractures associated with knee osteoarthritis of varied grades. Out of 20 patients, five were acute fresh fractures. The mean age was 64 years (range, 52-78) which includes three men and 17 women. Previous surgery in the same limb, rheumatoid arthritis, valgus deformity were excluded. All patients were treated with posterior stabilised TKA with long stem, of which, four patients had screw augmentation for medial tibial bone defect and two patients with malunited fracture at stress fracture site required osteotomy, plating and bone grafting. Two patients had two level stress fracture of tibia in the same leg. The mean follow-up period was 28 (range, 6-60) months. The mean tibiofemoral angle improved from 18.27° varus to 1.8° valgus. The mean knee society score improved from 21.9 (range, -10 to 45) to 82.8 (range, 15-99) [p fractures got united at the last follow-up. One patient had infection and wound dehiscence at six months for which debridement done and had poor functional outcome. TKA with long stem gives excellent outcome, irrespective of severity of arthritis associated with stress fracture. By restoring limb alignment and bypassing the fracture site, it facilitates fracture healing. Early detection and prompt intervention is necessary to prevent the progression to recalcitrant non-union or malunion. © The Authors, published by EDP Sciences, 2018.

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

International Nuclear Information System (INIS)

Archambeau, C.B.

1994-01-01

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

The impact of different aperture distribution models and critical stress criteria on equivalent permeability in fractured rocks

DEFF Research Database (Denmark)

Bisdom, Kevin; Bertotti, Giovanni; Nick, Hamid

2016-01-01

Predicting equivalent permeability in fractured reservoirs requires an understanding of the fracture network geometry and apertures. There are different methods for defining aperture, based on outcrop observations (power law scaling), fundamental mechanics (sublinear length-aperture scaling...... in the fraction of open fractures. For the applied stress conditions, Coulomb predicts that 50% of the network is critically stressed, compared to 80% for Barton-Bandis peak shear. The impact of the fracture network on equivalent permeability depends on the matrix hydraulic properties, as in a low...

Macro-mesoscopic Fracture and Strength Character of Pre-cracked Granite Under Stress Relaxation Condition

Science.gov (United States)

Liu, Junfeng; Yang, Haiqing; Xiao, Yang; Zhou, Xiaoping

2018-05-01

The fracture characters are important index to study the strength and deformation behavior of rock mass in rock engineering. In order to investigate the influencing mechanism of loading conditions on the strength and macro-mesoscopic fracture character of rock material, pre-cracked granite specimens are prepared to conduct a series of uniaxial compression experiments. For parts of the experiments, stress relaxation tests of different durations are also conducted during the uniaxial loading process. Furthermore, the stereomicroscope is adopted to observe the microstructure of the crack surfaces of the specimens. The experimental results indicate that the crack surfaces show several typical fracture characters in accordance with loading conditions. In detail, some cleavage fracture can be observed under conventional uniaxial compression and the fractured surface is relatively rough, whereas as stress relaxation tests are attached, relative slip trace appears between the crack faces and some shear fracture starts to come into being. Besides, the crack faces tend to become smoother and typical terrace structures can be observed in local areas. Combining the macroscopic failure pattern of the specimens, it can be deduced that the duration time for the stress relaxation test contributes to the improvement of the elastic-plastic strain range as well as the axial peak strength for the studied material. Moreover, the derived conclusion is also consistent with the experimental and analytical solution for the pre-peak stage of the rock material. The present work may provide some primary understanding about the strength character and fracture mechanism of hard rock under different engineering environments.

Residual stress state in pipe cut ring specimens for fracture toughness testing

Energy Technology Data Exchange (ETDEWEB)

Damjanovic, Darko [J.J. Strossmayer Univ. of Osijek, Slavonski Brod (Croatia). Mechanical Engineering Faculty; Kozak, Drazan [Zagreb Univ. (Croatia). Dept. for Mechanical Design; Marsoner, Stefan [Materials Center, Leoben (Austria).; Gubeljak, Nenad [Maribor Univ. (Slovenia). Chair of Mechanics

2017-07-01

Thin-walled pipes are not suitable for measuring fracture toughness parameters of vital importance because longitudinal crack failure is the most common failure mode in pipes. This is due to the impossibility to manufacture standard specimens for measuring fracture toughness, such as SENB or CT specimens, from the thin wall of the pipe. Previous works noticed this problem, but until now, a good and convenient solution has not been found or developed. To overcome this problem, very good alternative solution was proposed, the so-called pipe ring notched bend specimen (PRNB) [1-5]. Until now, only the idealized geometry PRNB specimen is analyzed, i. e., a specimen which is not cut out from an actual pipe but produced from steel plate. Based on that, residual stresses are neglected along with the imperfections in geometry (elliptical and eccentricity). The aim of this research is to estimate the residual stress state(s) in real pipes used in the boiler industry produced by hot rolling technique. These types of pipes are delivered only in normalized condition, but not stress relieved. Therefore, there are residual stresses present due to the manufacturing technique, but also due to uneven cooling after the production process. Within this paper, residual stresses are estimated by three methods: the incremental hole drilling method (IHMD), X-ray diffraction (XRD) and the splitting method (SM). Knowing the residual stress state in the ring specimen, it is possible to assess their impact on fracture toughness measured on the corresponding PRNB specimen(s).

Residual stress state in pipe cut ring specimens for fracture toughness testing

International Nuclear Information System (INIS)

Damjanovic, Darko; Kozak, Drazan; Marsoner, Stefan; Gubeljak, Nenad

2017-01-01

Thin-walled pipes are not suitable for measuring fracture toughness parameters of vital importance because longitudinal crack failure is the most common failure mode in pipes. This is due to the impossibility to manufacture standard specimens for measuring fracture toughness, such as SENB or CT specimens, from the thin wall of the pipe. Previous works noticed this problem, but until now, a good and convenient solution has not been found or developed. To overcome this problem, very good alternative solution was proposed, the so-called pipe ring notched bend specimen (PRNB) [1-5]. Until now, only the idealized geometry PRNB specimen is analyzed, i. e., a specimen which is not cut out from an actual pipe but produced from steel plate. Based on that, residual stresses are neglected along with the imperfections in geometry (elliptical and eccentricity). The aim of this research is to estimate the residual stress state(s) in real pipes used in the boiler industry produced by hot rolling technique. These types of pipes are delivered only in normalized condition, but not stress relieved. Therefore, there are residual stresses present due to the manufacturing technique, but also due to uneven cooling after the production process. Within this paper, residual stresses are estimated by three methods: the incremental hole drilling method (IHMD), X-ray diffraction (XRD) and the splitting method (SM). Knowing the residual stress state in the ring specimen, it is possible to assess their impact on fracture toughness measured on the corresponding PRNB specimen(s).

Hydraulic fracturing stress measurements at Yucca Mountain, Nevada, and relationship to the regional stress field

International Nuclear Information System (INIS)

Stock, J.M.; Healy, J.H.; Hickman, S.H.; Zoback, M.D.

1985-01-01

Hydraulic fracturing stress measurements and acoustic borehole televiewer logs were run in holes USW G-1 and USW G-2 at Yucca Mountain as part of the Nevada Nuclear Waste Storage Investigations for the U. S. Department of Energy. Eight tests in the saturated zone, at depths from 646 to 1288 m, yielded values of the least horizontal stress S/sub h/ that are considerably lower than the vertical principal stress S/sub v/. In tests for which the greatest horizontal principal stress S/sub H/ could be determined, it was found to be less than S/sub v/, indicating a normal faulting stress regime. The borehole televiewer logs showed the presence of long (in excess of 10 m), vertical, drilling-induced fractures in the first 300 m below the water table. These are believed to form by the propagation of small preexisting cracks under the excess downhole fluid pressures (up to 5.2 MPa) applied during drilling. The presence of these drilling-induced hydrofractures provides further confirmation of the low value of the least horizontal stresses. A least horizontal principal stress direction of N60 0 W--N65 0 W is indicated by the orientation of the drilling-induced hydrofractures (N25 0 E--N30 0 E), and the orientation of stress-induced well bore breakouts in the lower part of USW G-2 (N65 0 W). This direction is in good agreement with indicators of stress direction from elsewhere at the Nevada Test Site. The observed stress magnitudes and directions were examined for the possibility of slip on preexisting faults. Using these data, the Coulomb criterion for frictional sliding suggests that for coefficients of friction close to 0.6, movement on favorably oriented faults could be expected

Stress Fractures of the Distal Femur Involving Small Nonossifying Fibromas in Young Athletes.

Science.gov (United States)

Robertson, Michael; Gilley, Jasen; Nicholas, Richard

2016-11-01

Small nonossifying fibromas (ie, fibrocortical defects) are incidental findings commonly seen on radiographs of young patients evaluated for extremity pain or sport-related trauma. Although pathological fractures have been reported in larger lesions, the subcentimeter, intracortical defects are not generally thought to predispose to pathological fractures. The authors report on 2 young athletes who presented with knee pain after initiating conditioning exercise programs (cross-training). Both were diagnosed with transverse metaphyseal stress fractures involving fibrous cortical defects of the distal femur. Initial radiographs were interpreted without evidence of fractures. However, subsequent magnetic resonance imaging was informative, suggesting that magnetic resonance imaging may have value in identifying potential stress reactions in young athletes. In addition, subsequent plain radiographs of both patients showed subperiosteal new bone formation in these nondisplaced fractures, suggesting that serial radiographs and close clinical follow-up are warranted for patients with persistent symptoms. The authors propose that, in the appropriate clinical setting, the presence of a small nonossifying fibroma may be a clinical indication that further evaluation is needed when plain radiographs show normal findings, as the defect could be an unrecognized area of fracture initiation. [Orthopedics. 2016; 39(6):e1197-e1200.]. Copyright 2016, SLACK Incorporated.

Coulomb stress change during and after tensile fracture opening in a geothermal reservoir

NARCIS (Netherlands)

Urpi, L.; Blöcher, G.; Zimmermann, G.; Wees, J.D. van; Fokker, P.

2013-01-01

Stress shadowing and the ratio of shear to normal stress in the rock surrounding a newly created tensile fracture are investigated. Shearing on plane of weakness near the stimulated volume can be inhibited or promoted by change in poro- and thermo-elastic stress, while pore pressure increase tends

[Stress fractures in disabled athletes' preparation for the paralympic games in Athens, 2004: an assessment].

Science.gov (United States)

Laboute, E; Druvert, J C; Pailler, D; Piera, J-B

2008-03-01

To identify stress fracture frequency and the associated risk factors in disabled female athletes preparing the Paralympic Games in Athens in 2004. The study is focused on four athletes (including one with a vision impairment) among the 31 women selected to participate in the Paralympic Games. The medical records of selected athletes not having been able to participate in the Games due to a stress fracture were analyzed. One case of stress fracture to the first metatarsal was reported of one below-knee amputee and an additional case to the second metatarsal of one hemiplegic athlete. Two of three athletes with physical disability were unable to participate in the Games because of stress fracture occurring during the preparatory phase. Among four athletes selected to take part in the Paralympic Games. If morphological predispositions are inherent to the sportswomen, the main favouring factor to be retained is their running asymmetry. Training programmes must therefore take this characteristic into account and must not offer heavy-load repetitive exercise (such as endurance or jogging) at the expense of technique. Over-intense training exposes the disabled athlete to this type of pathology and is likely to affect his chances of competing.

Influence of stress-induced deformations on observed water flow in fractures at the Climax granitic stock

International Nuclear Information System (INIS)

Wilder, D.G.

1987-06-01

Three examples of stress-induced displacement influence on fracture-dominated hydrology were noted in drifts 1400 ft below surface in granite. Seepage into drifts was limited to portions of shears near a fault zone. No water entered the drifts from the fault itself, although its orientation relative to Basin and Range extension is favorable for fracture opening. Localization of seepage appears to result from excavation block motion that increased apertures of the shear zones in contrast to the fault where asperities had been destroyed by earlier shearing thus minimizing aperture increases. Seepage was also noted, in an adjoining drift, from a set of shallow-dip healed fractures that intersected the rib, and from vertical fractures that increased the crown. The restricted location of this seepage apparently was a result of shear opening of the joints that occurred because of cantilevered support of tabular rock between joints. Interpretation of paleostresses based on joint chronologies and orientations indicates that sets subjected to shear stresses at a time when normal stresses were low contained mineral infilling. Sets subjected to shear stresses at a time when the normal stresses were significant had minimal mineral infilling. 8 refs., 7 figs

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

Science.gov (United States)

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

2015-04-01

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

Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia

International Nuclear Information System (INIS)

Ohashi, Kenjirou; Ohnishi, Takeshi; Ishikawa, Tohru; Tani, Haruo; Uesugi, Keisuke; Takagi, Masayuki

1999-01-01

We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH) 2 vitamin D 3 . The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. Patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity. (orig.)

Bilateral Stress Fractures of the Femoral Neck from Renal Osteomalacia: A Case Report

Directory of Open Access Journals (Sweden)

S Sengupta

2008-04-01

Full Text Available A rare case of spontaneous bilateral stress fractures of femoral neck leading to coxa vara in a young female with history of chronic renal disease and secondary osteomalacia is described. Once the underlying disease was controlled, the fracture was treated by valgus osteotomy with good result.

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

International Nuclear Information System (INIS)

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

2012-01-01

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

Are certain fractures at increased risk for compartment syndrome after civilian ballistic injury?

Science.gov (United States)

Meskey, Thomas; Hardcastle, John; O'Toole, Robert V

2011-11-01

Compartment syndrome after ballistic fracture is uncommon but potentially devastating. Few data are available to help guide clinicians regarding risk factors for developing compartment syndrome after ballistic fractures. Our primary hypothesis was that ballistic fractures of certain bones would be at higher risk for development of compartment syndrome. A retrospective review at a Level I trauma center from 2001 through 2007 yielded 650 patients with 938 fractures resulting from gunshots. We reviewed all operative notes, clinic notes, discharge summaries, and data from our prospective trauma database. Cases in which the attending orthopedic surgeon diagnosed compartment syndrome and performed fasciotomy were considered cases with compartment syndrome. We excluded all prophylactic fasciotomies. Univariate analyses were conducted to identify risk factors associated with development of compartment syndrome. Twenty-six (2.8%) of the 938 fractures were associated with compartment syndrome. Only fibular (11.6%) and tibial (11.4%) fractures had incidence significantly higher than baseline for all ballistic fractures (p Ballistic fractures of the fibula and tibia are at increased risk for development of compartment syndrome over other ballistic fractures. We recommend increased vigilance when treating these injuries, particularly if the fracture is in the proximal aspect of the bone or is associated with vascular injury.

Effect of Stress State on Fracture Features

Science.gov (United States)

Das, Arpan

2018-02-01

Present article comprehensively explores the influence of specimen thickness on the quantitative estimates of different ductile fractographic features in two dimensions, correlating tensile properties of a reactor pressure vessel steel tested under ambient temperature where the initial crystallographic texture, inclusion content, and their distribution are kept unaltered. It has been investigated that the changes in tensile fracture morphology of these steels are directly attributable to the resulting stress-state history under tension for given specimen dimensions.

Data for the study of fibulae pivot in the Iberian Peninsula. The piece of Cerro de la Mora (Moraleda de Zafayona, Granada

Directory of Open Access Journals (Sweden)

Javier CARRASCO RUS

2016-07-01

Full Text Available Due to the complexity of the archaic elbow fibulae of the Iberian Peninsula, our work traits to organize the pivot group. First, its mechanics and conceptualization are defined precisely. Later, an analysis of the previous known facts is done, taking into account its cultural ascription, its chronology, its territorial distribution, its morphology and its technology. This analysis is made with the idea of advancing a viable typologic organisation. To realise the work some representative fibulae are considered, especially those more relevant. The criteria used to select these are its contextualization, its metalic composition, internal relation and time and space characteristics. There are no references to fibulae from out of the Peninsula. The main conclusion of the article is that these pieces are older than what was though in the traditional interpretations.

Atypical femoral neck stress fracture in a marathon runner: a case report and literature review.

LENUS (Irish Health Repository)

2012-02-01

BACKGROUND: Femoral neck stress fractures are relatively rare and may present as sports-related injuries. The presentation is variable, and prompt diagnosis facilitates the earliest return to pre-morbid functional activity levels. Delayed detection may precipitate femoral non-union or avascular necrosis, resulting in long-term functional deficit. AIMS: We present the case of a basicervical femoral neck stress fracture occurring in a 23-year-old marathon runner. The pathophysiology and practical management issues related to this unusual injury pattern are discussed. CONCLUSION: The growing interest in amateur athletic activities should raise the index of suspicion for stress fractures of the femoral neck in healthy adults with atypical hip pain. Increased levels of patient education and physician awareness can reduce the incidence of long-term morbidity in cases of this unusual sports-related injury.

Simulation of three-dimensional tectonic stress fields and quantitative prediction of tectonic fracture within the Damintun Depression, Liaohe Basin, northeast China

Science.gov (United States)

Guo, Peng; Yao, Leihua; Ren, Desheng

2016-05-01

Tectonic fractures are important factors that influence oil and natural gas migration and accumulation within "buried hill" reservoirs. To obtain a quantitative forecast of the development and distribution of reservoir fractures in the Damintun Depression, we analyzed the characteristics of regional structural evolution and paleotectonic stress field setting. A reasonable geological model of the research area was built based on an interpretation of the geological structure, a test for rock mechanics, and experiment on acoustic emission. Thereafter, a three-dimensional paleotectonic stress field during the Yanshan movement was simulated by the finite element method. Rock failure criterion and comprehensive evaluation coefficient of fractures were used to determine the quantitative development of fractures and predict zones that are prone to fracture development. Under an intense Yanshan movement, high stress strength is distributed in the south and northeast parts of the study area, where stress is extremely high. The fracture development zones are mainly controlled by the tectonic stress field and typically located in the same areas as those of high maximum principal and shear stresses. The predicted areas with developed fractures are consistent with the wells with high fracture linear density and in locations with high-producing oil and gas wells.

Bone geometry, strength, and muscle size in runners with a history of stress fracture.

Science.gov (United States)

Popp, Kristin L; Hughes, Julie M; Smock, Amanda J; Novotny, Susan A; Stovitz, Steven D; Koehler, Scott M; Petit, Moira A

2009-12-01

Our primary aim was to explore differences in estimates of tibial bone strength, in female runners with and without a history of stress fractures. Our secondary aim was to explore differences in bone geometry, volumetric density, and muscle size that may explain bone strength outcomes. A total of 39 competitive distance runners aged 18-35 yr, with (SFX, n = 19) or without (NSFX, n = 20) a history of stress fracture were recruited for this cross-sectional study. Peripheral quantitative computed tomography (XCT 3000; Orthometrix, White Plains, NY) was used to assess volumetric bone mineral density (vBMD, mg x mm(-3)), bone area (ToA, mm(2)), and estimated compressive bone strength (bone strength index (BSI) = ToA x total volumetric density (ToD(2))) at the distal tibia (4%). Total (ToA, mm(2)) and cortical (CoA, mm(2)) bone area, cortical vBMD, and estimated bending strength (strength-strain index (SSIp), mm(3)) were measured at the 15%, 25%, 33%, 45%, 50%, and 66% sites. Muscle cross-sectional area (MCSA) was measured at the 50% and 66% sites. Participants in the SFX group had significantly smaller (7%-8%) CoA at the 45%, 50%, and 66% sites (P stress fracture. However, the lower strength was appropriate for the smaller muscle size, suggesting that interventions to reduce stress fracture risk might be aimed at improving muscle size and strength.

Stress analysis and optimization of Nd:YAG pulsed laser processing of notches for fracture splitting of a C70S6 connecting rod

International Nuclear Information System (INIS)

Kou, Shuqing; Gao, Yan; Zhao, Yong; Lin, Baojun

2017-01-01

The pulsed laser pre-processing of a notch as the fracture initiation source for the splitting process is the key mechanism of an advanced fracture splitting technology for C70S6 connecting rods. This study investigated the stress field of Nd:YAG pulsed laser grooving, which affects the rapid fracture initiation at the notch root and the controlled crack extension in the critical fracture splitting quality, to improve manufacturing quality. Thermal elastic-plastic incremental theory was applied to build the finite element analysis model of the stress field of pulsed laser grooving for fracture splitting based on the Rotary-Gauss body heat source. The corresponding numerical simulation of the stress field was conducted. The changes and distributions of the stress during pulsed laser grooving were examined, the influence rule of the primary technological parameters on the residual stress was analyzed, and the analysis results were validated by the corresponding cutting experiment. Results showed that the residual stress distribution was concentrated in the Heat-affected zone (HAZ) near the fracture splitting notch, which would cause micro-cracks in the HAZ. The stress state of the notch root in the fracture initiation direction was tensile stress, which was beneficial to the fracture initiation and the crack rapid extension in the subsequent fracture splitting process. However, the uneven distribution of the stress could lead to fracture splitting defects, and thus the residual stress should be lowered to a reasonable range. Decreasing the laser pulse power, increasing the processing speed, and lowering the pulse width can lower the residual stress. Along with the actual production, the reasonable main technological parameters were obtained.

Stress analysis and optimization of Nd:YAG pulsed laser processing of notches for fracture splitting of a C70S6 connecting rod

Energy Technology Data Exchange (ETDEWEB)

Kou, Shuqing; Gao, Yan; Zhao, Yong; Lin, Baojun [Jilin University, Changchun (China)

2017-05-15

The pulsed laser pre-processing of a notch as the fracture initiation source for the splitting process is the key mechanism of an advanced fracture splitting technology for C70S6 connecting rods. This study investigated the stress field of Nd:YAG pulsed laser grooving, which affects the rapid fracture initiation at the notch root and the controlled crack extension in the critical fracture splitting quality, to improve manufacturing quality. Thermal elastic-plastic incremental theory was applied to build the finite element analysis model of the stress field of pulsed laser grooving for fracture splitting based on the Rotary-Gauss body heat source. The corresponding numerical simulation of the stress field was conducted. The changes and distributions of the stress during pulsed laser grooving were examined, the influence rule of the primary technological parameters on the residual stress was analyzed, and the analysis results were validated by the corresponding cutting experiment. Results showed that the residual stress distribution was concentrated in the Heat-affected zone (HAZ) near the fracture splitting notch, which would cause micro-cracks in the HAZ. The stress state of the notch root in the fracture initiation direction was tensile stress, which was beneficial to the fracture initiation and the crack rapid extension in the subsequent fracture splitting process. However, the uneven distribution of the stress could lead to fracture splitting defects, and thus the residual stress should be lowered to a reasonable range. Decreasing the laser pulse power, increasing the processing speed, and lowering the pulse width can lower the residual stress. Along with the actual production, the reasonable main technological parameters were obtained.

Proximal tibia stress fracture with Osteoarthritis of knee − Radiological and functional analysis of one stage TKA with long stem

Science.gov (United States)

Soundarrajan, Dhanasekaran; Rajkumar, Natesan; Dhanasekararaja, Palanisamy; Rajasekaran, Shanmuganathan

2018-01-01

Introduction: Proximal tibia stress fractures with knee osteoarthritis pose a challenging situation. We evaluated the radiological and functional outcome of one-stage total knee arthroplasty (TKA) and long stem for patients with varied grades of knee arthritis and proximal tibia stress fractures.  Methods: We analysed 20 patients from April 2012 to March 2017 with proximal tibia stress fractures associated with knee osteoarthritis of varied grades. Out of 20 patients, five were acute fresh fractures. The mean age was 64 years (range, 52–78) which includes three men and 17 women. Previous surgery in the same limb, rheumatoid arthritis, valgus deformity were excluded. All patients were treated with posterior stabilised TKA with long stem, of which, four patients had screw augmentation for medial tibial bone defect and two patients with malunited fracture at stress fracture site required osteotomy, plating and bone grafting. Two patients had two level stress fracture of tibia in the same leg. Results: The mean follow-up period was 28 (range, 6–60) months. The mean tibiofemoral angle improved from 18.27° varus to 1.8° valgus. The mean knee society score improved from 21.9 (range, −10 to 45) to 82.8 (range, 15–99) [p fractures got united at the last follow-up. One patient had infection and wound dehiscence at six months for which debridement done and had poor functional outcome. Conclusion: TKA with long stem gives excellent outcome, irrespective of severity of arthritis associated with stress fracture. By restoring limb alignment and bypassing the fracture site, it facilitates fracture healing. Early detection and prompt intervention is necessary to prevent the progression to recalcitrant non-union or malunion. PMID:29667926

Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers

National Research Council Canada - National Science Library

Jones, D

1995-01-01

.... Pulsing electromagnetic fields (PEMFs)have been shown to speed the healing of non-union fractures and we have used them successfully to treat stress fractures in the lower limbs. All women at Ft...

Fractures and Osteomalacia in a Patient Treated With Frequent Home Hemodialysis.

Science.gov (United States)

Hanudel, Mark R; Froch, Larry; Gales, Barbara; Jüppner, Harald; Salusky, Isidro B

2017-09-01

Bone deformities and fractures are common consequences of renal osteodystrophy in the dialysis population. Persistent hypophosphatemia may be observed with more frequent home hemodialysis regimens, but the specific effects on the skeleton are unknown. We present a patient with end-stage renal disease treated with frequent home hemodialysis who developed severe bone pain and multiple fractures, including a hip fracture and a tibia-fibula fracture complicated by nonunion, rendering her nonambulatory and wheelchair bound for more than a year. A bone biopsy revealed severe osteomalacia, likely secondary to chronic hypophosphatemia and hypocalcemia. Treatment changes included the addition of phosphate to the dialysate, a higher dialysate calcium concentration, and increased calcitriol dose. Several months later, the patient no longer required a wheelchair and was able to ambulate without pain. Repeat bone biopsy revealed marked improvements in bone mineralization and turnover parameters. Also, with increased dialysate phosphate and calcium concentrations, as well as increased calcitriol, circulating fibroblast growth factor 23 levels increased. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle.

Science.gov (United States)

Seidel, Angela; Krause, Fabian; Weber, Martin

2017-07-01

Isolated lateral malleolar fractures may result from a supination-external rotation (SER) injury of the ankle. Stable fractures maintain tibiotalar congruence due to competent medial restraints and can be treated nonoperatively with excellent functional results and long-term prognosis. Stability might be assessed with either stress radiographs or weightbearing radiographs. A consecutive series of patients with closed SER fractures (presumed AO 44-B1) were prospectively enrolled from 2008 to 2015. Patients with clearly unstable fractures (medial clear space more than 7 mm) on the initial nonweightbearing radiograph were excluded and operated on. All other patients were examined with a gravity stress and a weightbearing anteroposterior radiograph. Borderline instability of the fracture was assumed when the medial clear space was 4 to 7 mm. Those were treated nonoperatively. Of 104 patients with isolated lateral malleolar fractures of the SER type, 14 patients were treated operatively because of clear instability (displacement) on the initial radiographs. Of the nonoperative patients, 44 patients demonstrated borderline instability on the gravity stress but stability on the weightbearing radiograph ("gravity borderline"); the remaining 46 were stable in both tests ("gravity stable"). At an average follow-up of 23 months, no significant differences were seen in the American Orthopaedic Foot & Ankle Society hindfoot score (92 points gravity-borderline group vs 93 points gravity-unstable group), the Foot Functional Index score (11 vs 10 points), the Short Form 36 (SF-36) physical component (86 vs 85 points), and SF-36 mental component (84 vs 81 points). Radiographically, all fractures had healed with anatomic congruity of the ankle. Weightbearing radiographs provided a reliable basis to decide about stability and nonoperative treatment in isolated lateral malleolar fractures of the SER type with excellent clinical and radiographic outcome at short-term follow-up. Gravity